Analysis Of Related Factors Of Occurrence And Prognosis Of Acute Kidney Injury In Children With Sepsis

Objective: To explore the risk factors related to the occurrence and death of sepsis-associated acute kidney injury in children,so as to identify,prevent and treat acute kidney injury as early as possible in children with sepsis who have the related risk factors in the early stage.Methods: A total of 560 children with sepsis admitted to Hunan children’s Hospital from January 2018 to July 2021 were analyzed retrospectively,and the clinical data,laboratory data and treatment were collected after admission.The enrolled children were divided into sepsis AKI group and sepsis non-AKI group according to whether Acute kidney injury(AKI)occurred.According to whether AKI occurred or not at the time of admission,children in sepsis AKI group were further divided into sepsis AKI group 1(which did not occur at the time of admission)and sepsis AKI group 2(which occurred at the time of admission).According to the survival at the time of discharge,they were divided into death group and survival group.The differences in general conditions,clinical characteristics and laboratory indicators between groups were analyzed,and the single-factor and multi-factor Logistic regression methods were used to analyze the risk factors for the occurrence and death of AKI in children with sepsis.Results:1.A total of 560 children with sepsis were included in this study,including 354 cases(63.2%)in the non-AKI group and 206 cases(36.8%)in the AKI group.In the septic AKI group,75 patients(36.4%)had no AKI at the time of admission and 131 patients(63.6%)had AKI at the time of admission.According to the prognosis,the septic AKI group was divided into the sepsis AKI survival group(139 cases)(67.5%)and the sepsis AKI death group(67 cases(32.5%).There was no significant difference in age and gender composition ratios between sepsis AKI group and non-AKI group,and between the survival group and the death group.Compared with the non-AKI group,the mechanical ventilation ratio,vasoactive drug use,hospitalization cost and hospitalization time in the septic AKI group were not statistically significant.In the sepsis AKI survival group and the sepsis AKI death group,the proportion of mechanical ventilation,the use of vasoactive drugs,and the proportion of Renal replacement therapy(RRT)were significantly increased in the death group,and there was no difference in hospital costs.To analyze the primary infection sites in children with sepsis,respiratory system infection is the primary infection site.2.Compared with the non-AKI group,sepsis AKI group 1 had statistically significant differences in many laboratory indicators and clinical characteristics.Elevated lactic acid,prothrombin time,activated partial prothrombin time,urea nitrogen,procalcitonin,uric acid,and p-SOFA score were risk factors for the development of AKI in sepsis.When the above factors were included in the multi-factor regression analysis,the increased lactic acid,uric acid and p-SOFA score were the independent risk factors for AKI in sepsis.3.Compared with the sepsis AKI survival group,there were significantly statistical differences in multiple laboratory indicators,critical illness score and clinical characteristics in the death group of sepsis AKI children.The stage of AKI,prothrombin time,activated partial thromboplastin time,elevated lactic acid level,and decreased PH,albumin,and oxygenation index levels were the risk factors for death in children with septic AKI.Among them,increased partial thromboplastin time and AKI staging,as well as decreased oxygenation index and PH level were the independent risk factors for AKI death complicated with sepsis.Conclusions:1.The increased uric acid,lactic acid and P-SOFA scores at the time of admission were the independent risk factors for AKI in children with sepsis.2.High level of AKI staging,prolonged APTT at the time of admission,and decreased PH and oxygenation index were the independent risk factors for death of AKI children with sepsis.