Medical Sciences Postgraduate Program, Universidade de Fortaleza- UNIFOR, Fortaleza, Ceará, Brazil.
BMC Nephrol. 2024 Oct 8;25(1):336. doi: 10.1186/s12882-024-03766-w.
Glomerular diseases, encompassing primary and secondary forms, pose significant morbidity and mortality risks. Despite their impact, little is known about critically ill patients with primary glomerulopathy admitted to the intensive care unit (ICU).
We conducted a case‒control study of patients with primary glomerulopathy using the Medical Information Mart for Intensive Care IV database. Demographic, clinical, and outcome data were collected. Logistic regression and mediation analysis were performed to identify predictors of hospital and long-term mortality.
Among 50,920 patients, 307 with primary glomerulopathy were included. Infectious and cardiovascular-related causes were the main reasons for ICU admission, with sepsis being diagnosed in more than half of the patients during their ICU stay. The hospital mortality rate was similar to that of the control group, with a long-term mortality rate of 29.0% three years post-ICU discharge. Reduced urine output and serum albumin were identified as independent predictors of hospital mortality, while serum albumin and the Charlson comorbidity index were significantly associated with long-term mortality. Notably, although acute kidney injury was frequent, it was not significantly associated with mortality. Additionally, reduced urine output mediates nearly 25% of the association between serum albumin and hospital mortality.
Critically ill patients with primary glomerulopathy exhibit unique characteristics and outcomes. Although hospital mortality was comparable to that of the control group, long-term mortality remained high. The serum albumin concentration and Charlson Comorbidity Index score emerged as robust predictors of long-term mortality, highlighting the importance of comprehensive risk assessment in this population. The lack of an association between acute kidney injury and mortality suggests the need for further research to understand the complex interplay of factors influencing outcomes in this patient population.
肾小球疾病包括原发性和继发性，具有显著的发病率和死亡率风险。尽管其影响较大，但人们对重症原发性肾小球病患者入住重症监护病房（ICU）的情况知之甚少。
我们使用医疗信息集市重症监护 IV 数据库对原发性肾小球病患者进行了病例对照研究。收集了人口统计学、临床和结局数据。采用逻辑回归和中介分析来确定医院和长期死亡率的预测因素。
在 50920 名患者中，纳入了 307 名原发性肾小球病患者。感染和心血管相关病因是 ICU 入院的主要原因，超过一半的患者在 ICU 期间被诊断为脓毒症。医院死亡率与对照组相似，ICU 出院后 3 年的长期死亡率为 29.0%。尿输出量减少和血清白蛋白是医院死亡率的独立预测因素，而血清白蛋白和 Charlson 合并症指数与长期死亡率显著相关。值得注意的是，尽管急性肾损伤很常见，但与死亡率无显著相关性。此外，尿输出量减少介导了血清白蛋白与医院死亡率之间近 25%的关联。
重症原发性肾小球病患者表现出独特的特征和结局。尽管医院死亡率与对照组相似，但长期死亡率仍然较高。血清白蛋白浓度和 Charlson 合并症指数评分是长期死亡率的有力预测因素，突出了在该人群中进行全面风险评估的重要性。急性肾损伤与死亡率之间缺乏关联表明需要进一步研究，以了解影响该患者人群结局的各种因素之间的复杂相互作用。
