Impact of Dialysis Requirement in Community-acquired Pneumonia Hospitalizations
Background Community-acquired pneumonia (CAP) is a common cause of hospitalization. While there are single-center studies on acute kidney injury requiring dialysis (AKI-D) and CAP, data on national trends and outcomes regarding AKI-D in CAP hospitalizations is lacking. Methods We utilized the Nation...
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creator | Mansuri, Uvesh Patel, Achint A Dave, Mihir Chauhan, Kinsuk Shah, Aakashi S Banala, Ramyasree Ali, David Kamal, Saad Verma, Pooja Ahmed, Shamim Maiyani, Prakash Pathak, Ambarish C Rahman, Shajoti Savani, Sejal Pandya, Surta Nadkarni, Girish |
description | Background Community-acquired pneumonia (CAP) is a common cause of hospitalization. While there are single-center studies on acute kidney injury requiring dialysis (AKI-D) and CAP, data on national trends and outcomes regarding AKI-D in CAP hospitalizations is lacking. Methods We utilized the Nationwide Inpatient Sample to analyze trends overall and within subgroups. We also utilized multivariate regression to adjust for potential confounders of annual trends and to generate adjusted odds ratios (aOR) for predictors and outcomes, including mortality and adverse discharge. Results There were 11,500,456 pneumonia hospitalizations between 2002 and 2013, of which 3675 (0.3%) were complicated by AKI-D. The AKI-D rate increased from 2.7/1000 hospitalizations in 2002 to 4.3/1000 hospitalizations in 2013. The rate of increase was higher in males and African Americans. Although temporal changes in demographics and comorbidities explained a substantial proportion, they could not explain the entire trend. The predictor with the highest odds of AKI-D required mechanical ventilation during hospitalization (aOR 12.47; 95% CI 11.66-13.34). Other significant predictors included sepsis (aOR 4.37; 95% CI 4.09-4.66), heart failure (aOR 2.40; 95% CI 2.25-2.55), and chronic kidney disease (CKD) (aOR 2.00; 95% CI 1.86-2.16). AKI-D was associated with increased in-hospital mortality (aOR 3.08; 95% CI 2.88-3.30) and adverse discharge (aOR 2.09; 95% CI 1.92-2.26). Although adjusted mortality decreased per year, attributable mortality remained stable. Conclusion Pneumonia hospitalizations complicated by AKI-D have increased with a differential increase by demographic groups. AKI-D is associated with significant morbidity and mortality. In the absence of effective AKI-D therapies, the focus should be on early risk stratification and prevention to avoid this devastating complication. |
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While there are single-center studies on acute kidney injury requiring dialysis (AKI-D) and CAP, data on national trends and outcomes regarding AKI-D in CAP hospitalizations is lacking. Methods We utilized the Nationwide Inpatient Sample to analyze trends overall and within subgroups. We also utilized multivariate regression to adjust for potential confounders of annual trends and to generate adjusted odds ratios (aOR) for predictors and outcomes, including mortality and adverse discharge. Results There were 11,500,456 pneumonia hospitalizations between 2002 and 2013, of which 3675 (0.3%) were complicated by AKI-D. The AKI-D rate increased from 2.7/1000 hospitalizations in 2002 to 4.3/1000 hospitalizations in 2013. The rate of increase was higher in males and African Americans. Although temporal changes in demographics and comorbidities explained a substantial proportion, they could not explain the entire trend. The predictor with the highest odds of AKI-D required mechanical ventilation during hospitalization (aOR 12.47; 95% CI 11.66-13.34). Other significant predictors included sepsis (aOR 4.37; 95% CI 4.09-4.66), heart failure (aOR 2.40; 