Impact of Dialysis Requirement in Community-acquired Pneumonia Hospitalizations

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

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.

Trimethylamine-N-oxide is an independent risk factor for hospitalization events in patients receiving maintenance hemodialysis

Background

Hospitalization is a significant outcome measurement for maintenance hemodialysis pantients. Trimethylamine-N-oxide (TMAO), created by gut microflora from dietary l-carnitine and choline, cleared by the kidney, has been implicated in the causation of cardiovascular diseases in patients with chronic kidney disease. However, whether it associates with hospitalization risk for these patients is unclear.

Methods

In this study, 69 patients undergoing outpatient dialysis were enrolled. Enzyme-linked immunosorbent assay was used to quantitate the baseline plasma TMAO levels in patients. The patients were divided into a high TMAO level group (TMAO ≥ 15 μmol/L) and a low TMAO level group (TMAO < 15 μmol/L). During the 1-year follow-up, 1-year dialysis-related data and all-cause hospitalization events were recorded.

Results

The incidence of hospitalization events was significantly higher in the high TMAO level group than in the low TMAO level group (91 per 100 patient-year vs. 32 per 100 patient-year). The Kaplain–Meier survaial analysis showed that the incidence of hospitalization events in the high TMAO level group was significantly higher than that in the low TMAO level group (log-rank p = 0.0004). After adjustment age, sex, CK-MB and albumin, the results of multivariate Cox proportional hazard analysis showed that high TMAO level was an independent risk factor for hospitalization in maintenance hemodialysis patients.

Conclusion

TMAO is an independent risk factor for hospitalization events in patients receiving maintenance hemodialysis. It may be a new therapeutic target for improving the outcomes of these patients.