Ckd Increased the Risk of Adverse Outcomes Shortly after an Acute Community-acquired Pneumonia in Very Patients with Stable Coronary Artery Disease

Abstract

Objective The aim of this study was to examine the prognostic value of CKD for the short-term adverse outcomes, which included various cardiovascular events (CVEs) and all-cause mortality, during 90 days after an acute community-acquired pneumonia in very old elderly with stable coronary artery disease (sCAD). Methods A prospective and observational study, collected 514 very old patients (median 87.8 years) hospitalized with acute community-acquired pneumonia and had a history of sCAD, during 2017 Mar to 2019 Jun. The subjects were divided into two groups, normal renal function group and CKD group, based on the plasma creatinin and estimated glomerular filtration rate (eGFR) levels determined by the Chinese-modified MDRD equation. Follow-up was for up to 90 days after the onset of an acute community-acquired pneumonia, the end-points were various cardiovascular events (CVEs) and all -cause death. Results A total of 514 patients were included in the final analysis, and the prevalence of CKD at baseline was 37.9%. During follow-up, 245 patients suffered endpoint events: 177 cases (34.4%) had CVEs and 68 (13.2%) had an all-cause death. The incidences of CVEs and all-cause deaths both were significantly higher in the CKD group than those in normal renal function group(43.1% vs 29.2%,P = 0.001; 17.9% vs 10.3%,P = 0.014). The mortality in very old patients coexisted with stable coronary heart disease and CKD was significantly reduced(Log-rank χ2 = 4.968, P = 0.026). Multivariant analysis showed that CKD independently predicted having the final event. Conclusions Patients coexisted with stable coronary artery disease and CKD are at higher risk of cardiovascular events (CVEs) and all -cause death shortly after acute community-acquired pneumonia. This association was not explained by existing co-morbidities. Increasing provider awareness of CKD as a risk factor for pulmonary infection is needed to reduce infection-related morbidity and mortality. Keywords the elderly pneumonia, chronic kidney disease, cardiovascular event, all cause mortality.