Clinical Characteristics And Risk Factors Analysis Of Pulmonary Infection In Patients With Primary Nephrotic Syndrome Receiving Immunosuppressive Agents

Objectives:By investigating the clinical characteristics and risk factors of pulmonary infection in adults with Primary Nephrotic Syndrome(PNS)receiving immunosuppressive agents,we can provide evidence for the prevention and treatment of clinical high-risk groups.Methods:376 patients with PNS receiving immunosuppressive agents who were admitted to the department of nephrology,Zhongda Hospital Affiliated to Southeast University from January 2013 to December 2019 were selected as subjects.Patients with previous underlying pulmonary disease,cancer,immunosuppressive disease,other site infection receiving immunosuppressive agents,less than 14 years old and unknown data records were excluded.The patients were divided into pulmonary infection group and non-pulmonary infection group according to whether pulmonary infection occurred or not.The patients were divided into severe pulmonary infection group and non-severe pulmonary infection group according to the severity of pulmonary infection.Clinical and laboratory records were collected.Clinical characteristics and risk factors analysis were performed with the Statistical Product and Service Solutions.Results:The study included 376 admissions from the patients.Among these patients,there were 77 cases(20.48%)of pulmonary infection,including 24 cases(31.17%)of severe pulmonary infection.Within three months after receiving immunosuppressive agents was a high risk period for pulmonary infection and severe pulmonary infection.28 strains of bacteria(22 strains of gram-negative bacteria,6 strains of gram-positive bacteria),12 strains of fungi,but no viruses were detected in patients with pulmonary infection,among which Candida albicans,Klebsiella pneumoniae and Acinetobacter baumannii were the most distributed pathogens.Gram-negative bacteria had the lowest resistance to amikacin,gram-positive bacteria were sensitive to linezolid and vancomycin,and the fungi were generally sensitive.Binary multivariate Logistic regression analysis showed that age ≥60(OR=2.265,P=0.012),smoking history(OR=2.470,P=0.025),clinical outcome of PNS(partial remission:OR=2.325,P=0.014,complete remission:OR=10.075,P=0.002),CD4+T lymphocyte count ≤500(OR=8.076,P<0.001),and admission in winter(OR=2.316,P=0.014)were potential risk factors for pulmonary infection.The higher cumulative dose of immunosuppressive agents in the 3 months before infection(OR=1.003,P=0.002)and CD4+T lymphocyte count ≤200(OR=19.764,P<0.001)were potential risk factors for severe pulmonary infection.Conclusions:Age≥60,smoking history,clinical outcome of PNS,CD4+T lymphocyte count is 500 or less,admission in winter were potential independent risk factors for pulmonary infection in patients with PNS receiving immunosuppressive agents.The higher cumulative dose of immunosuppressive agents in the 3 months before infection and CD4+T lymphocyte count ahead of the 200 were potential independent risk factors for the development of severe pulmonary infection.Immunosuppressive therapy,especially in the first 3 months,the patient’s immune function should be closely monitored to prevent the occurrence of infection.For the patients with pulmonary infection should be timely sent to the examination of pathogens specimen for bacterial culture,and reasonable selection of antibiotics.