Evaluation of prognostic factors of elderly patients with acute renal injury treated with hemofiltration by critical care ultrasound
Objective To evaluate the influencing factors and predictive value of renal function recovery in elderly patients with heart failure(HF)and acute renal injury(AKI)after intermittent veno-venous hemofiltration(IVVH)using critical care ultrasound.Methods The clinical data of elderly patients with heart failure(NYHF grade Ⅲ～Ⅳ)complicated with acute kidney injury(stage 2～stage 3)who underwent intravenous veno-venous hemofiltration(IVVH)in the critical care unit(CCU)of our hospital were retrospectively analyzed.The demographic information of the patients and the changes in clinical biochemical and critical care ultrasound monitoring parameters before and after 7 days of IVVH were recorded.Based on the recovery of renal function,the patients were divided into two groups:a renal function recovery group and a renal function non-recovery group.Logistic regression and Receiver Operating Characteristic Curve(ROC)curve analysis were performed to determine the predictive value of various influencing factors on the recovery of renal function in patients.Results A total of 178 patients were enrolled in this study.After starting IVVH treatment,renal function recovered in 143 cases at 30 days,and in 138 cases at 90 days.However,renal function did not recover in 35 cases at 30 days,and in 40 cases at 90 days.The proportion of NYHF Ⅲ patients、the proportion of diabetic patients、the decrease of Beta 2-microglobulin(β2-MC)、the decrease of Cystain C(CysC)、the increase of venous transit time index(VTI)、the increase of Cardiac Output(CO)and the decrease in renal blood flow resistance index(RI)in the recovery groups at both 30 days and 90 days was significantly higher than that in the non-recovery group(all P＜0.05).The total treatment time of IVVH in the recovery group was significantly shorter than that in the non-recovery group,with 30 days and 90 days(P＜0.05).Logistic analysis revealed that the total treatment time of IVVH(OR=1.067,P＜0.001),VTI(OR=0.652,P=0.024),CO(OR=0.037,P＜0.001),and RI(OR＜0.001,P=0.010)of the interlobar artery were identified as independent factors influencing the recovery of renal function in AKI patients at 30 days and 90 days after IVVH treatment.The ROC curve demonstrated the predictive value of various independent influencing factors for 30-day renal function recovery.The area under the curve(AUC)for VTI was 0.610(95％CI:0.513-0.707),for CO it was 0.760(95％CI:0.656-0.864),and for RI it was 0.694(95％CI:0.589-0.799).Similarly,the ROC curve showed the predictive value of these factors for renal function recovery at 90 days.The AUC for VTI was 0.654(95％CI:0.564-0.744),for CO it was 0.697(95％CI:0.605-0.789),and for interlobar artery RI it was 0.605(95％CI:0.495-0.715).Conclusions The venous transit time index(VTI),cardiac output(CO),and renal interlobar artery RI,monitored by critical care ultrasound,are independent factors that can be used to evaluate the recovery of renal function in elderly patients with HF and AKI after IVVH treatment.Additionally,the changes in these parameters within 7 days after IVVH treatment have a high predictive value for the improvement of renal function in elderly patients after 30 days and 90 days.
UltrasonographyRenal insufficiency,acuteCritical care ultrasoundIntermittent veno-venous hemofiltration
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