Acute kidney injury in non-severe pneumonia is associated with an increased immune response and lower survival

Raghavan Murugan, Vijay Karajala-Subramanyam, Minjae Lee, Sachin Yende, Lan Kong, Melinda Carter, Derek C. Angus, John A. Kellum

Research output: Contribution to journalArticle

200 Citations (Scopus)

Abstract

While sepsis is a leading cause of acute kidney injury in critically ill patients, the relationship between immune response and acute kidney injury in less severely ill patients with infection is not known. Here we studied the epidemiology, 1-year mortality, and immune response associated with acute kidney injury in 1836 hospitalized patients with community-acquired severe and non-severe pneumonia. Acute kidney injury developed in 631 patients of whom 329 had severe and 302 had non-severe sepsis. Depending on the subgroup classification, 16-25% of the patients with non-severe pneumonia also developed acute kidney injury. In general, patients with acute kidney injury were older, had more comorbidity, and had higher biomarker concentrations (interleukin-6, tumor necrosis factor, D-dimer) even among patients without severe sepsis. The risk of death associated with acute kidney injury varied when assessed by Gray's survival model and after adjusting for differences in age, gender, ethnicity, and comorbidity. This risk was significantly higher immediately after hospitalization but gradually fell over time in the overall cohort and in those with non-severe pneumonia. A significantly higher risk of death (hazard ratio 1.29) was also present in those never admitted to an intensive care unit. Hence acute kidney injury is common even among patients with non-severe pneumonia and is associated with higher immune response and an increased risk of death.

Original languageEnglish (US)
Pages (from-to)527-535
Number of pages9
JournalKidney International
Volume77
Issue number6
DOIs
StatePublished - Mar 1 2010

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Acute Kidney Injury
Pneumonia
Survival
Sepsis
Comorbidity
Critical Illness
Intensive Care Units
Interleukin-6
Epidemiology
Hospitalization
Tumor Necrosis Factor-alpha
Biomarkers
Mortality
Infection

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Murugan, R., Karajala-Subramanyam, V., Lee, M., Yende, S., Kong, L., Carter, M., ... Kellum, J. A. (2010). Acute kidney injury in non-severe pneumonia is associated with an increased immune response and lower survival. Kidney International, 77(6), 527-535. https://doi.org/10.1038/ki.2009.502
Murugan, Raghavan ; Karajala-Subramanyam, Vijay ; Lee, Minjae ; Yende, Sachin ; Kong, Lan ; Carter, Melinda ; Angus, Derek C. ; Kellum, John A. / Acute kidney injury in non-severe pneumonia is associated with an increased immune response and lower survival. In: Kidney International. 2010 ; Vol. 77, No. 6. pp. 527-535.
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Murugan, R, Karajala-Subramanyam, V, Lee, M, Yende, S, Kong, L, Carter, M, Angus, DC & Kellum, JA 2010, 'Acute kidney injury in non-severe pneumonia is associated with an increased immune response and lower survival', Kidney International, vol. 77, no. 6, pp. 527-535. https://doi.org/10.1038/ki.2009.502

Acute kidney injury in non-severe pneumonia is associated with an increased immune response and lower survival. / Murugan, Raghavan; Karajala-Subramanyam, Vijay; Lee, Minjae; Yende, Sachin; Kong, Lan; Carter, Melinda; Angus, Derek C.; Kellum, John A.

In: Kidney International, Vol. 77, No. 6, 01.03.2010, p. 527-535.

Research output: Contribution to journalArticle

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