Allon Michael, Radeva Milena, Bailey James, Beddhu Srinivasan, Butterly David, Coyne Daniel W, Depner Thomas A, Gassman Jennifer J, Kaufman Allen M, Kaysen George A, Lewis Julia A, Schwab Steve J
Division of Nephrology, University of Alabama at Birmingham, AL, USA.
Nephrol Dial Transplant. 2005 Jun;20(6):1180-6. doi: 10.1093/ndt/gfh729. Epub 2005 Mar 15.
Infection is a common cause of mortality and morbidity in haemodialysis patients. Few prospective studies have examined the clinical consequences of infection-related hospitalizations in haemodialysis patients or the risk factors predictive of clinical outcomes.
The outcomes of all first infection-related hospitalizations of patients enrolled in the HEMO Study were categorized in terms of mortality, requirement for intensive care unit (ICU) stay and length of hospitalization. In addition, the association of hospitalization outcomes with clinical and laboratory parameters was evaluated.
Among the 783 first infection-related hospitalizations, 57.7% had a severe outcome (death, ICU stay or hospitalization >/=7 days). The likelihood of a severe outcome increased with patient age (P<0.0001) and with decreased serum albumin (P<0.001). The frequency of a severe outcome varied greatly by infectious disease category (P<0.001), being highest for cardiac infections (95.6%) and infection of unknown source (68.4%), and lowest for urinary tract infections (35.5%) and access-related infections (43.8%). On multivariate analysis, hospitalization outcome was independently associated with patient age, serum albumin and disease category, but not with the randomized Kt/V or flux, gender, race or diabetic status.
In summary, infection-related hospitalizations are associated with substantial morbidity. Patient age, serum albumin and infectious disease category are independently correlated with the hospitalization outcome, and can be used to estimate the likelihood of serious outcomes at the time of hospital admission.
感染是血液透析患者死亡和发病的常见原因。很少有前瞻性研究探讨血液透析患者感染相关住院的临床后果或预测临床结局的危险因素。
将参加血液透析（HEMO）研究的患者首次感染相关住院的所有结局按照死亡率、重症监护病房（ICU）住院需求和住院时间进行分类。此外，评估住院结局与临床和实验室参数之间的关联。
在783例首次感染相关住院病例中，57.7%出现严重结局（死亡、入住ICU或住院时间≥7天）。严重结局的可能性随患者年龄增加（P<0.0001）和血清白蛋白降低（P<0.001）而增加。严重结局的发生率因传染病类别而异（P<0.001），心脏感染（95.6%）和不明来源感染（68.4%）最高，尿路感染（35.5%）和血管通路相关感染（43.8%）最低。多因素分析显示，住院结局与患者年龄、血清白蛋白和疾病类别独立相关，但与随机分组的Kt/V或通量、性别、种族或糖尿病状态无关。
总之，感染相关住院与严重发病相关。患者年龄、血清白蛋白和传染病类别与住院结局独立相关，可用于估计入院时出现严重结局的可能性。
