The Study Of Severe Pulmonary Infection And Its Related Factors In Inpatients With Nephrotic Syndrome After Immunosuppressant Treatment

BackgroundAt present,the morbidity and prevalence rate of chronic glomerular disease in China are still increasing year by year,and the burdens for the health care systems are very huge.Chronic glomerular disease is an important part of chronic renal disease and is also the most common cause of nephrotic syndrome.It often requires glucocorticoid and/or immunosuppressant treatment,there is an additional risk of infection for these patients.It is not rare that the Infection especially pulmonary infections in patients with nephrotic syndrome who is offering the glucocorticoid and/or immunosuppressant treatment.In addition,low-status of our body's immune system is often complicated with severe infections.Compared with general community-acquired pneumonia,they have different clinical manifestations,pathogenology and imaging characteristics,Such patients can not be treated entirely on the basis of the treatment experience of common pulmonary infections.At present,there are many reports on the clinical features and risk factors of children's nephrotic syndromes infection at home and abroad,but there are few reports on adult nephrotic syndromes infection.Unfortunately,the relative guideline and researches are rather rare or lacking of the support of evidence-based medicine.The low alertness of clinicians to such infections may lead to delays in diagnosis and treatment or progression.Therefore,the purpose of this study is to explore the risk factors of pulmonary infection associated with nephrotic syndrome,especially severe pneumonia,and provide a theoretical basis for clinical prevention and treatment of severe pneumonia.ObjectiveTo observe the related factors of severe pulmonary infection in inpatients with nephrotic syndrome during glucocorticoid and Immunosuppressant therapy.Methods96 hospitalized patients with nephrotic syndrome after immunosuppressant therapy in the department of nephrology of anhui provincial hospital from January 2015 to December 2017 were selected.The demographic and clinical data of patients were retrospectively collected.Patients were divided into two groups according to their severity of pulmonary infection:mild pneumonia group and severe pneumonia group.Logistic regression analysis was used to analyze the related factors of severe pneumonia,calculate the Odds Ratio(OR)and 95%confidence interval(CI).The predicting value of lymphocyte count for severe pneumonia was evaluated by area under receiver operation characteristic curve(AUROC)for discrimination and Hosmer-Lemeshow goodness-of-fit test for calibration.Results22 patients developed severe pneumonia after taking glucocorticoids with an average time of 2.77±1.07 months.They complained of progressive dyspnea and fever.Coarse breath sounds was haerd initially and a few wet and dry rales later on lung auscultation.Chest CT or chest radiography was suggestive of bilateral diffuse interstitial inflammation.The patients were mostly pneumocystis carinii pneumonia,seven cases were diagnosed and six cases were suspected.The triple therapy of antiinfection drugs was SMZ,caspofungin and methylprednisolone.After therapy,16(72.7%)patients recovered and 6(27.3%)patients died or gave up treatment.The levels of glucocorticoid and serum creatinine and urea nitrogen levels in the patients with severe pneumonia were significantly higher than those of the mild pneumonia group(P<0.05).The time of use glucocorticoid and immunosuppressant and the number of lymphocytes were significantly higher than those in the severe pneumonia group(P<0.05).The multivariate logistic regression analysis showed that lymphocyte count was the protective factor of severe pneumonia(OR 0.293,95%CI 0.088-0.974,P=0.045).The AUROC was 0.779(95%CI0.666-0.893,P<0.001)in assessing the discrimination of lymphocyte count for severe pneumonia and The cut-off point was 0.80×10~9/L(OR 0.117,95%CI 0.666-0.893,P<0.001).The value of P was 0.645 in Hosmer-Lemeshow goodness-of-fit test.ConclusionRapid progression of pulmonary infection was observed in the patients with nephrotic syndrome after immunosuppression treatment.The use of glucocorticoids and immunosuppressants for about 3 months is a high risk period for severe pneumonia.The infection was mostly pneumocystis carinii pneumonia.The reduction of lymphocyte count may be the risk factor of severe pneumonia in patients.The peripheral blood lymphocyte count should be closely monitored during the clinical follow-up.The decline of its number,especially?0.80×10~9/L,should be alert to the occurrence of severe pneumonia.