Risk factors of acute kidney injury in the patients with bloodstream infection caused by different pathogens

doi:10.16138/j.1673-6087.2021.01.006

Abstract

Abstract:

Objective To investigate the incidence, risk factors and prognosis of acute kidney injury(AKI) in the patients with bloodstream infection caused by different pathogens. Methods From January 1, 2018 to December 31, 2018, the patients with blood stream infection in our hospital were enrolled and four most common pathogens including Klebsiella pneumoniae, Escherichia coli, coagulase-negative Staphylococcus and Staphylococcus aureus were tested and total 348 patients were included in this study. The basic information, biochemical indicators during hospitalization and the time and type of invasive procedures before positive blood culture of patients were collected. In accordance with Kidney Disease: Improving Global Outcomes(KDIGO) AKI diagnostic criteria, the definition of AKI was an creatinine increase ≥26.5 μmol/L within 48 h or an 1.5 time increase than the baseline creatinine level within 1 week. The Logistic regression analysis was used to analyze the risk factors, incidence, and prognosis of AKI in the patients with bloodstream infection caused by different pathogens. Results A total of 348 patients with positive blood culture were included in this study. Among them, 70 patients (20.1%) developed AKI. The incidence of AKI was 23.3%, 22.2%, 22% and 15.1% in the patients infected with Staphylococcus aureus, coagulase negative Staphylococcus, Klebsiella pneumoniae and Escherichia coli, respectively. The basic creatinine in the patients with AKI was (80.01±37.09) μmol/L, which was significantly higher than that in the cases without AKI [(69.98±46.40) μmol/L, P=0.008], and the patients in the AKI group received more invasive procedures (70.0% vs 34.5%, P=0.001). Multivariate Logistic regression analysis showed that the invasive procedures were risk factors for AKI patients with bloodstream infection caused by different pathogens [odds ratio(OR)=3.25, 95% confidence interval (CI): 1.80-5.89, P<0.001]. The incidence of AKI (χ²=2.42, P=0.49), kidney function recovery (χ²=6.40, P=0.09) and mortality (χ²=2.40, P=0.49) in bloodstream infection caused by different pathogens didn’t show statistical difference. Conclusions The invasive procedures are risk factors for AKI in the patients with bloodstream infection caused by different pathogens. There is no statistical difference in the incidence and prognosis of AKI among the patients with bloodstream infection caused by different pathogens.

Key words: Pathogen, Bloodstream infection, Acute kidney injury, Creatinine, Sepsis

CLC Number:

R692

WANG Xuejie, CHEN Zijin, DU Wen, GU Feifei, YU Haijin, ZHANG Wen, CHEN Xiaonong. Risk factors of acute kidney injury in the patients with bloodstream infection caused by different pathogens[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(01): 22-26.

Figures/Tables 3

References 25

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项目	金黄色葡萄球菌(n=43)	肺炎克雷伯菌(n=118)	大肠埃希菌(n=106)	凝固酶阴性葡萄球菌(n=81)
男性[n(%)]	33(76.7)	77(65.3)	68(64.2)	53(65.4)
高血压[n(%)]	17(39.5)	49(41.5)	38(35.8)	40(49.4)
糖尿病[n(%)]	9(20.9)	27(22.9)	25(23.6)	29(35.8)
有创操作[n(%)]	26(60.5)	75(63.6)	42(39.6)	39(48.1)
年龄(岁)	60.51±19.78	56.72±16.89	61.55±17.45	59.53±17.30
血红蛋白(g/L)	118.23±28.19	118.60±35.19	114.49±27.61	117.22±26.40
白蛋白(g/L)	33.44±7.30	33.31±6.73	34.22±7.22	35.84±6.79
肌酐(μmol/L)	70.49±37.00	67.94±46.40	70.13±37.00	72.57±45.10
eGFR[mL/(min·1.73m²)]	92.28±30.02	86.73±32.25	86.85±29.79	80.18±28.24
尿酸(μmol/L)	319.58±136.60	299.09±140.48	303.11±120.82	362.02±146.78
尿素(mmol/L)	6.98±3.98	7.26±5.10	6.61±4.58	7.98±6.00

指标	AKI (n=70)	非AKI(n=278)	t/χ²	P
男性[n(%)]	52(74.3)	179(54.6)	3.506	0.061
年龄(岁)	62.63±13.62	58.49±18.63	1.977	0.048
高血压[n(%)]	31(44.3)	143(51.4)	1.001	0.317
糖尿病[n(%)]	22(31.4)	68(24.5)	0.343	0.558
有创操作[n(%)]	49(70.0)	96(34.5)	17.832	0.001
病原菌种类
金黄色葡萄球菌[n(%)]	10(23.3)	33(76.7)	3.501	0.583
凝固酶阴性葡萄球菌[n(%)]	18 (22.2)	63 (77.8)	1.713	0.589
肺炎克雷伯菌[n(%)]	26 (22.0)	92 (78.0)	2.295	0.522
大肠埃希菌[n(%)]	16(15.1)	90(84.9)	0.003	0.122
血红蛋白(g/L)	119.13±27.10	116.89±30.63	0.530	0.597
白蛋白(g/L)	33.93±6.45	34.44±7.13	0.538	0.538
肌酐(μmol/L)	80.01±37.09	69.98±46.40	1.736	0.008
eGFR[mL/(min·1.73m²)]	80.05±27.82	87.76±30.98	1.796	0.557
尿酸(μmol/L)	345.79±144.62	306.23±134.44	2.055	0.487
尿素(mmol/L)	7.30±3.84	6.95±4.92	0.521	0.521

变量	单因素分析		多因素分析
变量	OR (95% CI)	P	OR (95% CI)	P
年龄（岁）	1.01(1.00~1.03)	0.10	1.02(1.00~1.04)	0.10
女性	0.55(0.29~1.04)	0.06	1.68 (0.87~3.27)	0.12
血红蛋白	1.00(0.99~1.01)	0.60	-	-
白蛋白	0.99(0.95~1.03)	0.59	-	-
GFR	0.99(0.98~1.00)	0.07	1.00(0.99~1.02)	0.77
尿酸	1.00(1.00~1.00)	0.04	1.00(1.00~1.00)	0.16
尿素	1.02(0.96~1.07)	0.60	-	-
合并基础疾病	1.21(0.84~1.76)	0.31	-	-
接受有创操作	3.34(1.88~5.96)	<0.01	3.25(1.80~5.89)	<0.01
病原菌种类	1.189(0.93~1.516)	0.17	-	-
大肠埃希菌	-	-		-
金黄色葡萄球菌	-	-	0.99(0.35~2.78)^*	0.98
肺炎克雷伯菌	-	-	1.33(0.46~2.89)^*	0.46
凝固酶阴性葡萄球菌	-	-	1.64(0.72~3.70)^*	0.24