| ObjectiveThe objective is to compare the clinical data of AKI patients(type I cardiorenal syndrome)and non AKI patients in the emergency care unit of Renji Hospital.By exploring the clinical characteristics,risk factors and prognosis analysis of the CRS patients,we expected to identify,prevent and delay the occurrence of AKI after acute heart diseases in the early stage and improve the prognosis of such population.MethodData collection:a single center retrospective study method was used to screen 354 patients with acute heart disease admitted to the emergency ICU of Renji Hospital from January 1,2014 to January 1,2019 through the electronic medical record system of Renji Hospital.140 patients were excluded according to the exclusion criteria,and 214 patients were finally selected.The general clinical data were recorded in detail,including sex,age,basic diseases,drug use,advanced life support,admission vital signs(mean arterial pressure,heart rate),ICU hospitalization time and outcome;clinical indicators of patients’heart evaluation in first day of admission:heart function grading,BNP,Tn I,CKMB,EF;clinical indicators of patients’kidney evaluation in first day of admission:admission,within 48h of onset,discharge creatinine,urea nitrogen,uric acid,eGFR,cystatin C,renal replacement therapy,and other clinical indicators:CRP,PCT,liver function,blood gas analysis,lactate,etc.were analyzed by SPSS 25.0statistical software.The main statistical methods included t test,chi square test,single factor correlation analysis and binary multivariate logistic analysis.Result1.Baseline characteristics of patients with acute heart disease at admission:at present,214 patients with acute heart disease are included in this study,including 121 males and 93 females,aged 67.5±14.56 years;126 patients(58.88%)with AKI,most of them have one or more basic diseases.Of 214 patients with acute heart disease,160 patients survived,54of them died.Of 126 type 1 CRS patients,83 patients survived and 43patients died.2.The analysis of clinical data of patients with acute heart disease complicated with AKI and non AKI group shows that:the prevalence of type I cardiorenal syndrome patients with diabetes,chronic kidney disease and hyperlipidemia will be higher;there are statistical differences in the number of patients who induce AKI in three different cardiac causes;there are statistical differences between the two groups in CRRT use and mechanical ventilation.There were significant differences between the two groups in creatinine,EGFR;bun;WBC;CRP,HCO3~-;Tn I;lactate;BNP.The independent risk factors of AKI were BNP>400pg/ml,mechanical ventilation,Tn I>0.2ng/l,lac>4.0mmol/l,Tn I>0.2ng/L.3.Factor analysis of different KDIGO grades in patients with type I CRS:KDIGO grade 1 and 2 were divided into one group,compared with KDIGO grade 3 patients,there were significant differences in diabetes,chronic kidney disease,adrenaline use,CRRT use,creatinine,urea nitrogen,eGFR,HCO3-,WBC and serum albumin.The single factor analysis(P<0.05)and binary logistic regression analysis showed that diabetes mellitus,epinephrine use and urea nitrogen were independent risk factors of KDIGO 3 AKI in patients with acute heart disease.4.Analysis of survival and death factors in patients with type I CRS:there were statistical differences in the concentration of KDIGO 3,adrenaline use,mechanical ventilation,CRRT use,creatinine,eGFR,urea nitrogen,hemoglobin,C-reactive protein,bicarbonate ion in patients with type I CRS.Multiple logistic regression analysis showed that epinephrine use,EGFR and CRP were independent risk factors of type I CRS death.5.The predictive effect of HCO3~-on the occurrence and prognosis of type I cardiorenal syndrome:the sensitivity of HCO3~-to the occurrence of CRS was 73.39%,and the specificity was 56.82%;The AUC area was0.679;HCO3~-was negatively correlated with the KDIGO level of patients with cardiorenal syndrome by Spearman analysis,and the prognosis of CRS patients by ROC curve analysis showed that AUC was 0.71;the sensitivity and specificity of HCO3~-<23.60mmol/l to predict the death of patients were 78.57%and 57.32%.6.Combined with CRP,EGFR and HCO3~-to predict the prognosis of patients with CRS I:ROC curve analysis revealed that CRP,EGFR and HCO3~-could predict the prognosis of patients with CRS I(area under ROC curve was 0.68,0.73 and 0.71 respectively,all P values were less than0.001),and the cut-off values calculated according to yoden index were55.39mg/l and 23.98ml/min.1.73 and 23.60mmol/l;CRP,EGFR and HCO3~-combined to predict the area under the death curve of CRS type I was 0.79,The OR value was 42.429(P<0.001).Conclusion1.The incidence of type I cardiorenal syndrome was higher in hospitalized patients with acute heart disease(58.88%)and the prognosis was worse.2.Chronic kidney disease,BNP>400pg/ml,mechanical ventilation,lactate>4.0mmol/l,Tn I>0.2ng/l are independent risk factors for AKI in patients with acute heart disease.3.Diabetes mellitus,epinephrine use,and increased urea nitrogen levels often indicate that the higher the KDIGO level,the more serious the disease is.The higher the use of adrenaline,eGFR and CRP,the higher the risk of death.4.HCO3~-concentration is a commonly used clinical indicator,whichis related to the occurrence,KDIGO classification and prognosis of CRS type I.the sensitivity of HCO3~-to predict the occurrence of CRS type I is 73.39%;the specificity is 56.82%;the Spearman coefficient of HCO3~-to KDIGO classification of such patients is-0.396,which is negative correlation,and has statistical difference.HCO3~-to predict the mortality of patients is 78.57%,the specificity is 57.32%.The hospital mortality of patients with HCO3~-decreased was significantly higher.5.Using HCO3~-,CRP and EGFR to judge the prognosis of CRS patients is more significant than one index.The sensitivity and specificity of three indexes were 75.61%and 79.27%respectively.The mortality rate of patients with two or more abnormal indexes was significantly higher than that of patients with three normal indexes(76.7%vs 2.3%). |
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