Study on the prognosis and intervention opportunity of continuous renal replacement therapy for senile multiple organ dysfunction syndrome combined with acute kidney injury

Abstract

Objective To investigate the prognosis and intervention opportunity of continuous renal replacement therapy (CRRT) for senile multiple organ dysfunction syndrome (MODS) combined with acute kidney injury (AKI). Methods A total of 160 elderly patients with MODS and AKI hospitalized in People’s Liberation Army 464 Hospital from August 2012 to August 2016 were enrolled in the study. The patients were divided into CRRT group (group A, 96 cases) and conservative treatment group (group B, 64 cases). Patients in group A were also divided into three subgroups of A1, A2 and A3 according to stages of AKI, with 32 patients in each group. Patients in group A1, group A2 and group A3 started CRRT at AKI 1, 2 and 3 stage, respectively. Observation indexes: ①survival of two groups at 7, 14, 21, 28 d after treatment; ②the survival rate at 14 d and 28 d after treatment in group A1, A2 and A3; ③scores of neutrophil gelatinase-associated lipocalin (NGAL), B-type natriuretic peptide (BNP), and acute physiology and chronic health Ⅱ (APACHE Ⅱ) of group A before CRRT. Results The survival rate at 7, 14, 21, and 28 d after treatment in group A were significantly higher than those in group B (P<0.01). Survival rates at 14 d, 28 d after treatment of group A1 were higher than those of group A2 and group A3(P<0.05). Regression analysis found that NGAL, BNP and APACHE Ⅱ scores were independent factors influencing prognosis of elderly patients with MODS and AKI. Conclusions For elderly patients with MODS and AKI, early intervention with CRRT can effectively improve the prognosis of patients. Besides the renal function, NGAL, BNP, APACHE Ⅱ scores should be considered as timing references. Key words: Continues renal replacement therapy; Multiple organ dysfunction syndrome; Acute renal injury; Prognosis; Timing of intervention