Clinical Features And Risk Factors For Prognoses In The ICU And Non-ICU Patients With Acute Kidney Injury

Objective: To investigate the clinical features and prognoses of the acute kidneyinjury (AKI) in intensive care unit (ICU)and non-ICU, to further identify the riskfactors associated with the prognoses of the AKI patients．Methods：703patients met the AKIN criterion in the First Affiliated Hospital ofFujian Medical Univesity from Jan2011to Dec were retrospectively studied. Toobserve clinical outcomes of AKI classified by AKIN stage, multivariate analyseswere performed to investigate the risk factors for prognoses of AKI.Results：1. There were217critically ill patients diagnosed as AKI while the non-ICU grouphas486patients．In the ICU group, it has the poorer AKI stage: stage I (35.0%vs57.8%, P<0.001), stage II (21.2%vs15.8%, P=0.084), stage III (43.8%vs26.4%,P<0.001)；the higher renal loss rate (56.7%vs21.5%, P<0.001)；the higher mortality(53.9%vs10.7%, P<0.001).2. The pathogenesis of both group is mainly prerenal (73.3%vs60.0%, P <0.001).The requirement of RRT (25.8%vs7.4%, P <0.001), mechanical ventilation (71.9%vs2.9%, P <0.001)，and vasopressor (61.8%vs11.1%, P<0.001) is more common inICU group.3. APACHII score (P<0.001, OR=1.181), requiring mechanical ventilation (P=0.001,OR=4.187), oliguria (P=0.015, OR=2.981), hypotension (P=0.001, OR=3.422) anddisturbance of blood coagulation (P=0.021, OR=3.455) are independent risk factorsfor renal loss among AKI patients in ICU group, while the non-ICU group are AKIstage (P<0.001, OR=3.187), hypotension (P=0.035, OR=1.984), malignancy (P=0.001,OR=3.225), CKD (P=0.018, OR=2.131), diuretic (P=0.004, OR=2.437), hypotension(P<0.001, OR=10.152), and the number of failure organs except kidney (P=0.001,OR=2.055).4. APACHII score (P<0.001,OR=1.289), mechanical ventilation (P=0.006,OR=4.241), hypotension (P<0.001, OR=17.308) and sepsis (P=0.027, OR=4.050) are independentrisk factors for death among AKI patients in ICU group, while the non-ICU group aremalignancy (P=0.005, OR=3.513), hypotension(P<0.001, OR=34.724), requiring RRT(P=0.011, OR=3.673), diuretic (P=0.011, OR=3.673), and the number of failureorgans except kidney (P<0.001, OR=2.737).Conclusions：1. For critically ill patients, the mortality of AKI and the renal loss rate is higher whilecontrasted with non-ICU patients, the requirement of RRT、mechanical ventilation andvasopressor is more common in ICU group.2. Hypotension is the independent risk factor for renal loss and death among AKIpatients in both ICU and non-ICU group.3. APACHII score and requiring mechanical ventilation are independent risk factorsfor renal loss and death among AKI patients in the ICU group while the non-ICUgroup are combined with basic diseases, failure organs except kidney and usingdiuretics.