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Abstract: FR-PO259

eGFR in the Emergency Department as a Predictor of In-Hospital Mortality in Pneumonia

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Author

  • Liu, Chung-te, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan

Group or Team Name

  • Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University
Background

Pneumonia is a global leading cause of mortality. Severity-assessment scores in pneumonia are crucial for guiding the treatment. Community-based studies have demonstrated the association between pre-existing low estimated glomerular filtration rate (eGFR) and outcomes in pneumonia. However, whether a single eGFR measurement in the emergency department can predict in-hospital mortality in pneumonia remains to be investigated.

Methods

This hospital-based, retrospective cohort study was conducted at Wan Fang Hospital and included 1554 patients hospitalized with pneumonia between January 2013 and December 2015. Patients under 20 years of age were excluded. The main predictor was eGFR in the emergency department calculated according to the equation suggested by Chronic Kidney Disease Epidemiology Collaboration. The outcomes included in-hospital mortality, intensive care unit (ICU) admission, need for ventilator, durations of hospital and ICU stay, and ventilator use. Receiver operating characteristic (ROC) curve and Youden criteria for determining the optimal cut-off value of eGFR to predict in-hospital mortality were used and confirmed using a multivariate logistic regression model.

Results

Of 1554 patients, 263 (16.9%) had chronic kidney disease (CKD) and demonstrated higher C-reactive protein (CRP) levels and SMART-COP score and more events of multilobar pneumonia, acute kidney injury, ICU admission, and in-hospital mortality. Patients with higher pneumonia severity scores tended to have lower eGFR. eGFR of 55.89 mL/min/1.73m2 was the optimal cut-off value for predicting in-hospital mortality. Multivariate logistic regression analysis adjusted for sex, co-morbidities, CRP, liver function tests, and SMART-COP score demonstrated that eGFR <55.89 mL/min/1.73m2 had odds ratio of 3.2 (95% confidence interval: 2.3–4.4) for in-hospital mortality.

Conclusion

Low eGFR in the emergency department is associated with higher pneumonia severity. eGFR <55.89 mL/min/1.73m2 is an independent predictor of in-hospital mortality in patients hospitalized with pneumonia.