Pneumococcal Pneumonia Infection Is Associated With End-Stage Renal Disease in Adult Hospitalized Patients: A Nationwide Population-Based Cohort Study

• Main Authors: Shih-Ting Huang, 黃士婷
• Other Authors: Yuh-Pyng Sher
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/xgdxef

碩士 === 中國醫藥大學 === 臨床醫學研究所碩士班 === 102 === Streptococcus pneumoniae is the most common pathogen in community-acquired pneumonia (CAP) cases. CAP caused by S. pneumoniae has a poorer long-term prognosis compared with those of other forms of CAP, with a high all-cause mortality rate and cardiovascular-related mortality rate in elderly patients. Pneumococcal pneumonia (PP) might also contribute to extra-pulmonary complications, including bacteremia with metastatic infection, endocarditis, and meningitis. An association between PP and acute cardiac events, such as myocardial infarction, arrhythmia, and congestive heart failure, has also been reported. Pneumococcal disease also leads to renal complications, ranging from persistent proteinuria to end-stage renal disease (ESRD) in pediatric patients. Although studies on P-HUS and invasive pneumococcal disease have characterized the long-term renal effects in pediatric patients, the long-term renal effects in adult patients diagnosed with PP remain unclear. In this study, our aim was to determine the relationship between pneumococcal pneumonia (PP) and the subsequent risk for end-stage renal disease (ESRD) in adult patients. We conducted a population-based retrospective cohort study of 18 733 cases of PP infection diagnosed between 1998 and 2010 using claims data from the National Health Insurance Research Database (NHIRD) in Taiwan. The comparison cohort contained 74 762 age- and sex-matched patients without PP. The incidence rate ratios (IRRs) and hazard ratios (HRs) of ESRD were calculated. The overall incidence of ESRD was 23% higher in the PP cohort than in the non-PP cohort (5.26 vs. 3.10 per 1000 person-years), with an adjusted HR of 1.14 (95% Confidence interval (CI) = 1.01–1.29). The highest age-specific ESRD incidence rates for patients with PP were observed in patients aged 50–64 years (7.68 per 1000 person-years), with an adjusted HR of 1.61 (95% CI: 1.28–2.02) compared with the non-PP cohort in the same age subgroup. The age-specific hazard ratio of ESRD in PP cohort was greatest for patients aged ≤ 34 years with an adjusted HR of 4.15 (95% CI: 1.55–11.1) compared with the non-PP cohort in the same age subgroup. The increased adjusted HRs of ESRD in PP cohort were observed in the comorbid subgroups of hypertension (adjusted HR, 1.19; 95% CI = 1.01–1.39) and malignancy (adjusted HR, 2.15; 95% CI = 1.05–4.40) compared to that of the non-PP cohort. In the non-CKD subgroup, the adjusted HR of ESRD was higher in patients with pneumococcal pneumonia compared to those without pneumococcal pneumonia (adjusted HR, 1.20; 95% CI =1.05–1.37). After univariate and multivariate competing-risk regression analyses, The risk of developing ESRD among patients older than 75 years of age was 3.04-fold higher than that for patients who were younger than 34 years of age (95% CI = 2.64–7.15, P < .001). The risk of developing ESRD was also greater for patients with chronic kidney disease (CKD) (adjusted HR = 9.59, 95% CI = 8.20–11.2, P < .001), diabetes mellitus (DM) (adjusted HR = 3.56, 95% CI = 3.15–4.02, P < .001), hypertension (adjusted HR = 1.88, 95% CI = 1.65–2.14, P < .001), hyperlipidemia (adjusted HR = 1.39, 95% CI = 1.20–1.62, P < .001), and heart failure (HF) (adjusted HR = 1.20, 95% CI = 1.03–1.40, P < .05); while the decreased risk of ESRD was observed in COPD patients (adjusted HR = 0.57, 95% CI = 0.50–0.66, P < .001) . The ESRD cumulative incidence curve showed that the PP cohort had a considerably higher risk of ESRD than the non-PP cohort (log-rank test, P < .001). In summary, PP might be associated with an increased risk of ESRD in adult patients. A long-term follow up of renal function is recommended in adult hospitalized patients for PP infection.