Retrospective Study On TCM Syndrome Characteristics And Risk Factors Of Acute Renal Injury In Sepsis

Background:Acute kidney injury (AKI) is one of the severe and common organ damages in the patients with sepsis. It not only increases the severity of sepsis, but also increases the economic burden of the patients. Despite advances in the diagnosis and treatment of sepsis associated with acute kidney injury, the mortality rate remains high. And up to recent years, there has been an increasing trend. It’s because that the current diagnosis of inflammatory response syndrome and sepsis also lack of some clearer and earlier predicting indicators. When the diagnosis of acute renal injury in sepsis is specific, the treatment has already been delayed. At the same time, the exact mechanism of acute kidney injury caused by sepsis is still controversial, so there is a controversy on the treatment method.Objective:To explore the characteristics of TCM Syndromes of AKI patients with sepsis, and to analyze the risk factors influencing the occurrence and development of sepsis.Methods:A total of 588 patients with ICU admitted to Beijing Traditional Chinese Medicine Hospital from February 1,2012 to June 30,2014 were selected, and 146 patients with sepsis were chosen according to the inclusion and exclusion criteria. According to concurrent acute renal injury or not, these patients were divided into 2 groups, including 40 patients with sepsis with AKI and 106 patients with sepsis with non-AKI group. Were collected from two groups of patients admitted to the clinical data, produced and filled in the case report form, observed two groups of patients in general, laboratory index, TCM symptoms and syndrome classification, syndrome elements such as the difference by SPSS 19.0 software for clinical data for statistical analysis, to explore the epidemiological characteristics of patients with sepsis induced AKI, traditional Chinese medicine clinical characteristics and risk factors.Result:1 General information:all patients with sepsis were between 35-99 years old, average (78.68+10.53) years old, male and female ratio was 1.28:1, ICU average hospital stay (13.12 +11.04) days,28-days-mortality was 21.23%. Among all 146 patients, sepsis complicated with AKI in 40 cases, accounting for 27.4% of the total.2 Prognosis analysis:21 cases (52.5%) died of sepsis in AKI group,10 patients (9.43%) died in the non-AKI group, the former was significantly higher than the latter (p<0.01). In AKI patients with sepsis, the higher the AKI stage, the higher the mortality rate, but no statistical difference.3 Comparison of TCM Syndromes of AKI group and non-AKI group of sepsis: compared to the non-AKI patients with sepsis, septic AKI patients with the symptoms of slightly different, more easy to see "is not the end of four temperature", "dysuria"; syndromes in the distribution of "sthenia syndrome" the most widely distributed, "purely empirical" at least; syndrome "Qi" and "Yin", "poison", "phlegm" more than half, and more prone to "Qi" and "Yin Deficiency" and "relieving" elements of non.4 Septic AKI group in different stages of TCM clinical features analysis:with the progression of the disease, the phase III the most common to "pee adverse" symptoms; different stages in the distribution of syndromes no difference; I and III are more prone to" phlegm "elements, phase II more prone to" wet "elements.5 Risk factors:the average age of all patients in the survival group was greater than the death group, ICU hospital days than the death group leader, but no statistical difference. Compared with septic AKI group and sepsis non-AKI group, we can figure that the two groups, which most of the patients had a history of chronic diseases and between groups no significant difference; sepsis septic AKI patients were admitted to our hospital with organ function, need the proportion of mechanical ventilation greater was significantly higher than that of septic Aki group, the difference is statistically significant (P= 0.042, P= 0.005). AKI in patients with sepsis in different stages, there were significant differences in the maximum value of Cr in the survival group and the death group, and the mean value of the death group was higher than that of the survival group, the difference was statistically significant (0.006).Conclusion:1 Sepsis patients prone to AKI, and the severity of the disease, poor prognosis; compared with the AKI patients did not appear, the mortality was significantly increased.2 The characteristics of TCM syndrome of septic AKI, "sthenia syndrome"-one of the most common. The syndrome elements of "Qi" and "Yin Deficiency", "poison", "phlegm" see more.3 In the present study, there may be no correlation between TCM Syndromes of AKI and AKIN in different stages of sepsis.4 If the patients with sepsis and other organ dysfunction, or hospitalized patients need mechanical ventilation, then there is a higher probability of AKI.5 The maximum value of blood Cr is an important influence factor of the disease progression and mortality of sepsis AKI.