Estimated Glomerular Filtration Rate in the Emergency Department Predicts Mortality During Hospitalisation for Pneumonia

October 31, 2018

By Brian Hoyle

SAN DIEGO -- October 30, 2018 -- Patients with pneumonia who present at the emergency department with an estimated glomerular filtration rate (eGFR) under 55.89 mL/min/1.73 m2 are likely to have more severe pneumonia, and are at greater risk of dying during their hospitalisation, according to results of a hospital-based, retrospective cohort study presented here on October 26 at Kidney Week 2018, the Annual Meeting of the American Society of Nephrology.

Chung-Te Liu, MD, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan and colleagues included adults (age 20 and older) who were hospitalised with pneumonia at their institution between January 2013 and December 2015. The major outcome of the study was in-hospital mortality, with the main predictor being eGFR in the emergency department.

Of 1,554 patients treated, 263 (16.9%) had chronic kidney disease (CKD). The patients with CKD had more severe pneumonia, as assessed using the SMART-COP score, and lower eGFR than patients without CKD (89.4 mL/min/1.73 m2 [range: 63.5 to 124.1 mL/min/1.73 m2] versus 25.7 mL/min/1.73 m2 [range: 5.0 to 40.4 mL/min/1.73 m2]; P

More severe pneumonia was associated with lower eGFR, with a value of 55.89 mL/min/1.73 m2, identified as the optimal cut-off value for predicting in-hospital mortality in a multivariate logistic regression analysis adjusted for sex, co-morbidities, C-reactive protein, and liver-function tests (odds ratio [OR] 2.5; 95% confidence interval [CI]: 1.6 to 4.0; P

Pneumonia severity itself was also a significant risk factor for in-hospital mortality (OR 1.5; 95% CI: 1.3 to 1.7; P

The researchers determined the optimal cut-off value of eGFR that predicted in-hospital mortality using receiver operating characteristic curve and Youden criteria. They performed multivariate logistic regression to confirm the predictive capability of eGFR on in-hospital mortality.

Dr. Liu and colleagues calculated eGFR in the emergency department according to the equation suggested by Chronic Kidney Disease Epidemiology Collaboration.

The 1,291 patients without CKD were distinguished by older age (PPPPPPPP

There were no apparent differences in patients with CKD and without CKD concerning coronary artery disease, chronic obstructive pulmonary disease, albumin level, activities of aspartate aminotransferase, and alanine aminotransferase.

Study limitations include the retrospective design, unspecified causes of death, and lack of data concerning the severity of pneumonia for some patients.

[Presentation title: eGFR in the Emergency Department as a Predictor of In-Hospital Mortality in Pneumonia. Abstract FR-PO259]