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Objective To investigate the incidence and mortality of acute kidney injury (AKI) in posttraumatic patients, and to analyze the risk factors influencing the incidence and outcomes of AKI. Methods Totally 4 221 patients with trauma who were admitted to No. 309 Hospital of PLA between Jan. 2004 and Jan. 2014 were screened and subjected to a retrospective study, and the incidence rate of AKI and mortality were analyzed. Multivariate logistic regression analysis was conducted to identify the risk factors for the incidence and prognosis of the patients with AKI. Results The incidence of AKI in posttraumatic patients in this study was 11. 6% (489/4 221) according to the classification and diagnosis criteria from Kidney Disease:Improving Global Outcomes (KDIGO), and 46. 0% (225/489) of them died prior to hospital discharge. There was an increasing hospital mortality tendency with the increase of AKI severity, with the hospital mortality rates being 30. 1% (84/279), 54. 6% (53/97), and 77. 9% (88/113) in AKI patients with KDIGO 1, 2, and 3 stage, respectively. Multivariate logistic regression analysis showed that increase of age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores on admission > 17, injury severity score (ISS) on admission > 16, severe head injury, abdominal organ injury, rhabdomyolysis, shock and respiration system dysfunction were risk factors for occurrence of AKI (P25, severe head injury, KDIGO stage 3, cardiovascular and respiratory system dysfunction (P < 0. 05, P < 0. 01). Conclusion AKI is a common clinical complication with high mortality in posttraumatic patients. To prevent severe complications after trauma is the key for improving the prognosis of patients.
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Objective To investigate the prognosis evaluation of acute kidney injury (AKI) by kidney disease staging of Improving Global Outcomes Organization (KDIGO) criteria and neutrophil gelatinase-associated lipocalin (NGAL) in severe sepsis patients treated with continuous blood purification (CBP).Methods In this prospective study, 84 severe sepsis patients treated with venous-venous CBP were selected from January 2013 to December 2014 in emergency intensive care unit of Medical University of China, Shun Yi Hospital and were divided into 3 groups based on the KDIGO staging criteria.Blood NGAL, ICU survival rate and renal function outcome of survivals were compared among groups.Results Compared with KDIGO stage 3, KDIGO stages 1 and 2 hospitalized patients had significantly lower NGAL [(453.9 ± 74.4) ng/mL vs.(789.1 ±86.8) ng/mL, P ＜0.01];Hospitalized survival rate was 92.3％ (24/26) in KDIGO stages 1 and 2 which was significantly higher than 69.0％ (40/58) in KDIGO stage 3 (P =0.026).Renal function improvement rate in KDIGO stages 1 and 2 was significantly higher than that in KDIGO stage 3 [83.3％ (20/24) vs.27.5％ (11/40), P ＜0.01].When the reliability of combination of KDIGO criteria and NGAL for prognosis evaluation was analyzed by ROC curve, the area under curve of survival was 0.703 (95％ confidence interval: 0.648-0.759, P ＜0.01) and area under curve of renal function improvement was 0.679 (95％ confidence interval: 0.627-0.731, P ＜ 0.01).Conclusions In severe sepsis patients complicated with AKI, CBP in KDIGO stages 1 and 2 might improve survival rate and renal function of sepsis patients.Combination of KDIGO criteria and NGAL maybe acted as an indicator of the prognosis in severe sepsis patients with complication of AKI.
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Objective To evaluate the value of Kidney Disease:Improving Global Outcomes (KDIGO) criteria in investigating clinical feature and prognosis of acute kidney injury (AKI) patients with sepsis in ICU.Methods Clinical data of patients with AKI defined by KDIGO criteria in ICU of Wuxi People's Hospital from June 2007 to June 2012 were collected.Clinical characteristics,prognosis and major risk factors of death of septic AKI patients were retrospectively analyzed.Results Of the enrolled 703 AKI patients,395 (56.2％) were caused by sepsis (septic AKI),which indicated that sepsis mainly contributed to the causes of AKI.For septic AKI stratified by KDIGO classification,146(37.0％) patients belonged to AKI Ⅰ,154(39.0％) to AKI Ⅱ,and 95 (24.1％) to AKI Ⅲ.Compared with the patients with non-septic AKI,septic AKI patients had greater APACHE Ⅱ and SOFA score (25.1 ±4.9 vs 20.5 ±6.4,12.9 ±2.6vs 10.4 ± 4.5 ; all P values ＜ 0.05).Although there was no significant difference in baseline serum creatinine [(82.9 ± 22.2) μmol/L vs (83.1 ± 30.O) μmol/L,P ＞ 0.05] between the two groups,patients with sepsis had higher serum creatinine [(143.5 ± 21.6) μmol/L vs (96.2 ± 15.5) μmol/L; P ＜ 0.05],a higher proportion fulfilled KDIGO categories for both AKI Ⅱ and Ⅲ (63.0％ vs 33.1％ ; P ＜ 0.05),a higher renal replacement therapy (RRT) rate (22.3％ vs 6.2％ ; P ＜ 0.05) and a lower proportion of complete renal recovery(74.4％ vs 82.8％) (all P values ＜ 0.05).The 90-day mortality of septic AKI patients was higher than that of non-septic AKI patients (52.2％ vs 34.1％ ; P ＜ 0.05).Septic AKI,graded by KDIGO,was associated with an increased mortality.Logistic regression analysis showed that APACHE Ⅱ score (OR =5.451,95％ CI:3.095-9.416),SOFA score (OR =2.166,95％ CI:1.964-4.515) and RRT (OR =4.021,95％ CI:2.975-6.324) were independent risk factors for mortality of septic AKI patients.Conclusion Septic AKI patients have a higher burden of illness,worse renal function and higher mortality.APACHE Ⅱ score,SOFA score and RRT are independent risk factors to septic AKI mortality.