Effect Of Glucocorticoids In The Treatment Of Acute Kidney Injury In Patients With Severe Sepsis

Objective To comprehend the effect and the timing and suitable patients of treatment of low dose glucocorticoids for patients with severe sepsis-induced acute kidney injury.To investigate that whether low dose glucocorticoids can reduce 28 day mortality. And to improve the treatment,survival rate and prognosis of sepsis-induced acute kidney injury.Method We adopted a cross sectional cluster sampling method and each time period was 24 hours.We collected 13901 cases of patients diagnosed in emergency department from19 hospitals between November 1, 2014 and May 1, 2015.There were 958 sepsis patients and included 155 patients with acute kidney injury. According to the principle of random, control and blind method, the control group and GC group were divided.The two groups were treated by antibiotics, fluid resuscitation, blood glucose control and low dose glucocorticoids were added on the GC group. Therapy was that for 1-5days,every 6 hours of intravenous infusion of hydrocortisone 50mg(dissolved in 50 ml of NS) and 6 days reduced to 12 hours per 50 mg till day 7 every 24 hours 50 mg and then end. We observed and evaluated the SCr,Cys C,GFR,PCT,daily urine output and the APACHE II score as well as the effect of 7 days and we must follow-up the mortality rate of 28 days. According to the plasma cortisol concentration(the random plasma cortisol concentration is less than 690 nmol/L is defined as adrenal insufficiency),we divided the patients into four subgroups: adrenal function normal GC group, adrenal function normal control group, adrenal insufficiency GC group and adrenal insufficiency control group and analysed the renal function of the patients.Then the GC group was defined as early group(GC < 9 hours) and late group(GC > 9 h)according to the time of the first use of glucocorticoids to the beginning of the application of antibiotics. To analyzed the timing of glucocorticoids on the control of inflammatory response, the recovery of renal function and the severity of the disease(APACHE II).Result The renal function recovery of the GC group was better than that of the control group(67 cases in the GC group and 44 cases in the control group, P < 0.05) after the treatment of 7 days. The renal function of patients in adrenal insufficiency GC group was better than adrenal insufficiency control group, adrenal function normal GC group and adrenal function normal control group. According to the time of the first use of glucocorticoids to the beginning of the application of antibiotics,we found that the control of inflammatory response, the recovery of renal function and the APACHE II score of the early group was significantly better late group. The mortality rate of 28 d in the GC group was lower than that in the control group, but there was no significant difference between the two groups.Conclusion Early use of low dose glucocorticoids within 9 hours can help to control the inflammatory response in patients with acute kidney injury induced by severe sepsis and there is a trend to reduce the mortality of patients with 28 days as well as improve the severity of the disease. Low dose glucocorticoids can improve severe sepsis patients with acute kidney injury especially who suffer the adrenal insufficiency.