Zhang Qiang, Song Xuefeng
Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China.
Department of Gastrointestinal Oncology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China.
Front Med (Lausanne). 2025 May 21;12:1596037. doi: 10.3389/fmed.2025.1596037. eCollection 2025.
This study employed a retrospective analysis to investigate whether probiotics were associated with a lower incidence of Acute Kidney Injury (AKI) in patients with severe pneumonia.
We retrospectively analyzed patients with severe pneumonia who required mechanical ventilation and had no prior history of kidney disease.
Based on the inclusion and exclusion criteria, a total of 267 cases were included, comprising 190 patients who did not develop AKI and 77 patients who developed AKI. Statistically significant differences ( < 0.05) were observed between the AKI and non-AKI groups in terms of gender, CRP, PCT, PLT, SOFA score, ALB, Cr, and BUN. The proportion of probiotics use was lower in the AKI group, with a statistically significant difference between the two groups ( < 0.05). Using the occurrence of AKI as the dependent variable, a multivariate logistic regression analysis was performed including gender, CRP, PCT, PLT, SOFA score, ALB, Cr, and BUN. The analysis demonstrated that probiotics were associated with a lower incidence of AKI during ICU hospitalization in patients with severe pneumonia ( = 0.031). The results of the ordered logistic regression further indicated that probiotics use reduced the incidence of AKI (Coefficient = -0.7748, = 0.006). Subgroup analysis revealed that probiotics were associated with a lower incidence of stage 1 AKI (OR: 0.4023, 95% CI: 0.1895-0.8540, = 0.018) but not stage 2 (OR: 0.683, 95% CI: 0.2083-2.242, = 0.53) or stage 3 AKI (OR: 0.9007, 95% CI: 0.2851-2.845, = 0.859). Among the 146 patients in the probiotic group and 121 patients in the non-probiotic group, 44 patients developed stage 1 AKI, 15 developed stage 2 AKI, and 18 developed stage 3 AKI. Creatinine was selected for matching to balance the confounder. After propensity score matching, a total of 224 cases were matched (112 in each group). The incidence of stage 1 AKI ( = 0.019) remained statistically significant, while no significant differences were observed in the incidence of stage 2 AKI ( = 0.757) or stage 3 AKI ( = 0.757) between the two groups.
Probiotics were associated with a lower incidence of stage 1 AKI in patients with severe pneumonia. However, our research was a single-center retrospective study, and multi-center randomized controlled studies would be needed in the future for validation.
本研究采用回顾性分析，探讨益生菌是否与重症肺炎患者急性肾损伤（AKI）发生率较低相关。
我们回顾性分析了需要机械通气且既往无肾脏疾病史的重症肺炎患者。
根据纳入和排除标准，共纳入267例患者，其中190例未发生AKI，77例发生AKI。AKI组和非AKI组在性别、CRP、PCT、PLT、SOFA评分、ALB、Cr和BUN方面存在统计学显著差异（<0.05）。AKI组益生菌使用比例较低，两组间差异有统计学意义（<0.05）。以AKI的发生作为因变量，进行多因素逻辑回归分析，纳入性别、CRP、PCT、PLT、SOFA评分、ALB、Cr和BUN。分析表明，益生菌与重症肺炎患者ICU住院期间AKI发生率较低相关（=0.031）。有序逻辑回归结果进一步表明，使用益生菌可降低AKI发生率（系数=-0.7748，=0.006）。亚组分析显示，益生菌与1期AKI发生率较低相关（OR：0.4023，95%CI：0.1895 - 0.8540，=0.018），但与2期（OR：0.683，95%CI：0.2083 - 2.242，=0.53）或3期AKI（OR：0.9007，95%CI：0.2851 - 2.845，=0.859）无关。益生菌组146例患者和非益生菌组121例患者中，44例发生1期AKI，15例发生2期AKI，18例发生3期AKI。选择肌酐进行匹配以平衡混杂因素。倾向得分匹配后，共匹配224例（每组112例）。1期AKI发生率（=0.019）仍有统计学意义，而两组间2期AKI（=0.757）和3期AKI（=0.757）发生率无显著差异。
益生菌与重症肺炎患者1期AKI发生率较低相关。然而，我们的研究是单中心回顾性研究，未来需要多中心随机对照研究进行验证。
