Interaction of Acute Respiratory Failure and Acute Kidney Injury on in-Hospital Mortality of Patients with Acute Exacerbation COPD

Dawei Chen; Linglin Jiang; Jing Li; Yan Tan; Mengqing Ma; Changchun Cao; Jing Zhao; Xin Wan

doi:10.2147/COPD.S334219

Interaction of Acute Respiratory Failure and Acute Kidney Injury on in-Hospital Mortality of Patients with Acute Exacerbation COPD

Int J Chron Obstruct Pulmon Dis. 2021 Dec 7:16:3309-3316. doi: 10.2147/COPD.S334219. eCollection 2021.

Authors

Dawei Chen¹, Linglin Jiang¹, Jing Li², Yan Tan³, Mengqing Ma⁴, Changchun Cao⁴, Jing Zhao¹, Xin Wan¹

Affiliations

¹ Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
² Department of Nephrology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China.
³ Department of Respiratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
⁴ Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.

Abstract

Purpose: Both acute respiratory failure (ARF) and acute kidney injury (AKI) are two common complications in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Moreover, both ARF and AKI are reported as increasing the risk of mortality of patients with AECOPD. However, the interaction of ARF and AKI on the mortality of patients with AECOPD remains unknown. Therefore, the aim of this study is to investigate the joint effect of ARF and AKI on in-hospital mortality in AECOPD patients.

Patients and methods: We performed a retrospective, observational cohort study of data from Nanjing First Hospital. The effect of AKI and ARF on in-hospital mortality was assessed using a multivariate logistic regression model. Additive interaction was assessed with the relative excess risk due to interaction.

Results: A total of 1647 participants were enrolled. ARF and AKI occurred in 515 (31.3%) and 357 (21.7%) patients, respectively. Overall, in-hospital mortality was 5.7%. The in-hospital mortality of the neither ARF nor AKI group, the ARF only group, the AKI only group, and both the ARF and AKI group were 0.8%, 7.0%, 7.5%, and 29.9%, respectively. After multivariate logistic regression analysis, the independent factors for in-hospital death included: albumin (OR 0.88, 95% CI 0.83-0.93, P < 0.001), ARF only (OR 8.53, 95% CI 3.64-19.99, P < 0.001), AKI only (OR 8.99, 95% CI 3.58-22.55, P < 0.001), and both ARF and AKI (OR 39.13, 95% CI 17.02-89.97, P < 0.001). The relative excess risk due to interaction was 22.62 (95% CI, 0.31 to 44.93), the attributable proportion due to interaction was 0.59 (95% CI, 0.36 to 0.79), and the synergy index was 2.46 (95% CI, 1.44 to 4.20), indicating ARF and AKI had a significant synergic effect on in-hospital mortality.

Conclusion: ARF and AKI had a synergistic effect on in-hospital mortality in AECOPD patients.

Keywords: acute exacerbation chronic obstructive pulmonary disease; acute kidney injury; acute respiratory failure; in-hospital mortality.

Publication types

Observational Study

MeSH terms

Acute Kidney Injury* / diagnosis
Hospital Mortality
Humans
Pulmonary Disease, Chronic Obstructive* / complications
Pulmonary Disease, Chronic Obstructive* / diagnosis
Respiratory Insufficiency* / complications
Respiratory Insufficiency* / diagnosis
Retrospective Studies
Risk Factors

Grants and funding

There is no funding to report.