Clinical Characteristics And Risk Factors Of Sepsis-related Acute Lung Injury Complicated With Kidney Injury

Objective Sepsis is a potentially fatal organ dysfunction brought on by an improperly controlled host reaction to infection,which is characterized by high morbidity and mortality.The lungs and kidneys are the two organs most commonly involved in sepsis,and their failure is also the main cause of death.The purpose of this study is to analyze the main clinical characteristics of patients with sepsis-related acute lung injury complicated with kidney injury,screen the risk factors affecting the prognosis of these patients,evaluate the predictive value of various indexes for their prognosis,and build an early warning model.Methods A retrospective cohort study was conducted.According to the diagnostic criteria of sepsis 3.0,325 adult patients with sepsis complicated with acute lung injury and kidney injury admitted to ICU,EICU and TICU of the First Affiliated Hospital of Hainan Medical University from January 2018 to January 2022 were consecutively enrolled.The patients were divided into survival group and death group according to their 28-day survival status.The selected independent risk factors and associated variables were evaluated by drawing ROC curve,and their estimated value on the condition and prognosis of patients with sepsis related acute lung injury combined with acute kidney injury was evaluated,and an early warning model was established for these patients with sepsis.Results A total of 325 patients with sepsis-related acute lung injury complicated with kidney injury were included in this study,with an average age of 67.85±15.12,including 227 males（69.8%）and 98 females（30.2%）.134 cases were included in the28-day survival group and 191 cases in the 28-day death group,with a mortality rate of58.8%.Gram-negative bacteria were the main pathogenic bacteria,accounting for68.9%.Acinetobacter baumannii was the most common pathogen in both the 28-day survival group and the death group.The mortality rate of patients in high lactic acid group（>2mmol/L）was 70.0%,which was significantly higher than that in low lactic acid group（≤2mmol/L）（40.0%）.Univariate analysis showed that there were significant differences in age,body temperature,PLT,PT,INR,APTT,Fbg,AT-III,FDP,D-dimer,TBIL,PH,LAC,Pa O₂/Fi O₂,SOFA score and APACHEII score in sepsis-related acute lung injury patients with kidney injury.Taking significant single factors into multivariate Logistic regression equation analysis showed that age,body temperature,APTT,Fbg,LAC,Pa O₂/Fi O₂ and SOFA score were independently correlated with 28-day mortality in patients with sepsis-related acute lung injury with kidney injury,with odds ratio was 0.973（95%CI,0.953-0.993）,1.478（95%CI,1.114-1.960）,0.963（95%CI,0.929-0.998）,1.208（95%CI,1.054-1.385）,0.834（95%CI,0.739-0.941）,1.007（95%CI,1.002-1.011）,0.863（95%CI,0.751-0.992）.The area under the ROC curve for evaluating28-day fatality rate was 0.613,0.604,0.637,0.657,0.655,0.655,0.675 respectively.Lactic acid had the highest sensitivity（71.7%）in predicting 28-day death,but lower specificity（61.9%）.The sensitivity of Pa O₂/Fi O₂ to predict 28-day death was 70.7%,and the specificity was 56.7%.The sensitivity of body temperature to predict 28-day death was 60.2%,and the specificity was 59.7%.The sensitivity and specificity of Fbg in predicting 28-day death were 57.6%and 72.4%,respectively.The sensitivity and specificity of SOFA score for predicting 28-day death were 48.2%and 78.4%,respectively.The sensitivity of age to predict 28-day death was 46.1%,and the specificity was 73.1%.The sensitivity of APTT in predicting 28-day death was the lowest（34.0%）,but the specificity was the highest（91.8%）.The independent risk factors composed of joint variables were used to evaluate the prognosis of these patients,and the area under the ROC curve was 0.815.The sensitivity and specificity of predicting 28-day mortality in patients with sepsis-related acute lung injury with renal injury were 72.8%and 79.1%,respectively.Logistic regression model was constructed according to the corresponding coefficients of each independent risk factor,and the prediction model expression was established as follows:L=-0.028×age+0.391×T-0.038×APTT+0.189×Fbg-0.182×LAC+0.007×Pa O₂/Fi O₂-0.147×SOFA score.Conclusion 1.Sepsis-related acute lung injury complicated with kidney injury is common in elderly males,often accompanied by fever,increased heart rate,shortness of breath and other signs.2.Gram-negative bacteria are the main pathogenic bacteria in patients with Sepsis-related acute lung injury complicated with kidney injury.3.The mortality rate of patients in the high-lactate group was significantly higher than that in the low-lactate group.4.The independent risk factors affecting the prognosis of sepsis-related acute lung kidney with renal injury include age,body temperature,APTT,Fbg,LAC,Pa O₂/Fi O₂ and SOFA score.5.The combined variable composed of independent risk factors has a better predictive effect on this kind of patients,and plays a positive role in early clinical identification,active intervention and improving prognosis.6.The predictive model expression for patients with this type of sepsis was as follows:L=-0.028×age+0.391×T-0.038×APTT+0.189×Fbg-0.182×LAC+0.007×Pa O₂/Fi O₂-0.147×SOFA score.