The spectrum of infection-related morbidity in hospitalized haemodialysis patients.
BACKGROUND
Infection is a common cause of mortality and morbidity in haemodialysis patients. Few prospective studies have examined the clinical consequences of infection-related hospitalizations in haemodialysis patients or the risk factors predictive of clinical outcomes.


METHODS
The outcomes of all first infection-related hospitalizations of patients enrolled in the HEMO Study were categorized in terms of mortality, requirement for intensive care unit (ICU) stay and length of hospitalization. In addition, the association of hospitalization outcomes with clinical and laboratory parameters was evaluated.


RESULTS
Among the 783 first infection-related hospitalizations, 57.7% had a severe outcome (death, ICU stay or hospitalization >/=7 days). The likelihood of a severe outcome increased with patient age (P<0.0001) and with decreased serum albumin (P<0.001). The frequency of a severe outcome varied greatly by infectious disease category (P<0.001), being highest for cardiac infections (95.6%) and infection of unknown source (68.4%), and lowest for urinary tract infections (35.5%) and access-related infections (43.8%). On multivariate analysis, hospitalization outcome was independently associated with patient age, serum albumin and disease category, but not with the randomized Kt/V or flux, gender, race or diabetic status.


CONCLUSIONS
In summary, infection-related hospitalizations are associated with substantial morbidity. Patient age, serum albumin and infectious disease category are independently correlated with the hospitalization outcome, and can be used to estimate the likelihood of serious outcomes at the time of hospital admission.
Allon
Michael
M
Division of Nephrology, University of Alabama at Birmingham, AL, USA. mdallon@uab.edu.
Radeva
Milena
M
Bailey
James
J
Beddhu
Srinivasan
S
Butterly
David
D
Coyne
Daniel W
DW
Depner
Thomas A
TA
Gassman
Jennifer J
JJ
Kaufman
Allen M
AM
Kaysen
George A
GA
Lewis
Julia A
JA
Schwab
Steve J
SJ
D000328:Adult; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis
D012709:Serum Albumin