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Impact of renal dysfunction on in-hospital mortality of patients with severe chronic obstructive pulmonary disease: a single-center Italian study

  • Nephrology - Original Paper
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Abstract

Background

We conducted a study, based on discharge hospital sheets [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)], in order to evaluate the relationship between chronic kidney disease (CKD), acute kidney injury (AKI), multi-morbidity, and in-hospital mortality (IHM).

Methods

This study included all hospital admissions for chronic obstructive pulmonary disease (COPD) exacerbations between January 1, 2000, and December 31, 2013, recorded in the database of the University Hospital St. Anna of Ferrara. Age, sex, and diagnosis of CKD and AKI were collected, and Charlson comorbidity index (CCI) was calculated by ICD-9-CM codes. IHM was our main outcome.

Results

We analyzed 7073 subjects with COPD exacerbation; they were more frequently male (56.9 vs 43.1 %), and mean age was 76.7 ± 9.8 years. Diagnosis of CKD was present in 771 patients (10.9 %), while AKI was diagnosed in 354 cases (5 %). A total of 554 patients (7.8 %) died during hospitalization, and LOS was 10.3 ± 11.2 days (median 8 days); the CCI corrected for CKD was 2.30 ± 1.65. Univariate analysis showed that IHM group had higher age (81.2 ± 7.9 vs 76.3 ± 9.9 years, p < 0.001), CCI (2.61 ± 2.21 vs 2.28 ± 1.62, p = 0.001), and LOS (11.1 ± 15.1 vs 10.3 ± 10.8 days, p = 0.001) and developed AKI more frequently (16.6 vs 4 %, p < 0.001) than survivors. Multivariate logistic regression analysis showed an independent association of IHM with age (OR 1.063; 95 % CI 1.050–1.075, p < 0.001), male sex (OR 1.229; 95 % CI 1.016–1.486, p = 0.033), logCCI (OR 2.051; 95 % CI 1.419–2.964, p < 0.001), and AKI (OR 3.849; 95 % CI 2.874–5.155, p < 0.001).

Conclusions

Acute kidney injury (AKI) represents a very important predictive factor of IHM in male older adult with multi-morbidity admitted because of COPD exacerbations.

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Acknowledgments

We thank Franco Guerzoni and Nicola Napoli, Center for Health Statistics, Hospital of Ferrara, for their precious and valuable collaboration. This work has been supported, in part, by a research grant from the University of Ferrara Fondo Ateneo Ricerca—FAR).

Author contribution

FF had the primary idea and wrote the manuscript, ADG, FM, NL, SF, and AS researched and analyzed data and contributed to the discussion, and MG, GC, and RM contributed to the discussion and reviewed/edited the manuscript.

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Authors and Affiliations

  1. Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Via L. Ariosto 35, 44121, Ferrara, Italy

    Fabio Fabbian, Alfredo De Giorgi & Roberto Manfredini

  2. Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Via L. Ariosto 35, 44121, Ferrara, Italy

    Fabio Manfredini & Nicola Lamberti

  3. Department of Specialized Medicine, Nephrology Unit, University Hospital of Ferrara, Via A. Moro 8, 44124, Ferrara, Italy

    Silvia Forcellini & Alda Storari

  4. Department of Internal Medicine, University Hospital of Ferrara, Via A. Moro 8, 44124, Ferrara, Italy

    Massimo Gallerani

  5. Department of Medical Sciences, Cardiorespiratory Unit, School of Medicine, University of Ferrara, Via L. Ariosto 35, 44121, Ferrara, Italy

    Gaetano Caramori

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  1. Fabio Fabbian
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  2. Alfredo De Giorgi
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  3. Fabio Manfredini
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Corresponding author

Correspondence to Fabio Fabbian.

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Conflict of interest

F. Fabbian, A. De Giorgi, F. Manfredini, N. Lamberti, S. Forcellini, A. Storari, M. Gallerani, G. Caramori, and R. Manfredini had no conflict of interest. Authors declare that there are not any potential conflicts of interests that are directly or indirectly related to the data presented in the paper.

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Fabbian, F., De Giorgi, A., Manfredini, F. et al. Impact of renal dysfunction on in-hospital mortality of patients with severe chronic obstructive pulmonary disease: a single-center Italian study. Int Urol Nephrol 48, 1121–1127 (2016). https://doi.org/10.1007/s11255-016-1272-5

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