Garapati Hari Naga, Chandramohan Deepak, Lapsiwala Boney, Nangia Udit, Patel Devansh, Singh Prabhat, Avula Sreekant, Chauhan Aditya, Jena Nihar, Simhadri Prathap Kumar
Department of Internal Medicine/Nephrology, Baptist Medical Center South, Montgomery, AL 36116, USA.
Department of Internal Medicine/Nephrology, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
J Clin Med. 2025 Mar 25;14(7):2243. doi: 10.3390/jcm14072243.
Sepsis in patients with acute myeloid leukemia (AML) is one of the causes of acute kidney injury (AKI). There are no available data on the outcomes of AML-related AKI patients. We researched the 2016-2020 National Inpatient Sample (NIS) database to collect data on hospitalizations of patients ≥18 years old with sepsis and AML. These admissions were divided into two weighted groups, with and without AKI. A multivariable logistic regression was used with adjustment for possible confounders to generate the adjusted odds ratios for the outcomes of the study. A -value of <0.05 was considered significant. The primary outcome was all-cause inpatient mortality. Secondary outcomes were septic shock, fluid and electrolyte disorders, length of stay (LOS), vasopressor support, and the requirement for mechanical ventilation. Out of 288,435 hospital admissions of patients with sepsis and AML, 61,955 (21.4%) had AKI. Patients with AKI were older (mean age 66.1 vs. 60.4 years), males (63.1% vs. 52.8%), and more Black individuals were affected (12% vs. 9.2). They also had more comorbidities but had a significantly higher percentage of diabetes mellitus, congestive heart failure, cardiac arrhythmias, cerebrovascular disease, and chronic kidney disease. Tumor lysis syndrome was present in 11.1%. Compared to patients without AKI, patients with AKI had longer LOS days (15.4 ± 18 vs. 10.8 ± 13.1, < 0.001. Multivariable analysis showed that the patients with AKI had higher odds of mortality (OR: 3.8, 95% CI: 3.6-4.1, < 0.001). They also had a higher risk for fluid and electrolyte disorders (OR: 2.2, 95% CI: 2.1-2.4, < 0.001), septic shock (OR: 6.3, 95% CI: 5.7-6.9, < 0.001), vasopressor requirement (OR: 5.0, 95% CI: 4.3-5.8, < 0.001), and mechanical ventilation (OR: 5.2, 95% CI: 4.7-5.7, < 0.001). AKI in patients with sepsis and AML was associated with higher mortality compared to sepsis alone, as well as other complications. Further large studies are required to identify factors that could improve outcomes.
急性髓系白血病（AML）患者的脓毒症是急性肾损伤（AKI）的病因之一。目前尚无关于AML相关AKI患者预后的可用数据。我们研究了2016 - 2020年国家住院患者样本（NIS）数据库，以收集≥18岁的脓毒症和AML患者的住院数据。这些入院患者被分为两个加权组，有AKI组和无AKI组。使用多变量逻辑回归并对可能的混杂因素进行调整，以生成研究结果的调整后比值比。P值<0.05被认为具有统计学意义。主要结局是全因住院死亡率。次要结局包括感染性休克、液体和电解质紊乱、住院时间（LOS）、血管升压药支持以及机械通气需求。在288,435例脓毒症和AML患者的住院病例中，61,955例（21.4%）发生了AKI。发生AKI的患者年龄更大（平均年龄66.1岁对60.4岁），男性比例更高（63.1%对52.8%），受影响的黑人个体更多（12%对9.2%）。他们也有更多的合并症，但糖尿病、充血性心力衰竭、心律失常、脑血管疾病和慢性肾病的比例显著更高。肿瘤溶解综合征的发生率为11.1%。与无AKI的患者相比，发生AKI的患者住院天数更长（15.4±18天对10.8±13.1天，P<0.001）。多变量分析显示，发生AKI的患者死亡几率更高（OR：3.8，95%CI：3.6 - 4.1，P<0.001）。他们发生液体和电解质紊乱的风险也更高（OR：2.2，95%CI：2.1 - 2.4，P<0.001）、感染性休克（OR：6.3，95%CI：5.7 - 6.9，P<0.001）、血管升压药需求（OR：5.0，95%CI：4.3 - 5.8，P<0.001）以及机械通气（OR：5.2，95%CI：4.7 - 5.7，P<0.001）。与单纯脓毒症相比，脓毒症和AML患者的AKI与更高的死亡率以及其他并发症相关。需要进一步的大型研究来确定可以改善预后的因素。
