To study the incidence and mortality of acute kidney injury (AKI) in patients with septic shock and to find out its risk factors.

Totally 294 patients who met the criteria for diagnosis of septic shock in Departments of Emergency Medicine and Intensive Care Unit of Peking University People's Hospital from June 2015 to June 2016 were included in the retrospective study. According to the occurrence of AKI, 294 patients were divided into the AKI group (194 cases) and non-AKI group (100 cases). The general data of the two groups were compared and the risk factors of AKI patients with septic shock were analyzed by Logistic regression analysis.

In this study, the incidence of AKI in septic shock patients was 66.0% (194 / 294). The nosocomial mortality was significantly higher in the AKI group than in non-AKI group (70.6% vs. 22.0%, χ² = 26.327, P < 0.001). The age [60 (43, 73) years old vs. 43 (28, 67) years old, Z = 2.095, P = 0.036], mean arterial pressure [(60 ± 14) mmHg vs. (67 ± 16) mmHg, t = 2.175, P = 0.032], heart rate [(124 ± 23) beats / min vs. (112 ± 23) beats / min, t = 2.369, P = 0.020], oxygenation index [(166 ± 113) mmHg vs. (254 ± 150) mmHg, t = 2.820, P = 0.003), lactic acid [(4.6 ± 3.0) mmol / L vs. (2.5 ± 1.9) mmol / L, t = 3.026, P = 0.006)], sequential organ failure assessment (SOFA) score [(13 ± 4) vs. (8 ± 4), t = 4.936, P < 0.001)], ventricular and supraventricular arrhythmias (32.5% vs. 8.0%, χ² = 4.334, P = 0.037), C-reactive protein [(210 ± 104) mg / L vs. (145 ± 71) mg / L, t = 2.923, P = 0.005], aspartate aminotransferase [92 (41, 345) U / L vs. 36 (18, 65) U / L, Z = 3.794, P < 0.001], serum creatinine [(239 ± 164) μmol / L vs. (71 ± 22) μmol / L, t = 5.729, P < 0.001], blood urea nitrogen [(26 ± 16) mol / L vs. (10 ± 8) mol / L, t = 5.212, P < 0.001], glomerular filtration rate [(38 ± 29) mL·min^-1·1.73m^-2 vs. (101 ± 28) mL·min^-1·1.73m^-2, t = 9.944, P < 0.001], troponin I [0.39 (0.08, 1.60) μg / L vs. 0.05 (0.01, 0.20) μg / L, Z = 3.437, P = 0.001), D-dimer [3 538 (1 348, 9 310) μg / L vs. 2 333 (653, 4 169) μg / L, Z = 2.458, P = 0.049], norepinephrine (66.0% vs. 39.0%, χ² = 1.309, P = 0.007), daily maximum dose of furosemide [40 (20, 98) mg vs. 10 (0, 20) mg, Z = 3.992, P < 0.001], mechanical ventilation (59.8% vs. 25.0%, χ² = 0.145, P = 0.001), blood purification (12.9% vs. 0%, χ² = 76.945, P = 0.030) and deep vein catheterization (67.5% vs. 47.0%, χ² = 4.400, P = 0.041) were statistically significantly different in the AKI group and non-AKI group. Logistic regression analysis showed that the mean arterial pressure [OR = 1.035, 95%CI (0.997, 1.075), P = 0.032], lactic acid [OR = 1.065, 95%CI (0.982, 1.102), P = 0.028], SOFA score [OR = 1.232, 95%CI (1.013, 1.455), P = 0.049)], mechanical ventilation [OR = 1.942, 95%CI (1.461, 4.191), P = 0.036] and daily maximum dose of furosemide [OR = 1.123, 95%CI (0.884, 1.793), P = 0.013)] were risk factors for septic AKI.

The mean arterial pressure, lactic acid, SOFA score, mechanical ventilation and daily maximum dose of furosemide are helpful in early identification of high-risk patients with AKI in septic shock, so that early preventive measures can be taken.