PREDICTION OF MORTALITY IN PATIENTS WITH BACTEREMIA: THE IMPORTANCE OF PRE-EXISTING RENAL INSUFFICIENCY

Autor:	H. Konisberger, Silvio Pitlik, Leonard Leibovici, Zmira Samra, Moshe Drucker, Haim Shmuely
Rok vydání:	2000
Předmět:	Male medicine.medical_specialty Bacteremia Critical Care and Intensive Care Medicine chemistry.chemical_compound Diabetes mellitus Internal medicine medicine Humans Prospective Studies Renal Insufficiency Risk factor Fungemia Aged Creatinine business.industry General Medicine Prognosis medicine.disease Surgery chemistry Nephrology Heart failure Female business Complication Kidney disease
Zdroj:	Renal Failure. 22:99-108
ISSN:	1525-6049 0886-022X
DOI:	10.1081/jdi-100100856
Popis:	Pre-existing renal insufficiency serves as a common risk factor in the development of acute renal failure. Acute renal failure is a common finding in patients with bacteremia and is associated with poor prognosis. A total of 2722 consecutive patients 18 years old or older, fulfilling strike criteria of bacteremia or fungemia were prospectively evaluated to establish the prognostic importance of pre-existing renal insufficiency in bacteremic patients. They were classified according to serum creatinine levels upon admission into three groups. 915 patients had normal creatinine levels (or = 1.0 mg/dL), 1528 had mild to moderate renal failure (creatinine 1.1-3 mg/dL) and 279 patients had severe renal failure upon admission (creatinine3.0 mg/dL). Mild to severe renal failure upon admission was associated with old age, male gender, diabetes mellitus, ischemic heat disease, hypertension and congestive heart failure. The serum albumin in patients with severe renal failure was significantly low, with a mean of 2-9 mg/dL. Urinary tract infections were more prevalent in patients with mild to severe renal failure, while intravenous line infections, bacterial endocarditis and soft and skin tissue infections were more common in patients with normal renal function. In the 279 patients with severe renal failure the mortality rate was significantly higher (50%) compared to patents with mild to moderate renal failure and patients with normal renal function (21% and 26% respectively, p = 0.0001). Multiple regression analysis revealed that pre-existing serum creatinine3 mg/dL was significantly associated with death attributable to bacteremia (OR = 1.7, 95% CI 1.0-2.7). In conclusion, adult bacteremic patients with pre-existing serum creatinine above 3 mg/dL upon admission are at increased risk of mortality due to bacteremia than patients with normal or mild to moderate renal failure.
Databáze:	OpenAIRE
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