Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea.
PLoS One. 2021 Feb 25;16(2):e0247584. doi: 10.1371/journal.pone.0247584. eCollection 2021.
This study aimed to investigate the clinical significance of hypoalbuminemia (HA) in patients with scrub typhus complicated by acute kidney injury (AKI).
From 2009 to 2018, 611 patients were diagnosed with scrub typhus. We divided the patients into two groups [normoalbuminemia (NA) vs. HA] based on the serum albumin level of 3.0 g/dL and compared the incidence, clinical characteristics, and severity of AKI based on the RIFLE classification between the two groups.
Of the total 611 patients, 78 (12.8%) were categorized into the HA group. Compared to patients in the NA group, patients in the HA group were older (73 ± 9 vs. 62 ± 14 years, P<0.001). The HA group had a significantly longer hospital stay (9.6 ± 6.2 vs 6.2 ± 3.1 days, p<0.001) and a higher incidence of complications in respiratory and cardiovascular systems. Furthermore, AKI developed significantly more in patients in the HA group (58% vs. 18%, p<0.001) as compared to the NA group. The overall incidence of AKI was 23.1%; of which, 14.9%, 7.0%, and 1.2% of cases were classified as Risk, Injury, and Failure, respectively. The serum albumin level correlated with AKI severity (3.4 ± 0.5 vs 3.0 ± 0.5 vs 2.6 ± 0.3, p<0.05). In a multivariate logistic regression analysis for predicting AKI, age, presence of co-morbidities such as chronic kidney disease, total bilirubin, leukocytosis, and hypoalbuminemia were significant predictors for AKI.
Serum albumin level is helpful to predict the development and severity of scrub typhus-associated AKI.
本研究旨在探讨登革热合并急性肾损伤（AKI）患者低白蛋白血症（HA）的临床意义。
2009 年至 2018 年，共诊断出 611 例登革热患者。我们根据血清白蛋白水平 3.0 g/dL 将患者分为两组[正常白蛋白血症（NA）与 HA]，并比较两组间根据 RIFLE 分级的 AKI发生率、临床特征和严重程度。
在 611 例患者中，78 例（12.8%）为 HA 组。与 NA 组相比，HA 组患者年龄更大（73±9 岁比 62±14 岁，P<0.001）。HA 组的住院时间明显更长（9.6±6.2 天比 6.2±3.1 天，p<0.001），且呼吸系统和心血管系统并发症的发生率更高。此外，HA 组 AKI 的发生率明显高于 NA 组（58%比 18%，p<0.001）。总体 AKI 发生率为 23.1%；其中，风险、损伤和衰竭的分别占 14.9%、7.0%和 1.2%。血清白蛋白水平与 AKI 严重程度相关（3.4±0.5 比 3.0±0.5 比 2.6±0.3，p<0.05）。多因素 logistic 回归分析预测 AKI，年龄、合并慢性肾脏病等合并症、总胆红素、白细胞增多和低白蛋白血症是 AKI 的显著预测因素。
血清白蛋白水平有助于预测登革热相关 AKI 的发生和严重程度。
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