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Association between reduced renal function and cardiovascular mortality in patients hospitalized with infection: A multi-center cohort study

  • Guobin Su
    Affiliations
    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
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  • Yanjun Xu
    Affiliations
    Institute of chronic non-communicable disease, Center for Disease Control and Prevention of Guangdong Province, China
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  • Xiaojun Xu
    Affiliations
    Institute of chronic non-communicable disease, Center for Disease Control and Prevention of Guangdong Province, China
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  • Hong Xu
    Affiliations
    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
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  • Liming Lu
    Affiliations
    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
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  • Gaetano Marrone
    Affiliations
    Global Health – Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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  • Bengt Lindholm
    Affiliations
    Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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  • Zehuai Wen
    Affiliations
    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
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  • Xusheng Liu
    Correspondence
    Corresponding author.
    Affiliations
    Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong Province, China
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  • David W. Johnson
    Affiliations
    Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia

    Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia

    Translational Research Institute, Brisbane, Australia
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  • Juan-Jesus Carrero
    Affiliations
    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
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  • Cecilia Stålsby Lundborg
    Affiliations
    Global Health – Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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      Highlights

      • Infections increase cardiovascular mortality in patients with reduced eGFR.
      • Cardiovascular death after infections are predominantly due to ischemic heart disease.
      • Heart status should be monitored following infections, especially for those with reduced eGFR.

      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.

      Keywords

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