类鼻疽所致急性肾损伤及其结局。
Acute kidney injury and its outcomes in melioidosis.
机构信息
Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, 576104, Karnataka, India.
Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
出版信息
J Nephrol. 2021 Dec;34(6):1941-1948. doi: 10.1007/s40620-021-00970-x. Epub 2021 Jan 30.
BACKGROUND
Melioidosis is a potentially fatal tropical infection caused by Burkholderia pseudomallei. Kidney involvement is possible, but has not been well described.
AIM
This study aimed to assess the risk of acute kidney injury (AKI) and its outcomes in melioidosis.
METHODS
A retrospective observational cohort study was performed. Case records of consecutive patients with culture-confirmed melioidosis, observed from January 1st, 2012 through December 31st, 2019 were analysed for demographics, presence of comorbidities, including chronic kidney disease (CKD), diabetes mellitus (DM), and presence of bacteraemia, sepsis, shock, AKI, and urinary abnormalities. The outcomes we studied were: mortality, need for hospitalisation in an intensive care unit (ICU), duration of hospitalization. We then compared the outcomes between patients with and without AKI.
RESULTS
Of 164 patients, AKI was observed in 59 (35.98%), and haemodialysis was required in eight (13.56%). In the univariate analysis, AKI was associated with CKD (OR 5.83; CI 1.140-29.90, P = 0.03), bacteraemia (OR 8.82; CI 3.67-21.22, P < 0.001) and shock (OR 3.75; CI 1.63-8.65, P = 0.04). In the multivariate analysis, CKD (adjusted OR 10.68; 95% CI 1.66-68.77; P = 0.013) and bacteraemia (adjusted OR 8.22; 95% CI 3.15-21.47, P < 0.001) predicted AKI. AKI was associated with a greater need for ICU care (37.3% vs. 13.3%, P = 0.001), and mortality (32.2% vs. 5.7%, P < 0.001). Mortality increased with increasing AKI stage, i.e. stage 1 (OR 3.52, CI 0.9-13.7, P = 0.07), stage 2 (OR 6.79, CI 1.92-24, P = 0.002) and stage 3 (OR 17.8, CI 5.05-62.8, P < 0.001), however kidney function recovered in survivors. Hyponatremia was observed in 138 patients (84.15%) and isolated urinary abnormalities were seen in 31(18.9%).
CONCLUSIONS
AKI is frequent in melioidosis and occurred in 35.9% of our cases. Hyponatremia is likewise common. AKI was predicted by bacteraemia and CKD, and was associated with higher mortality and need for ICU care; however kidney function recovery was observed in survivors.
背景
类鼻疽是一种由伯克霍尔德氏菌引起的潜在致命热带感染。肾脏受累是可能的，但尚未得到很好的描述。
目的
本研究旨在评估类鼻疽病患者急性肾损伤（AKI）及其结局的风险。
方法
进行了一项回顾性观察队列研究。分析了 2012 年 1 月 1 日至 2019 年 12 月 31 日连续确诊为类鼻疽病患者的病例记录，以评估其人口统计学特征、合并症（包括慢性肾脏病（CKD）、糖尿病（DM）和菌血症、败血症、休克、AKI 和尿液异常）的存在情况。我们研究的结局包括：死亡率、需要住院重症监护病房（ICU）、住院时间。然后比较了有和没有 AKI 的患者的结局。
结果
在 164 名患者中，59 名（35.98%）出现 AKI，8 名（13.56%）需要血液透析。单因素分析显示，AKI 与 CKD（比值比 5.83；95%置信区间 1.140-29.90，P=0.03）、菌血症（比值比 8.82；95%置信区间 3.67-21.22，P<0.001）和休克（比值比 3.75；95%置信区间 1.63-8.65，P=0.04）相关。多因素分析显示，CKD（调整比值比 10.68；95%置信区间 1.66-68.77；P=0.013）和菌血症（调整比值比 8.22；95%置信区间 3.15-21.47，P<0.001）是 AKI 的预测因素。AKI 与更需要 ICU 护理（37.3% vs. 13.3%，P=0.001）和死亡率（32.2% vs. 5.7%，P<0.001）相关。死亡率随 AKI 分期的增加而增加，即 1 期（比值比 3.52，95%置信区间 0.9-13.7，P=0.07）、2 期（比值比 6.79，95%置信区间 1.92-24，P=0.002）和 3 期（比值比 17.8，95%置信区间 5.05-62.8，P<0.001），但幸存者的肾功能恢复。在 138 名患者（84.15%）中观察到低钠血症，31 名（18.9%）患者出现孤立性尿液异常。
结论
AKI 在类鼻疽病中很常见，在我们的病例中占 35.9%。低钠血症同样常见。AKI 由菌血症和 CKD 预测，与更高的死亡率和需要 ICU 护理相关；然而，幸存者的肾功能恢复。
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