Serov V A, Shutov A M, Kuzovenkova M Yu, Ivanova Ya V, Serova D V
Ulyanovsk State University, Ulyanovsk, Russia.
Ter Arkh. 2016;88(6):9-13. doi: 10.17116/terarkh20168869-13.
To investigate the incidence, severity, and prognostic value of acute kidney injury (AKI) in patients with community-acquired pneumonia (CAP).
A total of 293 CAP patients (185 men and 108 women; mean age 54.3±17.1 years) were examined. AKI was diagnosed and classified in accordance with the 2012 KDIGO guidelines.
On admission, the serum concentration of creatinine averaged 104.5±73.3 µmol/l. AKI was diagnosed in 83 (28.3%) patients with CAP. Hospital-acquired AKI was found in 25 (8.5%) patients, which amounted to 30.1% of all the AKI cases. The disease severity according to both the CURB-65 scale and the CRB-65 scale, which neglect blood urea nitrogen concentrations, was higher than that in patients with CAP associated with AKI (1.4±1.0 versus 0.4±0.6 scores; respectively; р<0.0001 and 0.8±0.7 versus 0.3±0.5 scores, respectively р<0.0001). The disease ended in a fatal outcome in 16 (5.5%) patients. The mortality in the presence of AKI was higher: 9 (10.1%) patients died in the AKI-complicated CAP group; that in the absence of AKI was 7 (5.2%; χ(2)=4.78; р=0.03), the odds ratio for death in the patients with CAP associated with AKI was 3.4; 95% confidence interval, 2.27 to 17.46. Multivariate logistic regression analysis revealed that the occurrence of AKI was independently influenced by age (р<0.001), systolic and diastolic blood pressures (p=0.01 and p=0.01, respectively), and a history of urinary tract diseases (p=0.04) and diabetes mellitus (p<0.001).
AKI complicates CAP in 28.3% of cases and increases mortality in patients with CAP. The predictors of AKI in CAP patients are old age, hemodynamic disorders, diabetes mellitus, and prior urinary tract diseases.
探讨社区获得性肺炎（CAP）患者急性肾损伤（AKI）的发生率、严重程度及预后价值。
共检查了293例CAP患者（185例男性和108例女性；平均年龄54.3±17.1岁）。根据2012年KDIGO指南对AKI进行诊断和分类。
入院时，血清肌酐浓度平均为104.5±73.3µmol/l。83例（28.3%）CAP患者被诊断为AKI。25例（8.5%）患者发生医院获得性AKI，占所有AKI病例的30.1%。根据CURB-65量表和忽略血尿素氮浓度的CRB-65量表评估，疾病严重程度均高于合并AKI的CAP患者（分别为1.4±1.0分对0.4±0.6分；p<0.0001；以及0.8±0.7分对0.3±0.5分，p<0.0001）。16例（5.5%）患者死亡。AKI患者的死亡率更高：9例（10.1%）合并AKI的CAP组患者死亡；未合并AKI的患者有7例（5.2%；χ(2)=4.78；p=0.03），合并AKI的CAP患者死亡的比值比为3.4；95%置信区间为2.27至17.46。多因素逻辑回归分析显示，AKI的发生独立受年龄（p<0.001）、收缩压和舒张压（分别为p=0.01和p=0.01）、泌尿系统疾病史（p=0.04）和糖尿病（p<0.001）影响。
28.3%的CAP病例合并AKI，且增加了CAP患者的死亡率。CAP患者发生AKI的预测因素为老年、血流动力学紊乱、糖尿病和既往泌尿系统疾病。
