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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Article info
Publication history
Published online: June 27, 2018
Accepted:
June 20,
2018
Received in revised form:
June 11,
2018
Received:
January 5,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
