Risk factors of acute kidney injury induced by hemorrhagic shock / 解放军医学杂志

ABSTRACT

Objective To explore the risk factors of acute kidney injury (AKI) complicating hemorrhagic shock (HS). Methods Clinical data of 1589 patients admitted to Intensive Care Unit (ICU) of the Second People's Hospital of Shenzhen from January 1st, 2010 to December 31th, 2015 were analyzed retrospectively. Univariable and multivariable logistic regressions were used to analyze the independent risk factors of AKI induced by HS. The area under receiver operating characteristic (AU-ROC) and Youde's index were used to determine the optimal cut-off value of nadir platelet count in AKI induced by HS. The Kaplan-Meier method was used to draw the 28-day survival curve and log-rank test was done to evaluate it in AKI and non-AKI groups. Results Of 1589 patients screened, 84 (mean age 37.1 years) were included in the primary analysis in whom 30 suffered AKI. Univariate and multivariate logistic regression analyses showed platelet count, lactic acid, carbon dioxide partial pressure, alanine aminotransferase, APACHE Ⅱ score, sequential organ failure assessment (SOFA) score, and mechanical ventilation were the independent factors for HS complicated by AKI, the differences were statistically significant (P<0.05). The nadir platelet count in the first 48h was an independent risk factor for AKI induced by HS (OR=0.71, P=0.0128). The optimal cut-off value was 75×109/L, and the AU-ROC was 0.838 (P<0.01, 95% CI 0.731-0.929; P0.01), and the sensitivity and specificity were 0.815 and 0.767, respectively. The Kaplan-Meier curve showed that 28-day all-cause mortality was significantly higher in HS patients with AKI than non-AKI (P<0.001). Conclusions Nadir platelet count in the first 48 hour is a dependent risk factor for occurence of AKI after HS and more than 75×109/L for platelet count may reduce its occurrence.