Risk Factors Analysis Of Prognosis Of Patients With Acute Kidney Injury Treated With Renal Replacement Therapy

BackgroundAcute kidney injury(AKI)is one of the most common and severe clinical disease,especially in the intensive care unit(ICU).The incidence and mortality remains high level.AKI often combines with multiple organ dysfunction syndrome(MODS)and is associated with poor clinical outcomes,but lacks efficient drug treatment.Continuous renal replacement therapy(CRRT)is an indispensable tool for critically ill patients with severe AKI.A study shows that CRRT can promote the recovery of renal function and improve the prognosis of patients,many critically ill patients benefit from it.In this paper,through the analysis of related factors affecting the prognosis of patients with AKI after CRRT,to provide clinical basis for the diagnosis and treatment measures to develop and improve the prognosis of patients with AKI.MethodsA retrospective study from August 2013 to December 2015 included all CRRT patients with AKI in ICU of the first affiliated hospital of Dalian Medical University.Inclusion criteria: all patients who met with the 2012 Kidney Disease Improving Global Outcomes(KDIGO)diagnostic criteria of AKI.Exclusion criteria:(1)Previous regular haemodialysis or peritoneal dialysis patients;(2)hospital days less than 48 hours;(3)those treated with CRRT for less than 24 hours or less than 8 hours every day;(4)patiens with severe blood disease,malignant tumor or serious metabolic diseases;(5)The family gave up treatment of patients;(6)others: children,pregnant women and other special crowdn.General situations,clinical and biochemical data,illness scores at the time of CRRT initiation and termination were recorded.The primary end point was 28-day mortality in the ICU.Data were analyzed using the SPSS version 17.0.Risk factors were evaluated by univariate analysis and in a multivariate analysis with a multiple logistic stepwise regression procedure.In all comparisons,p values < 0.05 were deemed to indicate statistical significance.Results1.62 patients were included in this study.The mean age of the patients was 67.74±16.39 years and they comprised 39 men(62.9%)and 23 women(37.1%).The all-cause mortality of ICU patients in 28 d was 54.84%(34 cases).Sepsis and septic shock were the most important causes of AKI in critically ill patients(40 cases,64.52%).Other reasons contributing to the developmemt of AKI include cardiopulmonary resuscitation(CPR),cardiogenic shock,severe acute pancreatitis(SAP),trauma and urinary tract obstruction.2.The main end point is 28-day mortality after entering into ICU,and the patients were divided into survival group and death group according to the prognosis.There were no statistical difference between two groups in terms of gender,age,underlying disease,etiology and stage of AKI,duration of CRRT,ventilation time,APACHE ?and SOFA scale(P>0.05).Ultimately,renal function in 12 cases were completely recovered(19.35%);17 cases incompletely recovered(27.42%);33 cases invalid at all(53.23%).The unrecovered cases among death group are obviously more than the survival group(P<0.01).3.Univariate analysis showed that the prognosis of patients with AKI was associated with mean arterial pressure(MAP),mean platelet volume(MPV),red blood cell distribution width(RDW)and urine output before the treatment;MPV,procalcitonin(PCT),platelet count(PLT),Cystatin C(Cys-C)and urine output after the treatment,and the changes in MPV,urine volume and Cys-C before and after the treatment.4.In the multivariate analysis,higher MAP maybe the protection factor,high level of MPV at the time of CRRT initiation and Cys-C after the treatment were independent risk factors for 28-day mortality.Conclusions1.Higher MAP may produce positive effects to outcome;2.High level of MPV at the time of CRRT initiation and Cys-C after the treatment were independent risk factors for 28-day mortality.