Chest
Original ResearchLung InfectionIncidence and Prognostic Implications of Acute Kidney Injury on Admission in Patients With Community-Acquired Pneumonia
Section snippets
Materials and Methods
A prospective observational study of consecutively unselected patients with CAP admitted to NHS Lothian University Hospitals Division (Edinburgh, Scotland) between January 2005 and January 2008 was carried out. The study was approved by the Lothian Research Ethics Committee. Patients were included in the study if they presented with a new infiltrate on chest radiograph and had three or more of the following symptoms or signs: cough, sputum production, breathlessness, pleuritic chest pain,
Results
The study population included 1,241 patients with CAP who met the study inclusion criteria. Overall, 8.9% required mechanical ventilation and inotropic support, 2.4% required renal replacement therapy, and 30-day mortality was 8.7%. Based on admission creatinine levels, 1,018 (82%) patients had no AKI. Of the 18% with AKI, 130 were assigned to the risk RIFLE classification, 63 to injury, and 30 to failure. Patients were evenly matched with regard to age, sex, and comorbidities, with the
Discussion
This study found that 18% of patients with CAP admitted to the hospital have evidence of AKI, and after adjusting for pneumonia severity, evidence of AKI on admission for CAP is independently associated with increased 30-day mortality and increased risk of requiring mechanical ventilation, inotropic support, and renal replacement therapy. We believe that this study is the first to describe the increase in morbidity and mortality associated with AKI on admission for CAP.
The assessment of AKI on
Acknowledgments
Author contributions: Dr Akram: contributed to the data collection and analysis, preparation and drafting of the manuscript, and final approval of the submitted manuscript.
Dr Singanayagam: contributed to the data collection, review of the manuscript, and final approval of the submitted manuscript.
Dr Choudhury: contributed to the data collection, review of the manuscript, and final approval of the submitted manuscript.
Dr Mandal: contributed to the data collection, review of the manuscript, and
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This work was presented at the British Thoracic Society Winter Meeting, London, 2009. [Akram AR, Singanayagam A, Choudhury G, Mandal P, Chalmers JD, Hill AT. Acute kidney injury on admission independently predicts need for dialysis and 30-day mortality in patients with pneumonia. Thorax 2009;64(suppl 4):A62-A64.]
Funding/Support: Dr Chalmers is supported by a Clinical Research Training Fellowship from the Medical Research Council.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).