Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong Province, China.
Institute of chronic non-communicable disease, Center for Disease Control and Prevention of Guangdong Province, China.
Eur J Intern Med. 2018 Nov;57:32-38. doi: 10.1016/j.ejim.2018.06.017. Epub 2018 Jun 28.
Infection is one of the main reasons for hospitalization worldwide, and is associated with an increased risk of cardiovascular mortality. It is unclear whether this association is modified by the presence of reduced renal function. The aim of this study was to analyze the relationship between estimated glomerular filtration rate (eGFR) and cardiovascular mortality in patients hospitalized with infection.
This cohort study included all adult, incident patients who were hospitalized at one of four hospitals in China between 2012 and 2015, had a discharge diagnosis of infection, and had a serum creatinine measurement at admission. Patients receiving renal replacement therapy were excluded. Hospital data were linked to death registry data. All-cause and cardiovascular mortality were evaluated according to admission eGFR [≥60 (reference), 30-59 and < 30 mL/min/1.73m] using multivariable Cox regression and competing risk analyses.
During a median follow-up period of 2.39 years, 40,524 patients were hospitalized with infection (mean age 61 years, 54.3% female 18.4% diabetic). Of these, 4781 died. Lower admission eGFR was associated with progressively increased risks of cardiovascular mortality (≥60 mL/min/1.73m reference; 30-59 mL/min/1.73m subdistribution hazard ratio [SHR] 2.15, 95% CI 1.85-2.50, P< .01; <30 mL/min/1.73m SHR 3.19, 95% CI 2.68-3.80, P < .01). The proportion of deaths due to cardiovascular disease increased as the eGFR decreased, predominantly due to ischemic heart disease.
Patients hospitalized with infections and reduced renal function have significantly increased risks of cardiovascular mortality. Heart status should be carefully monitored following infections, especially for those with reduced renal function.
感染是全球范围内住院的主要原因之一，与心血管死亡率增加相关。目前尚不清楚这种关联是否因肾功能降低而改变。本研究旨在分析住院感染患者估算肾小球滤过率（eGFR）与心血管死亡率之间的关系。
本队列研究纳入了 2012 年至 2015 年间在中国四家医院住院、出院诊断为感染且入院时检测到血清肌酐的所有成年初发患者。排除接受肾脏替代治疗的患者。医院数据与死亡登记数据相关联。采用多变量 Cox 回归和竞争风险分析，根据入院时 eGFR [≥60（参考）、30-59 和<30 mL/min/1.73m]评估全因和心血管死亡率。
在中位随访 2.39 年期间，40524 例患者因感染住院（平均年龄 61 岁，54.3%为女性，18.4%为糖尿病患者）。其中，4781 例死亡。较低的入院 eGFR 与心血管死亡率逐渐增加相关（≥60 mL/min/1.73m 参考；30-59 mL/min/1.73m 亚分布风险比 [SHR] 2.15，95%CI 1.85-2.50，P<0.01；<30 mL/min/1.73m SHR 3.19，95%CI 2.68-3.80，P<0.01）。随着 eGFR 降低，心血管疾病死亡比例增加，主要归因于缺血性心脏病。
住院感染且肾功能降低的患者心血管死亡率显著增加。感染后应密切监测心脏状况，尤其是那些肾功能降低的患者。
