The Discussion Of Optimal Timing Of Continuous Renal Replacement Therapy In Sepsis Patients With Acute Kidney Injury

Objectives: By analyzing the renal function,the hospitalization time of intensive care unit(ICU),the acute physiology and chronic health evaluation II(APACHE II)and the sequential organ failure score(SOFA),the mortality rate of 28,60 and 90 days of sepsis patients in different stages of acute kidney injury(AKI)undergoing continuous renal replacement therapy(CRRT)to discuss the most appropriate time for patients with sepsis and AKI to initiate CRRT.Methods: A prospective analysis was made of 31 patients diagnosed as sepsis with AKI and treated with CRRT from November 2017 to October 2018 in the Department of Critical Care Medicine of our hospital.There were 16 patients in the early group and 15 patients in the late group.The early group was sepsis patients with CRRT in AKI-2 phase,while the late group was sepsis patients with CRRT in AKI-3 phase or with absolute indication of RRT.Sex,age,history of past illness,ICU hospitalization time,24 hours before and after CRRT,blood PH,oxygenation index,white blood cell count,serum sodium,hematocrit,serum potassium,urine volume,bilirubin level,platelet count,creatinine,glasgow coma scale,28,60 and 90 days survival and renal function recovery were recorded.The APACHE II score and SOFA score of all patients were calculated according to the above related clinical indicators.Result: 1.Clinical data before treatment:(1)In the distribution of infection sites in all the patients,the results showed that respiratory tract infection and peritonitis ranked first and second,and the infection sites in the advanced group were mainly respiratory tract.The proportions of respiratory tract infection and peritonitis in the early group were 31.25% and 31.25% respectively,while those in the late group were 60% and 13.33% respectively.(2)There were no significant differences in body temperature,age,oxygenation index(PaO 2/FIO2),white blood cell count,mean arterial pressure,respiration and heart rate between the two groups before renal replacement therapy(P > 0.05).(3)As far as the severity of the disease is concerned,the APACHE II score of the early group and the late group before treatment is higher than that of the late group,but there is no significant difference(P > 0.05).There was no significant difference in SOFA score between the two groups(P > 0.05).2.Comparison of clinical indicators between early and late groups before and after treatment: After renal replacement therapy,urine volume in the early and late groups was significantly improved,and creatinine was significantly reduced.After treatment,the oxygenation index(PaO2/FIO2)of the two groups was better than that before treatment(P < 0.05).In the late stage group,there was no significant change in oxygenation index after treatment(P > 0.05).The mean arterial pressure(MAP),a hemodynamic parameter,tended to be stable after treatment in the early and late groups.In terms of disease severity,APACHE II score and SOFA score in early and late groups after treatment were significantly lower than those before treatment.3.Prognosis comparison between early and late groups: The changes of urine output after treatment in the two groups were(57.56±60.22)ml/h and(37.60±66.91)ml/h,with no significant difference(P=0.389 > 0.05).The hospitalization time of ICU in early group and late group was(16.19±12.82)days and(11.20±10.67)days respectively,but there was no significant difference(P=0.25 > 0.05).The 28-day,60-day and 90-day mortality rates of the two groups were compared.The results showed that there was no significant difference in 28-day mortality,60-day mortality and 90-day mortality between the early group and the late group(18.75% vs.26.67%,P > 0.05;31.25% vs.46.67%,P > 0.05;31.25% vs.53.33%,P > 0.05).Kaplan-Meier survival analysis was used to draw survival curves of early and late patients.Log-rank test showed no significant difference(?2= 1.517,P = 0.218).Conclusion: 1.CRRT is an effective treatment for sepsis with acute renal injury.2.Early and late CRRT treatment had no significant effect on urine output in sepsis patients with acute kidney injury.3.Early and late CRRT treatment for sepsis patients with acute kidney injury had no significant effect on the hospitalization time of ICU and the 28-day,60-day and 90-day mortality.