title: Acute kidney injury in non-severe pneumonia is associated with an increased immune response and lower survival.
abstract: While sepsis is a leading cause of acute kidney injury in critically ill patients, the relationship between immune response and acute kidney injury in less severely ill patients with infection is not known. Here we studied the epidemiology, 1-year mortality, and immune response associated with acute kidney injury in 1836 hospitalized patients with community-acquired severe and non-severe pneumonia. Acute kidney injury developed in 631 patients of whom 329 had severe and 302 had non-severe sepsis. Depending on the subgroup classification, 16-25% of the patients with non-severe pneumonia also developed acute kidney injury. In general, patients with acute kidney injury were older, had more comorbidity, and had higher biomarker concentrations (interleukin-6, tumor necrosis factor, D-dimer) even among patients without severe sepsis. The risk of death associated with acute kidney injury varied when assessed by Gray's survival model and after adjusting for differences in age, gender, ethnicity, and comorbidity. This risk was significantly higher immediately after hospitalization but gradually fell over time in the overall cohort and in those with non-severe pneumonia. A significantly higher risk of death (hazard ratio 1.29) was also present in those never admitted to an intensive care unit. Hence acute kidney injury is common even among patients with non-severe pneumonia and is associated with higher immune response and an increased risk of death.
authors.affiliation: The CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA.
authors.forename: Raghavan
authors.initials: R
authors.lastname: Murugan
authors.forename: Vijay
authors.initials: V
authors.lastname: Karajala-Subramanyam
authors.forename: Minjae
authors.initials: M
authors.lastname: Lee
authors.forename: Sachin
authors.initials: S
authors.lastname: Yende
authors.forename: Lan
authors.initials: L
authors.lastname: Kong
authors.forename: Melinda
authors.initials: M
authors.lastname: Carter
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000276:immunology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D055633:Immune System Phenomena; D007362:Intensive Care Units / Q000706:statistics & numerical data; D015850:Interleukin-6 / Q000276:immunology; D007668:Kidney / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology*; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000276:immunology / Q000401:mortality; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology; D014481:United States / Q000453:epidemiology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; C036309:fibrin fragment D