Risk Factors And Prognostic Implications Of Acute Kidney Injury In Patients With Community Acquired Pneumonia-associated Acute Respiratory Distress Syndrome

Objective: To explore the risk factors and prognosis of acute kidney injury(AKI)in patients with community acquired pneumonia-associated acute respiratory distress syndrome(CAP-ARDS).Methods: This was a retrospective analysis of 837 patients with CAP-ARDS from Nanjing First Hospital between January 2014 and March 2017.AKI was defined and staged according to Kidney Disease Improving Global Outcomes(KDIGO)criteria.Acute respiratory distress syndrome(ARDS)was defined and staged according to Berlin definition.Univariate and multiple Logistic regression models were employed for determining the association between the development of AKI and risk factors.Cox regression analysis was utilized in the identification of variables influencing in-hospital death and length of hospital stay.30-day survival was assessed by the Kaplan-Meier method.Results: Of 837 patients,446(53.3%)occurred AKI.A total of 35(4.2%)patients required renal replacement therapy.Logistic regression analysis showed that male(OR 1.62;95% CI,1.16-2.25,P = 0.005),white blood cell count(OR 1.03;95% CI,1.01-1.06,P = 0.015),intravenous diuretic(OR 2.01;95% CI,1.35-2.98,P = 0.001),vancomycin(OR 2.03;95% CI,1.10-3.74,P = 0.024),requiring mechanical ventilation(OR 2.34;95% CI,1.67-3.28,P < 0.001),ARDS severity(OR 1.48;95% CI,1.17-1.87,P = 0.001),and proteinuria levels of trace to 1+(OR 1.79;95% CI,1.27-2.53,P = 0.001),2+(OR 3.65;95% CI,1.93-6.90,P < 0.001),and 3+(OR 11.17;95% CI,3.03-41.16,P < 0.001).The overall mortality was 27.8%(233/837).Patients who developed AKI had higher mortality compared with those without(43.0% vs.10.5%,P < 0.001).Cox regression analysis showed that respiratory rate(HR 1.02;95% CI,1.01-1.04,P = 0.038),hypertension(HR 1.44;95% CI,1.09-1.89,P = 0.010),vasopressor agents(HR 1.50;95% CI,1.14-1.97,P = 0.004),mechanical ventilation (HR 2.25;95% CI,1.51-3.36,P < 0.001),AKI(HR 1.62;95% CI,1.13-2.31,P = 0.008),ARDS severity(HR 1.50;95% CI,1.24-1.82,P < 0.001).In addition,the length of hospital stay was significantly longer in those with AKI at 17 days versus those without at 11 days(P < 0.001).Conclusions: AKI was common in patients with CAP-ARDS,and with high mortality.Male,white blood cell count,intravenous diuretic,vancomycin,mechanical ventilation,ARDS severity and proteinuria levels were risk factors of AKI in patients with CAP-ARDS.AKI is an independent risk factor for in-patient mortality.