| Objective:1.Analyze the clinical characteristics of Gastrointestinal cancer patients with acute kidney injury.2. Analyze the fatality rate and incidence of AKI in Gastrointestinal cancer.3. screening the risk factors of AKI in Gastrointestinal cancer. Methods:Review of the clinical data of 3399 cases in oncology of the First Affiliated Hospital of Kunming Medical from February 1,2014 to January 31,2015.Then 1726 cases were included with subjecting to the following conditions:Gastrointestinal cancer was confirmed by Biopsy; exclude patients of age<18 years old; exclude patients of end stage kidney disease;exclude the cases of incomplete data.These is 50 cases of AKI in Gastrointestinal cancer patients defined with KDIGO diagnostic criteria. Non-AKI patients is 1676. Analyze the clinical characteristics, fatality rate and risk factors of Gastrointestinal cancer patients associated with acute kidney injury.Results:1.1726 cases were included. These is 50 cases of AKI in Gastrointestinal cancer patients defined with KDIGO diagnostic criteria,average age is 62.56+14.13 years old.The incidence of AKI is 2.89%(50/1726). The total number of patients with each stages of AKI is 31 cases,10cases,9cases.2. The most common cancer is colon cancer for Gastrointestinal cancer patients with AKI, a total number of 24 cases, accounting for 48%(24/50) of all cancer patients, followed by gastric cancer 13 cases (26%), pancreatic cancer 5 cases (10%).3. Common causes of AKI was insufficient blood volume 21 cases (42%), multiple etiologies AKI 21 cases (42%),the use of contrast agents 4 cases (8%); renal obstruction 3 cases (6%); the use of platinum-based formulation 1 cases(2%)..4. Univariate Logistic regression analysis showed that: Men are more likely to suffer from AKI than women (p=0.013, OR=2.250,95% CI=1.187-4.264); and with increasing age, the risk of suffering from AKI is also increasing.The risk of AKI increased 1.037 times for each increase of 1 year old. Hyperuricemia (p=0.006, OR = 2.480,95% CI=1.298-4.737), hypokalemia (p=0.009, OR=2.372,95% CI = 1.241-4.533), hypocalcemia (p <0.001, OR=7.467,95% CI=4.109-13.568), hypoalbuminemia (p <0.001, OR=6.390,95% CI=3.313-12.326), anemia (p <0.001, OR=11.198,95 % CI=6.036-20.775), sepsis (p <0.001, OR=79.619,95% CI = 23.071-274.767), and hypertension (p=0.027, OR=2.006,95% CI - 1.082-3.721) are risk factors of Gastrointestinal cancer patients with AKI. Chemotherapy treatment (p<0.001, OR=0.119,95% CI=0.053-0.267) is regarded as the protective factors of AKI; tumor metastasis (p=0.483, OR=1.301,95% CI=0.624-2.711), diabetes ( p = 0.847, OR=0.912,95% CI=0.357-2.327), the use of contrast agents (p=0.464, OR = 0.795,95% CI=0.431-1.468) their discrepancy was not statistically significant.5. Multivariate Logistic regression analysis showed: hyperuricemia (p=0.013, OR=2.962,95% CI=1.252-7.007), sepsis (p <0.001, OR=31.288,95% CI = 4.698-208.374) , hypocalcemia (p=0.003, OR=3.536,95% CI=1.554-8.045), anemia (p <0.001, OR=5.884,95% CI=2.569-13.477) are associated with gastrointestinal cancer patients with AKI as independent risk factors.6. These is 14 patients died in this study,male patients in 9 cases, accounting for 64.29%, females in 5cases, accounting for 35.71%; the average age was 61.57 ± 13.30 years. 6 patients were combined with AKI, the mortality rate was 0.35% (6/1726);the fatality rate was 12% (6/50). Univariate analysis showed that: multiple organ failure (p <0.001, OR=6273.667,95% CI=604.610-65097.998), AKI (p O.001, OR = 28.432,95% CI=9.464-85.415), tumor metastasis (p= 0.001, OR=6.016,95% CI = 2.092-17.303), sepsis (p=0.022, OR=11.895,95% CI=1.430-98.960) are risk factors for death in patients of gastrointestinal cancer patients with AKI. Multivariate Logistic regression analysis showed: multiple organ failure (p <0.001, OR = 10470.775,95% CI=523.755-209328.904), AKI (p=0.006, OR=46.923,95% CI = 3.067-717.923) can be considered independent risk factors for death in AKI patients.7.44 cases of AKI in gastrointestinal cancer patients were followed up. There were 23 cases followed up in 1 month after discharge, losted 21 cases (47.7%); in the 3 months,the follow-up was 12 cases, losted 32 cases (72.7%); in the 6 months,the follow-up was 7 cases, losted 37 cases (84.1%). Wilcoxon test showed:the serum creatinine values after the patient discharged was stable. Only one person (14.2%) need dialysis.Conclusion:1. AKI is a common and serious complication of gastrointestinal cancer patients。The incidence of AKI is 2.89%. Men are more likely to suffer from AKI than women; and with increasing age, the risk of suffering from AKI is also increasing.The risk of AKI increased 1.037 times for each increase of 1 year old. The common causes of AKI was insufficient blood volume, multiple etiologies AKI.2. Hyperuricemia, sepsis, hypocalcemia, anemia can be considered independent risk factors for cancer patients with AKI.3. The risk factors of fatality rate are multiple organ failure, AKI, tumor metastasis and sepsis.4. After the patient was discharged a month,3 months,6 months, the serum creatinine values compare with the one at discharge, the difference was not statistically significant.By early and timely treatment, most AKI patients’renal function can recover or remain stable. When the cancer patients is associated with risk factors, clinicians should focus on prevention and individualized treatment of AKI. |
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