Guobin Su1, Yanjun Xu2, Xiaojun Xu2, Hong Xu3, Liming Lu4, Gaetano Marrone5, Bengt Lindholm6, Zehuai Wen4, Xusheng Liu7, David W Johnson8, Juan-Jesus Carrero3, Cecilia Stålsby Lundborg5. 1. Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong Province, China. 2. Institute of chronic non-communicable disease, Center for Disease Control and Prevention of Guangdong Province, China. 3. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. 4. Key Unit of Methodology in Clinical Research (KUMCR), Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong Province, China. 5. Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 6. Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. 7. Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong Province, China. Electronic address: xushengliu801@126.com. 8. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
Abstract
BACKGROUND: Infection is one of the main reasons for hospitalization worldwide, and is associated with an increased risk of cardiovascular mortality. It is unclear whether this association is modified by the presence of reduced renal function. The aim of this study was to analyze the relationship between estimated glomerular filtration rate (eGFR) and cardiovascular mortality in patients hospitalized with infection. METHODS: This cohort study included all adult, incident patients who were hospitalized at one of four hospitals in China between 2012 and 2015, had a discharge diagnosis of infection, and had a serum creatinine measurement at admission. Patients receiving renal replacement therapy were excluded. Hospital data were linked to death registry data. All-cause and cardiovascular mortality were evaluated according to admission eGFR [≥60 (reference), 30-59 and < 30 mL/min/1.73m2] using multivariable Cox regression and competing risk analyses. RESULTS: During a median follow-up period of 2.39 years, 40,524 patients were hospitalized with infection (mean age 61 years, 54.3% female 18.4% diabetic). Of these, 4781 died. Lower admission eGFR was associated with progressively increased risks of cardiovascular mortality (≥60 mL/min/1.73m2 reference; 30-59 mL/min/1.73m2 subdistribution hazard ratio [SHR] 2.15, 95% CI 1.85-2.50, P< .01; <30 mL/min/1.73m2 SHR 3.19, 95% CI 2.68-3.80, P < .01). The proportion of deaths due to cardiovascular disease increased as the eGFR decreased, predominantly due to ischemic heart disease. CONCLUSIONS: Patients hospitalized with infections and reduced renal function have significantly increased risks of cardiovascular mortality. Heart status should be carefully monitored following infections, especially for those with reduced renal function.
BACKGROUND:Infection is one of the main reasons for hospitalization worldwide, and is associated with an increased risk of cardiovascular mortality. It is unclear whether this association is modified by the presence of reduced renal function. The aim of this study was to analyze the relationship between estimated glomerular filtration rate (eGFR) and cardiovascular mortality in patients hospitalized with infection. METHODS: This cohort study included all adult, incident patients who were hospitalized at one of four hospitals in China between 2012 and 2015, had a discharge diagnosis of infection, and had a serum creatinine measurement at admission. Patients receiving renal replacement therapy were excluded. Hospital data were linked to death registry data. All-cause and cardiovascular mortality were evaluated according to admission eGFR [≥60 (reference), 30-59 and < 30 mL/min/1.73m2] using multivariable Cox regression and competing risk analyses. RESULTS: During a median follow-up period of 2.39 years, 40,524 patients were hospitalized with infection (mean age 61 years, 54.3% female 18.4% diabetic). Of these, 4781 died. Lower admission eGFR was associated with progressively increased risks of cardiovascular mortality (≥60 mL/min/1.73m2 reference; 30-59 mL/min/1.73m2 subdistribution hazard ratio [SHR] 2.15, 95% CI 1.85-2.50, P< .01; <30 mL/min/1.73m2 SHR 3.19, 95% CI 2.68-3.80, P < .01). The proportion of deaths due to cardiovascular disease increased as the eGFR decreased, predominantly due to ischemic heart disease. CONCLUSIONS:Patients hospitalized with infections and reduced renal function have significantly increased risks of cardiovascular mortality. Heart status should be carefully monitored following infections, especially for those with reduced renal function.
Authors: Vincenzo Livio Malavasi; Anna Chiara Valenti; Sara Ruggerini; Marcella Manicardi; Carlotta Orlandi; Daria Sgreccia; Marco Vitolo; Marco Proietti; Gregory Y H Lip; Giuseppe Boriani Journal: J Clin Med Date: 2022-02-08 Impact factor: 4.241