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

Abstract

Dawei Chen,1 Linglin Jiang,1 Jing Li,2 Yan Tan,3 Mengqing Ma,4 Changchun Cao,4 Jing Zhao,1 Xin Wan1 1Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 2Department of Nephrology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China; 3Department of Respiratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 4Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of ChinaCorrespondence: Xin WanDepartment of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of ChinaEmail wanxin@njmu.edu.cnPurpose: 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 respiratory failure, acute kidney injury, in-hospital mortality, acute exacerbation chronic obstructive pulmonary disease