Incidence, Risk Factors, and Prognostic Implications of Acute Kidney Injury in Patients with Acute Exacerbation of COPD

• Main Authors: Wan X, Chen D, Tan Y, Ma M, Zhang F, Liu Z, Chen Y, Shao W, Cao C
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-05-01
• Series: International Journal of COPD
• Subjects: acute kidney injury; acute exacerbation of chronic obstructive pulmonary disease; incidence; risk factor; prognostic implication
• Online Access: https://www.dovepress.com/incidence-risk-factors-and-prognostic-implications-of-acute-kidney-inj-peer-reviewed-article-COPD

Xin Wan,1,2,* Dawei Chen,1,* Yan Tan,3 Mengqing Ma,2 Feng Zhang,1 Zhihe Liu,1 Yue Chen,1 Wei Shao,2 Changchun Cao2 1Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 2Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 3Department of Respiratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Changchun CaoDepartment of Nephrology, Sir Run Run Hospital, Nanjing Medical University, No. 109 Longmian Street, Nanjing, Jiangsu 211100, People’s Republic of ChinaEmail [e-mail]: Little is known about the incidence, risk factors, and prognostic implications of acute kidney injury (AKI) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in China. In this study, we investigated the incidence, risk factors, and short-term outcomes of AKI in these patients.Patients and Methods: We analyzed the records of 1768 patients admitted to Nanjing First Hospital with a principal diagnosis of AECOPD. Of these, 377 patients had AKI.Results: AKI occurred in 377 patients (21%). Independent risk factors for AKI in patients with AECOPD were advanced age, coronary artery disease, anemia, cancer, chronic kidney disease, hypercapnic encephalopathy, acute respiratory failure, and mechanical ventilation. Patients with AKI had worse prognostic implications and were more likely to require mechanical ventilation (38.7% vs 19.1%, P< 0.001); non-invasive mechanical ventilation (38.2% vs 18.9%, P< 0.001); invasive mechanical ventilation (18.3% vs 3.1%, P< 0.001); intensive care unit (ICU) admission (33.7% vs 12.9%, P< 0.001); had a longer ICU stay (9 days vs 8 days, P=0.033) and longer hospitalization (13 days vs 10 days, P< 0.001); and higher in-hospital mortality (18.0% vs 2.7%, P< 0.001) than those without AKI. Multivariable analysis indicated that compared to patients without AKI, those with stage 1, 2, or 3 AKI had a 1.9-fold, 2.1-fold, or 6.0-fold increased risk of in-hospital death, respectively.Conclusion: AKI is common in patients with AECOPD requiring hospitalization. Patients with AKI have worse short-term outcomes. Thus, AKI may be a prognostic predictor of patient survival.Keywords: acute kidney injury, acute exacerbation of chronic obstructive pulmonary disease, incidence, risk factor, prognostic implication