影响社区获得性肺炎和医院获得性肺炎合并或不合并急性肾损伤患者 90 天死亡率的因素。

Factors affecting 90-day mortality in community and hospital acquired pneumonia patients with or without acute kidney injury.

机构信息

Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Intensive Care Unit, Ankara, Turkey. (Chest Disease Specialist , İntensive Care Specialist).

Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Intensive Care Unit, Ankara, Turkey. (Anaesthesiology and Reanimation Specialist).

出版信息

Afr Health Sci. 2022 Sep;22(3):567-577. doi: 10.4314/ahs.v22i3.61.

DOI:10.4314/ahs.v22i3.61

PMID:36910350

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9993250/

Abstract

BACKGROUND

AKI is a significant risk factor for mortality. Inflammatory markers are commonly used in the prediction of prognosis in pneumonia patients. The present study aimed to evaluate the prevalence of AKI in hospitalized CAP and HAP patients and to investigate the role of inexpensive, practical, routinely measured serum biomarkers in predicting 90-day mortality.

MATERIALS AND METHODS

The retrospective study included 381 patients in CAP patients and HAP patients who were hospitalized in our Chest Diseases clinic or ICU.

RESULTS

Ninety-day mortality occurred in 115 (30.2%) patients (CAP, 28.7%; HAP, 34.7%). AKI was detected in 25.5% of the patients. On multivariate logistic regression analysis, the 90-day mortality risk was 0.931, 1.05, 0.607, and 1.999 times greater in patients with an increased APACHE II score and increased WBC, 1-h creatinine, and 48-h creatinine levels, respectively. In CAP patients, the 90-day mortality risk was 0.296, 0.539, and 1.966 times greater in patients with an increased CURB-65 score and elevated 1-h and 48-h creatinine levels, respectively. In HAP patients, however, the 90-day mortality risk was 3.554 times greater in patients with an increased 48-h creatinine level.

CONCLUSION

Novel practical scoring systems based on serum creatinine levels are needed for the prediction of long-term prognosis in pneumonia patients.

摘要

背景

急性肾损伤（AKI）是导致死亡率升高的一个重要危险因素。炎症标志物常用于预测肺炎患者的预后。本研究旨在评估住院 CAP 和 HAP 患者中 AKI 的发生率，并探讨常用、实用且常规检测的血清生物标志物在预测 90 天死亡率方面的作用。

材料与方法

本回顾性研究纳入了在我院呼吸科门诊或 ICU 住院的 381 例 CAP 和 HAP 患者。

结果

90 天死亡率为 30.2%（CAP：28.7%；HAP：34.7%），115 例（29.2%）患者发生 AKI。多变量逻辑回归分析显示，APACHE II 评分升高、白细胞计数升高、1 小时肌酐升高、48 小时肌酐升高的患者，90 天死亡率的风险分别增加 0.931、1.05、0.607 和 1.999 倍。在 CAP 患者中，CURB-65 评分升高和 1 小时及 48 小时肌酐升高的患者，90 天死亡率的风险分别增加 0.296、0.539 和 1.966 倍。然而，在 HAP 患者中，48 小时肌酐升高的患者 90 天死亡率的风险增加 3.554 倍。