95% CI 2.25-2.55), and chronic kidney disease (CKD) (aOR 2.00; 95% CI 1.86-2.16). AKI-D was associated with increased in-hospital mortality (aOR 3.08; 95% CI 2.88-3.30) and adverse discharge (aOR 2.09; 95% CI 1.92-2.26). Although adjusted mortality decreased per year, attributable mortality remained stable. Conclusion Pneumonia hospitalizations complicated by AKI-D have increased with a differential increase by demographic groups. AKI-D is associated with significant morbidity and mortality. In the absence of effective AKI-D therapies, the focus should be on early risk stratification and prevention to avoid this devastating complication.</description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.3164</identifier><identifier>PMID: 30357013</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>Chronic illnesses ; Codes ; Diagnosis related groups ; Disease ; DRGs ; Epidemiology ; Health care policy ; Hemodialysis ; Hospitals ; Internal medicine ; Laboratories ; Medicine ; Morbidity ; Mortality ; Nephrology ; Nursing ; Patients ; Pneumonia ; Public health ; Pulmonology ; Sepsis ; Trends</subject><ispartof>Curēus (Palo Alto, CA), 2018-08, Vol.10 (8), p.e3164-e3164</ispartof><rights>Copyright © 2018, Mansuri et al. This work is published under http://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2018, Mansuri et al. 2018 Mansuri et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197503/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197503/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30357013$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mansuri, Uvesh</creatorcontrib><creatorcontrib>Patel, Achint A</creatorcontrib><creatorcontrib>Dave, Mihir</creatorcontrib><creatorcontrib>Chauhan, Kinsuk</creatorcontrib><creatorcontrib>Shah, Aakashi S</creatorcontrib><creatorcontrib>Banala, Ramyasree</creatorcontrib><creatorcontrib>Ali, David</creatorcontrib><creatorcontrib>Kamal, Saad</creatorcontrib><creatorcontrib>Verma, Pooja</creatorcontrib><creatorcontrib>Ahmed, Shamim</creatorcontrib><creatorcontrib>Maiyani, Prakash</creatorcontrib><creatorcontrib>Pathak, Ambarish C</creatorcontrib><creatorcontrib>Rahman, Shajoti</creatorcontrib><creatorcontrib>Savani, Sejal</creatorcontrib><creatorcontrib>Pandya, Surta</creatorcontrib><creatorcontrib>Nadkarni, Girish</creatorcontrib><title>Impact of Dialysis Requirement in Community-acquired Pneumonia Hospitalizations</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><description>Background Community-acquired pneumonia (CAP) is a common cause of hospitalization. While there are single-center studies on acute kidney injury requiring dialysis (AKI-D) and CAP, data on national trends and outcomes regarding AKI-D in CAP hospitalizations is lacking. Methods We utilized the Nationwide Inpatient Sample to analyze trends overall and within subgroups. We also utilized multivariate regression to adjust for potential confounders of annual trends and to generate adjusted odds ratios (aOR) for predictors and outcomes, including mortality and adverse discharge. Results There were 11,500,456 pneumonia hospitalizations between 2002 and 2013, of which 3675 (0.3%) were complicated by AKI-D. The AKI-D rate increased from 2.7/1000 hospitalizations in 2002 to 4.3/1000 hospitalizations in 2013. The rate of increase was higher in males and African Americans. Although temporal changes in demographics and comorbidities explained a substantial proportion, they could not explain the entire trend. The predictor with the highest odds of AKI-D required mechanical ventilation during hospitalization (aOR 12.47; 95% CI 11.66-13.34). Other significant predictors included sepsis (aOR 4.37; 95% CI 4.09-4.66), heart failure (aOR 2.40; 95% CI 2.25-2.55), and chronic kidney disease (CKD) (aOR 2.00; 95% CI 1.86-2.16). AKI-D was associated with increased in-hospital mortality (aOR 3.08; 95% CI 2.88-3.30) and adverse discharge (aOR 2.09; 95% CI 1.92-2.26). Although adjusted mortality decreased per year, attributable mortality remained stable. Conclusion Pneumonia hospitalizations complicated by AKI-D have increased with a differential increase by demographic groups. AKI-D is associated with significant morbidity and mortality. In the absence of effective AKI-D therapies, the focus should be on early risk stratification and prevention to avoid this devastating complication.