Morcos Zeina, Daniel Rachel, Hassan Mazen, Qandil Hamza, Lahoud Chloe, Wei Chapman, El Sayegh Suzanne
Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, USA.
Department of Nephrology, Staten Island University Hospital, Staten Island, NY 10305, USA.
J Clin Med. 2025 Jul 31;14(15):5393. doi: 10.3390/jcm14155393.
Acute kidney injury (AKI) worsens outcomes in COPD exacerbation (COPDe), yet limited data compare the demographics and mortality risk factors of COPDe admissions with and without AKI. Understanding this association may enhance risk stratification and management strategies. The aim of this study was to identify demographic differences and mortality risk factors in COPDe admissions with and without AKI. We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 1 January 2016 to 1 January 2021. Patients aged ≥ 35 years with a history of smoking and a diagnosis of COPDe were included. Patients with CKD stage 5, end-stage kidney disease (ESKD), heart failure decompensation, urinary tract infections, myocardial infarction, alpha-1 antitrypsin deficiency, or active COVID-19 infection were excluded. Baseline demographics were analyzed using descriptive statistics. Multivariate logistic regression analysis was used to measure the odds ratio (OR) of mortality. Statistical analyses were conducted using IBM SPSS Statistics V.30, with statistical significance at < 0.05. Among 405,845 hospitalized COPDe patients, 13.6% had AKI. These patients were older, had longer hospital stays, and included fewer females and White patients. AKI was associated with significantly higher mortality (OR: 2.417), more frequent acute respiratory failure (OR: 4.559), intubation (OR: 10.262), and vasopressor use (OR: 2.736). CVA, pneumonia, and pulmonary hypertension were significant mortality predictors. Hypertension, CAD, and diabetes were associated with lower mortality. AKI in COPDe admissions is associated with worse outcomes. Protective effects from certain comorbidities may relate to renoprotective medications. Study limitations include coding errors and retrospective design.
急性肾损伤（AKI）会使慢性阻塞性肺疾病急性加重（COPDe）的预后恶化，但比较有和没有AKI的COPDe入院患者的人口统计学特征和死亡风险因素的数据有限。了解这种关联可能会改善风险分层和管理策略。本研究的目的是确定有和没有AKI的COPDe入院患者的人口统计学差异和死亡风险因素。我们使用2016年1月1日至2021年1月1日的全国住院患者样本（NIS）进行了一项回顾性队列研究。纳入年龄≥35岁、有吸烟史且诊断为COPDe的患者。排除患有慢性肾脏病5期、终末期肾病（ESKD）、心力衰竭失代偿、尿路感染、心肌梗死、α-1抗胰蛋白酶缺乏症或活动性COVID-19感染的患者。使用描述性统计分析基线人口统计学特征。采用多因素逻辑回归分析来衡量死亡的比值比（OR）。使用IBM SPSS Statistics V.30进行统计分析，统计学显著性设定为<0.05。在405845例住院的COPDe患者中，13.6%患有AKI。这些患者年龄较大，住院时间较长，女性和白人患者较少。AKI与显著更高的死亡率（OR：2.417）、更频繁的急性呼吸衰竭（OR：4.559）、插管（OR：10.262）和血管升压药使用（OR：2.736）相关。脑血管意外、肺炎和肺动脉高压是显著的死亡预测因素。高血压、冠心病和糖尿病与较低的死亡率相关。COPDe入院患者中的AKI与更差的预后相关。某些合并症的保护作用可能与肾脏保护药物有关。研究局限性包括编码错误和回顾性设计。
