Mansuri Uvesh, Patel Achint A, Dave Mihir, Chauhan Kinsuk, Shah Aakashi S, Banala Ramyasree, Ali David, Kamal Saad, Verma Pooja, Ahmed Shamim, Maiyani Prakash, Pathak Ambarish C, Rahman Shajoti, Savani Sejal, Pandya Surta, Nadkarni Girish
Internal Medicine, Medstar Union Memorial Hospital, Baltimore, USA.
Nephrology, The Icahn School of Medicine at Mount Sinai, New York, USA.
Cureus. 2018 Aug 20;10(8):e3164. doi: 10.7759/cureus.3164.
Background Community-acquired pneumonia (CAP) is a common cause of hospitalization. While there are single-center studies on acute kidney injury requiring dialysis (AKI-D) and CAP, data on national trends and outcomes regarding AKI-D in CAP hospitalizations is lacking. Methods We utilized the Nationwide Inpatient Sample to analyze trends overall and within subgroups. We also utilized multivariate regression to adjust for potential confounders of annual trends and to generate adjusted odds ratios (aOR) for predictors and outcomes, including mortality and adverse discharge. Results There were 11,500,456 pneumonia hospitalizations between 2002 and 2013, of which 3675 (0.3%) were complicated by AKI-D. The AKI-D rate increased from 2.7/1000 hospitalizations in 2002 to 4.3/1000 hospitalizations in 2013. The rate of increase was higher in males and African Americans. Although temporal changes in demographics and comorbidities explained a substantial proportion, they could not explain the entire trend. The predictor with the highest odds of AKI-D required mechanical ventilation during hospitalization (aOR 12.47; 95% CI 11.66-13.34). Other significant predictors included sepsis (aOR 4.37; 95% CI 4.09-4.66), heart failure (aOR 2.40; 95% CI 2.25-2.55), and chronic kidney disease (CKD) (aOR 2.00; 95% CI 1.86-2.16). AKI-D was associated with increased in-hospital mortality (aOR 3.08; 95% CI 2.88-3.30) and adverse discharge (aOR 2.09; 95% CI 1.92-2.26). Although adjusted mortality decreased per year, attributable mortality remained stable. Conclusion Pneumonia hospitalizations complicated by AKI-D have increased with a differential increase by demographic groups. AKI-D is associated with significant morbidity and mortality. In the absence of effective AKI-D therapies, the focus should be on early risk stratification and prevention to avoid this devastating complication.
社区获得性肺炎（CAP）是住院治疗的常见病因。虽然有关于需要透析的急性肾损伤（AKI-D）与CAP的单中心研究，但缺乏关于CAP住院患者中AKI-D的全国趋势和结局的数据。方法：我们利用全国住院患者样本分析总体趋势及亚组趋势。我们还使用多变量回归来调整年度趋势的潜在混杂因素，并生成预测因素和结局的调整比值比（aOR），包括死亡率和不良出院情况。结果：2002年至2013年间有11500456例肺炎住院患者，其中3675例（0.3%）并发AKI-D。AKI-D发生率从2002年的每1000例住院患者2.7例增至2013年的每1000例住院患者4.3例。男性和非裔美国人的增长率更高。尽管人口统计学和合并症的时间变化解释了很大一部分，但它们无法解释整个趋势。发生AKI-D几率最高的预测因素是住院期间需要机械通气（aOR 12.47；95%CI 11.66 - 13.34）。其他重要预测因素包括脓毒症（aOR 4.37；95%CI 4.09 - 4.66）、心力衰竭（aOR 2.40；95%CI 2.25 - 2.55）和慢性肾脏病（CKD）（aOR 2.00；95%CI 1.86 - 2.16）。AKI-D与住院死亡率增加（aOR 3.08；95%CI 2.88 - 3.30）和不良出院情况（aOR 2.09；95%CI 1.92 - 2.26）相关。尽管调整后的死亡率逐年下降，但可归因死亡率保持稳定。结论：并发AKI-D的肺炎住院患者有所增加，不同人群的增加幅度存在差异。AKI-D与显著的发病率和死亡率相关。在缺乏有效的AKI-D治疗方法的情况下，重点应放在早期风险分层和预防上，以避免这种毁灭性的并发症。
