关键词: 慢性肾脏病, 社区获得性肺炎, 病死率, 危险因素

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To explore the characteristics and risk factors for 30day mortality of communityacquired pneumonia(CAP) patients with chronic kidney disease(CKD).
Ｍｅｔｈｏｄｏｌｏｇｙ：This was a multicenter,retrospective study.Data of patients hospitalized with CAP in five teaching hospitals from Beijing,Shandong and Yunnan province during 20130101 to 20151231 were reviewed.The CAP patients with(CKDCAP) and without(non CKDCAP) CKD were compared.Logistic regression model was used to analyse the impact of CKD on 30day mortality in CAP patients,and the risk factors for 30day mortality of CKDCAP patients.
Ｒｅｓｕｌｔｓ：Totally 3 561 CAP patients were entered into final analysis.CKDCAP patients accounted for 48% (170/3 561).Compared with non CKDCAP patients,CKDCAP patients showed older age(618 yrs vs 520 yrs),higher frequency of cardiovascular disease(482% vs 219%),cerebrovascular disease(282% vs 128%),mellitus diabetes(329% vs 137%),CURB65 score≥2(607% vs 131%) and pneumonia severity index(PSI) risk class≥Ⅲ(959% vs 400%).30day mortality in CKDCAP group were higher  (118% vs 18%).Staphylococcus aureus(194% vs 71%) and Klebsiella pneumoniae(361% vs 140%) were more common in CKDCAP patients.Adjusted for gender,age,comorbidities and CURB65 /PSI score,CKD was associated with increased risk for 30day mortality (OR 2552,95%CI 12035068,P=0018) in CAP patients.Logistic regression analysis confirmed PSI risk class(OR 5361,95%CI 164112036,P=0036),serum procalcitonin (PCT)≥ 2 ng/ml (OR 5102,95%CI 1324～9217, P=0042) and estimated glomerular filtration rate (eGFR) ≤30 ml/(min·173m2)(OR 4183,95%CI 1442～6201,P=0018) were independent risk factors for 30day mortality of CKDCAP patients
Ｃｏｎｃｌｕｓｉｏｎ：CKD was associated with exacerbated illness and worsen outcomes in CAP patients.Besides PSI risk class,serum PCT≥2 ng/ml and eGFR ≤30 ml/(min·173m2) contribute to identify CKDCAP patients with high mortality risk.

Key words: chronic kidney disease, community-acquired pneumonia, mortality, risk factors