Su Guobin, Iwagami Masao, Qin Xindong, McDonald Helen, Liu Xusheng, Carrero Juan Jesus, Stålsby Lundborg Cecilia, Nitsch Dorothea
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou City, China.
Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, China.
Clin Kidney J. 2020 Feb 10;14(2):602-611. doi: 10.1093/ckj/sfz188. eCollection 2021 Feb.
Respiratory tract infections (RTIs) are a common reason for people to seek medical care. RTIs are associated with high short-term mortality. Inconsistent evidence exists in the association between the presence of kidney disease and the risk of death in patient with RTIs.
We searched the PubMed, Cochrane Library and Embase databases from inception through April 2019 for cohort and case-control studies investigating the presence of kidney disease (defined as medical diagnosis of kidney disease, reduced estimated glomerular filtration rate or creatinine clearance, elevated serum creatinine and proteinuria) on mortality in adults with RTIs in different settings including community, inpatient and intensive care units. We assessed the quality of the included studies using Cochrane Collaboration's tool and conducted a meta-analysis on the relative risk (RR) of death.
Of 5362 records identified, 18 studies involving 16 676 participants met the inclusion criteria, with 15 studies investigating pneumonia and 3 studies exploring influenza. The risk of bias in the available evidence was moderate. Most [17/18 (94.5%)] of studies reported positive associations of underlying chronic kidney disease with mortality. The pooled adjusted risk for all-cause mortality in patients with RTIs almost doubled [RR 1.96 (95% confidence interval 1.48-2.59)] in patients with kidney disease. Associations were consistent across different timings of kidney disease assessment and provenances of RTIs (community-acquired or healthcare-associated).
The presence of kidney disease is associated with higher mortality among people with RTIs, especially in those with pneumonia. The presence of kidney disease might be taken into account when considering admission for patients who present with RTIs.
呼吸道感染（RTIs）是人们寻求医疗护理的常见原因。RTIs与短期高死亡率相关。关于肾病的存在与RTIs患者死亡风险之间的关联，证据并不一致。
我们检索了从数据库建立至2019年4月的PubMed、Cochrane图书馆和Embase数据库，以查找队列研究和病例对照研究，这些研究调查了肾病的存在（定义为肾病的医学诊断、估计肾小球滤过率或肌酐清除率降低、血清肌酐升高和蛋白尿）对不同环境（包括社区、住院和重症监护病房）中成年RTIs患者死亡率的影响。我们使用Cochrane协作工具评估纳入研究的质量，并对死亡相对风险（RR）进行荟萃分析。
在识别出的5362条记录中，18项涉及16676名参与者的研究符合纳入标准，其中15项研究调查肺炎，3项研究探索流感。现有证据中的偏倚风险为中等。大多数[17/18（94.5%）]研究报告潜在慢性肾病与死亡率呈正相关。肾病患者RTIs全因死亡率的合并调整风险几乎翻倍[RR 1.96（95%置信区间1.48 - 2.59）]。在肾病评估的不同时间和RTIs的来源（社区获得性或医疗保健相关）之间，关联是一致的。
肾病的存在与RTIs患者的较高死亡率相关，尤其是肺炎患者。对于出现RTIs的患者，在考虑入院时可能应考虑肾病的存在。