</description><subject>Chronic illnesses</subject><subject>Codes</subject><subject>Diagnosis related groups</subject><subject>Disease</subject><subject>DRGs</subject><subject>Epidemiology</subject><subject>Health care policy</subject><subject>Hemodialysis</subject><subject>Hospitals</subject><subject>Internal medicine</subject><subject>Laboratories</subject><subject>Medicine</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Nephrology</subject><subject>Nursing</subject><subject>Patients</subject><subject>Pneumonia</subject><subject>Public health</subject><subject>Pulmonology</subject><subject>Sepsis</subject><subject>Trends</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkV1LwzAUhoMoOuauvJeCN4JU89E0yY0g82OCMJHdhzRNNdImW9II89fbORX16hw4Dy_v4QHgCMFzxqi40CmYFM8JKosdMMKo5DlHvNj9tR-ASYyvEEIEGYYM7oMDAgllEJERmN93S6X7zDfZtVXtOtqYPZlVssF0xvWZddnUd11ytl_nSn8e6uzRmdR5Z1U283Fpe9Xad9Vb7-Ih2GtUG83ka47B4vZmMZ3lD_O7--nVQ66xYH1e81qZCuOGQF1qwZuCYc4NEpTSggtVYFZWRtCCwpowVpJGYFghpUVV16ggY3C5jV2mqjO1HqoG1cplsJ0Ka-mVlX8vzr7IZ_8mSyQYhWQIOP0KCH6VTOxlZ6M2bauc8SlKjDDFgsJP9OQf-upTcMN3G4pRUjLOBupsS-ngYwym-SmDoNyokltVcqNqoI9_9_9hv8WQDzlSkR4</recordid><startdate>20180820</startdate><enddate>20180820</enddate><creator>Mansuri, Uvesh</creator><creator>Patel, Achint A</creator><creator>Dave, Mihir</creator><creator>Chauhan, Kinsuk</creator><creator>Shah, Aakashi S</creator><creator>Banala, Ramyasree</creator><creator>Ali, David</creator><creator>Kamal, Saad</creator><creator>Verma, Pooja</creator><creator>Ahmed, Shamim</creator><creator>Maiyani, Prakash</creator><creator>Pathak, Ambarish C</creator><creator>Rahman, Shajoti</creator><creator>Savani, Sejal</creator><creator>Pandya, Surta</creator><creator>Nadkarni, Girish</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180820</creationdate><title>Impact of Dialysis Requirement in Community-acquired Pneumonia Hospitalizations</title><author>Mansuri, Uvesh ; Patel, Achint A ; Dave, Mihir ; Chauhan, Kinsuk ; Shah, Aakashi S ; Banala, Ramyasree ; Ali, David ; Kamal, Saad ; Verma, Pooja ; Ahmed, Shamim ; Maiyani, Prakash ; Pathak, Ambarish C ; Rahman, Shajoti ; Savani, Sejal ; Pandya, Surta ; Nadkarni, Girish</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c297t-d8daeb22f30c6c98f47288e19555489a4276be95450d37763f920b1ac9bdd143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Chronic illnesses</topic><topic>Codes</topic><topic>Diagnosis related groups</topic><topic>Disease</topic><topic>DRGs</topic><topic>Epidemiology</topic><topic>Health care policy</topic><topic>Hemodialysis</topic><topic>Hospitals</topic><topic>Internal medicine</topic><topic>Laboratories</topic><topic>Medicine</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Nephrology</topic><topic>Nursing</topic><topic>Patients</topic><topic>Pneumonia</topic><topic>Public health</topic><topic>Pulmonology</topic><topic>Sepsis</topic><topic>Trends</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mansuri, Uvesh</creatorcontrib><creatorcontrib>Patel, Achint A</creatorcontrib><creatorcontrib>Dave, Mihir</creatorcontrib><creatorcontrib>Chauhan, Kinsuk</creatorcontrib><creatorcontrib>Shah, Aakashi