Clinical characteristics and risk factors of infection-related hospitalization in maintenance hemodialysis patients / 中华肾脏病杂志

ABSTRACT

Objective:To explore the clinical characteristics and risk factors of maintenance hemodialysis (MHD) patients combined with infection-related hospitalization.Methods:Patients with MHD from December 1, 2013 to February 28, 2018 were retrospectively selected and then followed up for at least 1 year until February 28, 2019. Baseline data including demographic and clinical data of patients were collected. According to whether the infection-related hospitalization occurred, patients were divided into infection group and non-infection group. The clinical characteristics and related factors were compared between the two groups. Logistic regression model was used to analyze the influencing factors.Results:A total of 392 patients were included in the study. Two hundred and fifty-five cases were males, accounting for 65.1%. The age was (59.39±15.28) years old. The infection rate of diabetic kidney disease patients was the highest (32.2%). The main site of infection was the lung, accounting for 78.4%, which was far higher than the catheter-related infection in the second position. After infection, quinolones and cephalosporins were often the preferred drugs. Compared with the non-infection group, the infection group had older age [(62.96±15.16) years vs (57.98±15.12) years, t=-2.607, P=0.004], higher proportion of comorbid diabetes (45.9% vs 32.4%, χ2=6.334, P=0.012) and previous smoking history (30.6% vs 18.5%, χ2=6.831, P=0.009), longer time of first dialysis stay [13.0(9.0, 18.0) d vs 12.0(9.0, 17.5) d, Z=3.659, P=0.001] and lower hemoglobin [(74.43±19.93) g/L vs (79.06±17.10) g/L, t=1.612, P=0.022], albumin [(32.63±5.33) g/L vs (33.99±6.14) g/L, t=2.062, P=0.029] and red blood cell count [2.53×10 12/L (2.06×10 12/L, 3.06×10 12/L) vs 2.68×10 12/L(2.28×10 12/L, 3.07×10 12/L), Z=2.118, P=0.034]. Multivariate logistic analysis found that older age (every 1 year, OR=1.016, 95% CI 1.003-1.030, P=0.017) and longer hospital stay at first dialysis (every 1 d, OR=1.047, 95% CI 1.014-1.080, P=0.008) were independent risk factors, and higher hemoglobin (every 1 g/L, OR=0.987, 95% CI 0.975-0.999, P=0.033) was a protective factor for infection-related hospitalization in MHD patients. Conclusions:MHD patients with diabetic kidney disease have the highest infection incidence. The incidence of pulmonary infection is much higher than other types of infection such as catheter-related infection, urinary tract infection and sepsis. Aging and low hemoglobin are risk factors for MHD patients to prone to co-infection.