[Prognostic value of acute kidney injury in patients with community-acquired pneumonia].
OBJECTIVE
To investigate the incidence, severity, and prognostic value of acute kidney injury (AKI) in patients with community-acquired pneumonia (CAP).


METHODS
A total of 293 CAP patients (185 men and 108 women; mean age 54.3±17.1 years) were examined. AKI was diagnosed and classified in accordance with the 2012 KDIGO guidelines.


RESULTS
On admission, the serum concentration of creatinine averaged 104.5±73.3 µmol/l. AKI was diagnosed in 83 (28.3%) patients with CAP. Hospital-acquired AKI was found in 25 (8.5%) patients, which amounted to 30.1% of all the AKI cases. The disease severity according to both the CURB-65 scale and the CRB-65 scale, which neglect blood urea nitrogen concentrations, was higher than that in patients with CAP associated with AKI (1.4±1.0 versus 0.4±0.6 scores; respectively; р<0.0001 and 0.8±0.7 versus 0.3±0.5 scores, respectively р<0.0001). The disease ended in a fatal outcome in 16 (5.5%) patients. The mortality in the presence of AKI was higher: 9 (10.1%) patients died in the AKI-complicated CAP group; that in the absence of AKI was 7 (5.2%; χ(2)=4.78; р=0.03), the odds ratio for death in the patients with CAP associated with AKI was 3.4; 95% confidence interval, 2.27 to 17.46. Multivariate logistic regression analysis revealed that the occurrence of AKI was independently influenced by age (р<0.001), systolic and diastolic blood pressures (p=0.01 and p=0.01, respectively), and a history of urinary tract diseases (p=0.04) and diabetes mellitus (p<0.001).


CONCLUSIONS
AKI complicates CAP in 28.3% of cases and increases mortality in patients with CAP. The predictors of AKI in CAP patients are old age, hemodynamic disorders, diabetes mellitus, and prior urinary tract diseases.
Ulyanovsk State University, Ulyanovsk, Russia.
V A
VA
Serov
Ulyanovsk State University, Ulyanovsk, Russia.
A M
AM
Shutov
Ulyanovsk State University, Ulyanovsk, Russia.
M Yu
MY
Kuzovenkova
Ulyanovsk State University, Ulyanovsk, Russia.
Ya V
YV
Ivanova
Ulyanovsk State University, Ulyanovsk, Russia.
D V
DV
Serova
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections / Q000150:complications* / Q000453:epidemiology; D003404:Creatinine / Q000032:analysis; D005260:Female; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications* / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D012720:Severity of Illness Index
D003404:Creatinine