Abstract
To assess the association between low serum creatinine (SCr) value at admission and the risk of respiratory failure requiring mechanical ventilation in hospitalized patients. A retrospective cohort study was conducted at a tertiary referral hospital. All hospitalized adult patients from 2011 through 2013 who had an admission SCr value were included in this study. Patients who were mechanically ventilated at the time of admission were excluded. Admission creatinine was stratified into 7 groups: ≤0.4, 0.5–0.6, 0.7–0.8, 0.9–1.0, 1.1–1.2, 1.3–1.4, and ≥1.5 mg/dL. The primary outcome was the occurrence of respiratory failure requiring mechanical ventilation during hospitalization. Logistic regression analysis was used to assess the independent risk of respiratory failure based on various admission SCr, using SCr of 0.7–0.8 mg/dL as the reference group in the analysis of all patients and female subgroup and of 0.9–1.0 mg/dL in analysis of male subgroup. A total of 67,045 eligible patients, with the mean admission SCr of 1.0 ± 0.4 mg/dL, were studied. Of these patients, 799 (1.1%) had admission SCr of ≤0.4 mg/dL, and 2886 (4.3%) developed respiratory failure requiring mechanical ventilation during hospitalization. The U-curve relationship between admission SCr and respiratory failure during hospitalization was observed, with the nadir incidence of in-hospital respiratory failure in SCr of 0.7–0.8 mg/dL and increased in-hospital respiratory failure associated with both reduced and elevated admission SCr. After adjustment for confounders, very low admission SCr of ≤0.4 mg/dL was significantly associated with increased in-hospital respiratory failure (OR 3.11; 95% CI 2.33–4.17), exceeding the risk related to markedly elevated admission SCr of ≥1.5 mg/dL (OR 1.61; 95% CI 1.39–1.85). The association remained significant in the subgroup analysis of male and female patients. Low SCr value at admission is independently associated with increased in-hospital respiratory failure requiring mechanical ventilation in hospitalized patients.
Highlights
Respiratory failure is a serious condition caused by either lung pathology resulting in imbalances in oxygen or carbon dioxide exchanges
Our findings revealed that either serum creatinine (SCr) ≤0.6 mg/dL or ≥1.1 mg/dL at admission was significantly associated with a higher risk of respiratory failure requiring mechanical ventilation
Low SCr at admission ≤0.6 mg/dL in both men and women was significantly associated with a higher risk of respiratory failure requiring mechanical ventilation
Summary
Respiratory failure is a serious condition caused by either lung pathology resulting in imbalances in oxygen or carbon dioxide exchanges. Failure of ventilation is one of the major causes of acute respiratory failure. To improve gas exchange and decrease work of breathing, mechanical ventilation is often needed. Malnutrition, premorbid frailty, and severity of illness (measured by Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score) are associated with a higher need of mechanical ventilation among respiratory failure patients. Even though low SCr is associated with poor nutritional status and decreased muscle mass, low SCr has not been reported in the literature to be a predictor of respiratory failure requiring mechanical ventilation. Our goal is to investigate the association between low SCr at admission and the risk of respiratory failure requiring mechanical ventilation
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