Risk factors for mortality in intensive care unit patients with sepsis combined with acute kidney injury after continuous renal replacement therapy: secondary analysis of the data from a multicenter observational study
10.3760/cma.j.issn.2095-4352.2019.02.007
- VernacularTitle:ICU脓毒症合并急性肾损伤患者CRRT后死亡?危险因素:一项多中心观察研究数据的二次分析
- Author:
Qi ZHANG
1
;
Yanan FEI
;
Li JIANG
Author Information
1. 首都医科大学附属复兴医院重症医学科
- Keywords:
Sepsis;
Acute kidney injury;
Continuous renal replacement therapy;
Risk factor
- From:
Chinese Critical Care Medicine
2019;31(2):155-159
- CountryChina
- Language:Chinese
-
Abstract:
Objective? To?analyze?the?risk?factors?of?death?in?intensive?care?unit?(ICU)?patients?with?sepsis?and?acute?kidney?injury?(AKI)?undergoing?continuous?renal?replacement?therapy?(CRRT).? Methods? The?data?of?patients?with?sepsis?complicated?with?AKI?who?received?CRRT?treatment?from?March?1st?to?August?31st?in?2012?in?BAKIT?study?(a?prospective?observational?study?of?AKI?epidemiology?in?30?ICUs?of?28?hospitals?in?Beijing)?were?re-analyzed.??The?demographic?data,?clinical?and?laboratory?data?of?patients?were?collected,?including?gender,?age,?case?source,?body?mass?index?(BMI),?blood?pressure,?the?length?of?ICU?stay,?complications,?other?organs'?function,?drug?use,?CRRT,?mechanical?ventilation?and?vasoactive?drugs.?Acute?physiology?and?chronic?health?evaluation?Ⅱ?(APACHEⅡ)?and?sequential?organ?failure?score?(SOFA)?were?calculated?by?the?worst?value?of?the?index?within?24?hours?of?entry?into?ICU.?The?end?point?of?observation?was?to?ICU?mortality.?All?test?factors?were?analyzed?by?single?factor?analysis,?and?then?multivariate?Logistic?regression?analysis?was?carried?out?for?the?parameters?with?statistical?significance?in?single?factor? analysis.?Risk?factors?affecting?CRRT?in?ICU?sepsis?patients?with?AKI?were?screened.? Results? A?total?of?189?patients?were?enrolled,?103?of?whom?died,?with?a?mortality?rate?of?54.50%.?Compared?with?the?survival?group,?the?death?group?had?an?older?age?[years?old:?77(67,?83)?vs.?58?(39,?73)],?a?higher?proportion?of?ICU?entry?due?to?respiratory?diseases?(55.40%?vs.?38.37%),?a?higher?proportion?of?complications?such?as?grade?Ⅳ?of?cardiac?function,?hypertension,?coronary?heart?disease,?chronic?kidney?disease?(with?renal?insufficiency;?20.39%?vs.?3.49%,?53.40%?vs.?34.88%,?40.78%?vs.10.47%,?20.39%?vs.?9.30%,?respectively),?a?longer?the?length?of?ICU?stay?[days:?8?(5,?19)?vs.?13?(7,?22)],?a?higher?APACHEⅡ?and?SOFA?scores?(27.53±8.59?vs.?22.73±8.36,?12.22±4.00?vs.?9.51±4.49),?a?lower?mean?arterial?pressure?(MAP)?valley?value?[mmHg?(1?mmHg?=?0.133kPa):?65.36±19.52?vs.?71.60±17.92],?a?higher?proportion?of?invasive?mechanical?ventilation?(80.58%?vs.?65.12%),?high?proportion?of?CRRT?treatment?due?to?hyperkalemia?and?severe?metabolic?acidosis?(28.16%?vs.?9.30%,?63.11%?vs.?22.09%),?and?the?time?from?ICU?entry?to?CRRT?initiation?was?longer?[days:?1?(0,?5)?vs.?1?(0,?2)],?which?differences?were?statistically?significant?(all?P?
