title: Are pre-existing markers of chronic kidney disease associated with short-term mortality following acute community-acquired pneumonia and sepsis? A cohort study among older people with diabetes using electronic health records.
abstract: BACKGROUND
  We aimed to examine whether pre-existing impaired estimated glomerular filtration rate (eGFR) and proteinuria were associated with mortality following community-acquired pneumonia or sepsis among people aged ≥ 65 years with diabetes mellitus, without end-stage renal disease.
  
  
  METHODS
  Patients were followed up from onset of first community-acquired pneumonia or sepsis episode in a cohort study using large, linked electronic health databases. Follow-up was for up to 90 days, unlimited by hospital discharge. We used generalized linear models with log link, normal distribution and robust standard errors to calculate risk ratios (RRs) for all-cause 28- and 90-day mortality according to two markers of chronic kidney disease: eGFR and proteinuria.
  
  
  RESULTS
  All-cause mortality among the 4743 patients with pneumonia was 29.6% after 28 days and 37.4% after 90 days. Among the 1058 patients with sepsis, all-cause 28- and 90-day mortality were 35.6 and 44.2%, respectively. eGFR <30 mL/min/1.73 m(2) was a risk marker of higher 28-day mortality for pneumonia (RR 1.27: 95% CI 1.12-1.43) and sepsis (RR 1.32: 95% CI 1.07-1.64), adjusted for age, sex, socio-economic status, smoking status and co-morbidities. Neither moderately impaired eGFR nor proteinuria were associated with short-term mortality following either infection.
  
  
  CONCLUSIONS
  People with pre-existing low eGFR but not on dialysis are at higher risk of death following pneumonia and sepsis. This association was not explained by existing co-morbidities. These patients need to be carefully monitored to prevent modifiable causes of death.
authors.affiliation: Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Helen I
authors.initials: HI
authors.lastname: McDonald
authors.affiliation: Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Nitsch
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Elizabeth R C
authors.initials: ER
authors.lastname: Millett
authors.affiliation: Institute of Diabetes for Older People (IDOP), University of Bedfordshire, Luton, Bedfordshire LU1 3JU, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Sinclair
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Thomas
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000150:complications* / Q000401:mortality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000503:physiopathology*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008297:Male; D011014:Pneumonia / Q000150:complications* / Q000401:mortality; D011507:Proteinuria / Q000209:etiology / Q000401:mortality*; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000401:mortality; D015996:Survival Rate
chemical_list: D015415:Biomarkers
keywords: chronic kidney disease; community-acquired infections; electronic health records; infection/mortality; proteinuria