A Retrospective Study Of Risk Factors For Acute Kidney Injury Related To Acute Respiratory Distress Syndrome

Part one Incidence and influencing factors of acute respiratory distress syndrome-associated acute kidney injury:A retrospective cohort studyObjective: To analyze the incidence,risk or protective factors of acute kidney injury(AKI)in patients undergoing acute respiratory distress syndrome.Methods: A total of 501 subjects who underwent acute respiratory distress syndrome were enrolled in the Department of Respiratory Medicine of the First People's Hospital of Lianyungang between August 2015 to August 2017.Clinical data of patients were retrospectively analysed.Univariate and multivariate logistic regression models were empolyed for determining the association between the development of ARDS-AKI and risk factors.The multivariate Cox proportional hazards model was used to evaluate the impact of AKI and ARDS on patient outcomes.Kaplan-Meir survival analysis method was used to assess the effect of different stages of KDIGO on the prognosis of hospitalized patientsResults:Of the 501 patients,148(29.5%)had AKI,45(8.98%)had no improvement in hospitalization(unhealed),and 68 patients died(13.6%).Multivariate statistical analysis showed that unconscious(OR 0.47,95% CI 0.244-0.904,P=0.024),hypertension(OR 1.844,95% CI 1.173-2.899,P=0.008),basal creatinine(OR 3.796,1.799-8.01),P < 0.001),D-Dimer(OR 2.624,95% CI 1.549-4.445,P < 0.001),NLR ? 11(OR 1.861,95% CI 1.202-2.882,P = 0.005),mechanical ventilation(OR 1.398,95% CI 1.136-1.72,P=0.002)are independent risk factors for ARDS-AKI.AKI was significantly associated with poor prognosis in hospitalized patients(P=0.016,respectively).The poor prognosis rate was significantly increased in AKI(KDIGO 2-3)(P< 0.001)patients and patients with moderate-to-severe ARDS(P < 0.001).Conclusions: Studies have shown that disturbance of consciousness,hypertension,mechanical ventilation,basal creatinine and D-Dimer,NLR are independent risk factors for ARDS-AKI.Part two Correlation between Renin-AngiotensinAldosterone System Blockers and acute renal injury associated with acute respiratory distress syndromeObjective: To investigate whether renin-angiotensin-aldosterone system(RAAS)blockers for patients with acute respiratory distress syndrome(ARDS)is assiociated with a low incidence of acute respiratory distress syndrome associated acute kidney injury(ARDS-AKI)and improve its clinical prognosis,including angiotensinconverting enzyme inhibitors(ACEI)and angiotensin receptor blockers(ARB).Methods: A retrospective analysis method was used to collect 188 patients with hypertension in the respiratory department of Lianyungang First People's Hospital.Univariate and multivariate logistic regression models were used to analyze the relationship between ACEI/ARB drugs and the incidence of ARDS-AKI,and to analyze the difference in AKI between the two groups and the clinical prognosis.Results: Compared with the control group,the incidence of ARDS-AKI in the ACEIARB group decreased,but there was no statistical difference(P=0.493);the ACEIARB group had increased improvement rate and decreased unhealed rate,and mortality,but there were no statistical differences(P=0.149);compared with the control group,the ACEI/ARB group showed a downward trends with statistical differences at hs CRP level and neutrophil/lymphocyte ratio(NRL)(P=0.025;P=0.036).Multivariate logistic regression analysis showed that AKI risk factors for ARDS patients with hypertension included gender(male)(OR2.536,95CI1.207-5.329,P=0.014),mechanical ventilation(OR2.09,95% CI1.452-3.009,P < 0.001),NLR ? 11(OR 2.183,95 CI 1.053-4.525,P = 0.036),basal creatinine(OR 1.035,95% CI 1.89-1.222,P = 0.001).Conclusions: Our retrospective study showed that ACEI or ARB drugs did not reduce the incidence of ARDS-AKI,nor significantly improved their prognosis.However,in the ACEI or ARB intervention group,there was a decrease in levels of hs CRP and NRL which relating to inflammatory response,suggesting that ACEI or ARB may reduce the inflammatory response in patients with ARDS and hypertension.