S</creatorcontrib><creatorcontrib>Banala, Ramyasree</creatorcontrib><creatorcontrib>Ali, David</creatorcontrib><creatorcontrib>Kamal, Saad</creatorcontrib><creatorcontrib>Verma, Pooja</creatorcontrib><creatorcontrib>Ahmed, Shamim</creatorcontrib><creatorcontrib>Maiyani, Prakash</creatorcontrib><creatorcontrib>Pathak, Ambarish C</creatorcontrib><creatorcontrib>Rahman, Shajoti</creatorcontrib><creatorcontrib>Savani, Sejal</creatorcontrib><creatorcontrib>Pandya, Surta</creatorcontrib><creatorcontrib>Nadkarni, Girish</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Curēus (Palo Alto, CA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mansuri, Uvesh</au><au>Patel, Achint A</au><au>Dave, Mihir</au><au>Chauhan, Kinsuk</au><au>Shah, Aakashi S</au><au>Banala, Ramyasree</au><au>Ali, David</au><au>Kamal, Saad</au><au>Verma, Pooja</au><au>Ahmed, Shamim</au><au>Maiyani, Prakash</au><au>Pathak, Ambarish C</au><au>Rahman, Shajoti</au><au>Savani, Sejal</au><au>Pandya, Surta</au><au>Nadkarni, Girish</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Dialysis Requirement in Community-acquired Pneumonia Hospitalizations</atitle><jtitle>Curēus (Palo Alto, CA)</jtitle><addtitle>Cureus</addtitle><date>2018-08-20</date><risdate>2018</risdate><volume>10</volume><issue>8</issue><spage>e3164</spage><epage>e3164</epage><pages>e3164-e3164</pages><issn>2168-8184</issn><eissn>2168-8184</eissn><abstract>Background Community-acquired pneumonia (CAP) is a common cause of hospitalization. While there are single-center studies on acute kidney injury requiring dialysis (AKI-D) and CAP, data on national trends and outcomes regarding AKI-D in CAP hospitalizations is lacking. Methods We utilized the Nationwide Inpatient Sample to analyze trends overall and within subgroups. We also utilized multivariate regression to adjust for potential confounders of annual trends and to generate adjusted odds ratios (aOR) for predictors and outcomes, including mortality and adverse discharge. Results There were 11,500,456 pneumonia hospitalizations between 2002 and 2013, of which 3675 (0.3%) were complicated by AKI-D. The AKI-D rate increased from 2.7/1000 hospitalizations in 2002 to 4.3/1000 hospitalizations in 2013. The rate of increase was higher in males and African Americans. Although temporal changes in demographics and comorbidities explained a substantial proportion, they could not explain the entire trend. The predictor with the highest odds of AKI-D required mechanical ventilation during hospitalization (aOR 12.47; 95% CI 11.66-13.34). Other significant predictors included sepsis (aOR 4.37; 95% CI 4.09-4.66), heart failure (aOR 2.40; 95% CI 2.25-2.55), and chronic kidney disease (CKD) (aOR 2.00; 95% CI 1.86-2.16). AKI-D was associated with increased in-hospital mortality (aOR 3.08; 95% CI 2.88-3.30) and adverse discharge (aOR 2.09; 95% CI 1.92-2.26). Although adjusted mortality decreased per year, attributable mortality remained stable. Conclusion Pneumonia hospitalizations complicated by AKI-D have increased with a differential increase by demographic groups. AKI-D is associated with significant morbidity and mortality. In the absence of effective AKI-D therapies, the focus should be on early risk stratification and prevention to avoid this devastating complication.</abstract><cop>United States</cop><pub>Cureus Inc</pub><pmid>30357013</pmid><doi>10.7759/cureus.3164</doi><oa>free_for_read</oa></addata></record> |
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subjects | Chronic illnesses Codes Diagnosis related groups Disease DRGs Epidemiology Health care policy Hemodialysis Hospitals Internal medicine Laboratories Medicine Morbidity Mortality Nephrology Nursing Patients Pneumonia Public health Pulmonology Sepsis Trends |
title | Impact of Dialysis Requirement in Community-acquired Pneumonia Hospitalizations |
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