疑似社区获得性感染中急性肾损伤的重要性。

The importance of acute kidney injury in suspected community acquired infection.

机构信息

Renal Department, Salford Royal NHS Trust, Salford, United Kingdom.

University of Manchester, Oxford Road, Manchester, United Kingdom.

出版信息

PLoS One. 2019 May 7;14(5):e0216412. doi: 10.1371/journal.pone.0216412. eCollection 2019.

DOI:10.1371/journal.pone.0216412

PMID:31063508

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6504101/

Abstract

BACKGROUND

Most sepsis and acute kidney injury (AKI) cases are community acquired (CA). The aim of this study was to evaluate the characteristics of suspected community acquired infection (sCA-I) and CA-AKI and their impact upon patient outcomes.

METHODS

All adult creatinine blood tests from non-elective, non-dialysis attendances to a single centre over a 29-month period were analysed retrospectively. We defined sCA-I and CA-AKI cases as antibiotic prescription and AKI alert within 48 hours of attendance respectively. Binary logistic regression models were created to determine associations with 30-day mortality, intensive care unit (ICU) admission and length of stay (LOS) dichotomised at median.

RESULTS

Of 61,471 attendances 28.1% and 5.7% suffered sCA-I or CA-AKI in isolation respectively, 3.4% suffered both. sCA-I was present in 58.8% of CA-AKI cases and CA-AKI was present in 11.9% of CA-I cases. The combination of sCA-I and CA-AKI was associated with a higher risk for all outcomes compared to sCA-I or CA-AKI in isolation. The 30-day mortality was 8.1%, 11.8% and 26.2% in patients with sCA-I, CA-AKI and when sCA-I and CA-AKI occurred in combination respectively. The adjusted odds ratios (OR) and 95% confidence intervals (CI) for 30-day mortality, ICU admission and LOS for sCA-I combined with CA-AKI stage 1 were OR 6.09:CI: 5.21-7.12, OR 12.52 CI: 10.54-14.88 and OR 8.97 CI: 7.62-10.56, respectively, and for combined sCA-I and CA-AKI stage 3 were OR 9.23 CI: 6.91-12.33, OR 29.26 CI: 22.46-38.18 and OR 9.48 CI: 6.82-13.18 respectively.

CONCLUSION

The combination of sCA-I and CA-AKI is associated with worse outcomes.

摘要

背景

大多数脓毒症和急性肾损伤（AKI）病例为社区获得性（CA）。本研究旨在评估疑似社区获得性感染（sCA-I）和 CA-AKI 的特征及其对患者预后的影响。

方法

对单中心 29 个月内所有非择期、非透析成人肌酐血检进行回顾性分析。我们将抗生素处方和就诊后 48 小时内 AKI 警报分别定义为 sCA-I 和 CA-AKI 病例。采用二元逻辑回归模型确定与 30 天死亡率、重症监护病房（ICU）入住和住院时间（LOS）相关的因素，两者均以中位数进行二分类。

结果

在 61471 次就诊中，分别有 28.1%和 5.7%的患者孤立性出现 sCA-I 或 CA-AKI，3.4%的患者同时出现两种情况。sCA-I 出现在 58.8%的 CA-AKI 病例中，CA-AKI 出现在 11.9%的 CA-I 病例中。与 sCA-I 或 CA-AKI 单独发生相比，sCA-I 和 CA-AKI 同时发生与所有结局的风险增加相关。sCA-I、CA-AKI 和 sCA-I 合并 CA-AKI 患者的 30 天死亡率分别为 8.1%、11.8%和 26.2%。sCA-I 合并 CA-AKI 1 期患者 30 天死亡率、ICU 入住率和 LOS 的调整比值比（OR）和 95%置信区间（CI）分别为 6.09：CI：5.21-7.12、12.52 CI：10.54-14.88 和 8.97 CI：7.62-10.56，sCA-I 合并 CA-AKI 3 期患者分别为 9.23 CI：6.91-12.33、29.26 CI：22.46-38.18 和 9.48 CI：6.82-13.18。