MP283THE PROGNOSTIC VALUE OF ACUTE KIDNEY INJURY IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

Abstract

INTRODUCTION AND AIMS: The aim of this study was to determine the incidence, severity and prognostic value of acute kidney injury (AKI) in patients with community-acquired pneumonia (CAP). METHODS: 293 patients with CAP (185 males and 108 females, mean age was 54.3±17.1 years) admitted to the Central City Hospital in 2015, were studied. There were 9 (3.1%) patients on mechanical ventilation. AKI was diagnosed according to KDIGO Clinical Practice Guideline for Acute Kidney Injury (2012). 21 (7.2 %) of patients has the history of renal diseases. Mean glomerular filtration rate (GFR) on admission was 73.5±24.9 ml/min. RESULTS: Mean serum creatinine level on admission was 104.5±73.3 micromol/l. AKI was diagnosed in 83 (28.3%) patients with CAP. Hospital-acquired AKI was detected in 25 (8.5%) of patients with CAP (30.1% of all patient with AKI). So, community-acquired AKI was diagnosed in 58 (19.8%) patients with CAP (69.9% of all patient with AKI). The severity of disease according to scales CURB-65 and CRB-65 which are not taking into account serum creatinine level, was higher in patients with CAP which is associated with AKI (1.4±1.0 points versus 0.4±0.6 points, p<0.0001, and 0.8±0.7 points versus 0.3±0.5 points, p<0.0001, respectively). In 16 (5.5%) of patients the disease has been fatal including 11 patients on mechanical ventilation. The mortality was higher in the group of patients with AKI than in patients without AKI (10.1% versus 5.2% (χ2=4.78, h=0.03)). The odds ratio of death for patients with CAP associated with AKI was 3.4 (95% CI 2.27 - 17.46). The multivariate logistic regression analysis showed that age (h<0.001), diabetes mellitus ( p<0.001), low systolic and diastolic BP levels (p=0.01), a history of renal diseases (p=0.04) has independent assotiation with AKI in patients with CAP. CONCLUSIONS: Acute kidney injury complicates the course of pneumonia in 30.4% of patients and increases the mortality of patients with community-acquired pneumonia. AKI is community-acqured in 69.9 % of patients with community-acquired pneumonia. Predictors of Acute Kidney Injury in patients with community-acquired pneumonia are advanced age, diabetes mellitus, hemodynamic disorders and history of history of renal diseases.