Clinical characteristics of acute kidney injury in elderly patients with dengue fever

doi:10.20199/j.issn.1672-2302.2024.04.005

Abstract

Abstract:

Objective To investigate the clinical characteristics and risk factors for elderly patients with dengue fever complicated with acute kidney injury (AKI) for reference for clinical diagnosis and treatment of the elderly patients with dengue fever. Methods Elderly patients with dengue fever treated in Guangzhou Eighth People's Hospital, Guangzhou Medical University, were included from January 2013 to December 2019, and compared for the clinical characteristics of patients in AKI group and non-AKI group. Multivariate logistic regression model was used to analyze the influencing factors for dengue fever complicated with AKI. Results A total of 423 elderly patients with dengue fever were included, of whom 30 (7.09%) were complicated with AKI. The age of the patients in the AKI and non AKI group was 76 (68, 82) years, and 69 (63, 77) years, respectively. The difference was significant (Z=3.100, P<0.05). The scoring on Chalson's comorbidity index (CCI) less than 3 accounted for 19 cases in the AKI group (63.33%) and 334 cases in the non-AKI group (84.99%), with statistical significance (χ²=7.709, P<0.05). In laboratory indicators, there were statistical significance in blood potassium levels [3.46 (3.11, 3.79) mmol/L vs. 3.28 (2.98, 3.58) mmol/L], C-reactive protein levels [6.35 (3.78, 28.17) mg/L vs. 2.50 (0.88, 5.93) mg/L], and hematocrit [37.40 (33.58, 41.00)% vs. 39.70 (36.60, 42.45)%] between the AKI group and the non AKI group (Z=2.038, 3.866, -2.186, respectively, all P<0.05). The distribution of severe cases in the AKI and non-AKI groups [(15 cases, 50.00%) vs. (21 cases, 5.34%)] and the duration of hospitalization [7.5 (5,10) days vs. 5 (4,7) days] exhibited significant differences (χ²=65.765, Z=-3.802, P<0.05). Multivariate logistic regression analysis revealed that the age [OR=1.068, 95% CI: (1.020, 1.119)], C-reactive protein levels [OR=1.014, 95% CI: (1.004, 1.025)], and CCI score ≥3 points [OR=2.672, 95% CI: (1.176, 6.069)] were independent risk factors for elderly dengue fever patients complicated with AKI. Conclusion Elderly dengue fever patients have a high incidence of AKI, which may lead to poor prognosis. The risks of developing AKI can be added in the patients who are older, have elevated CRP levels, and higher CCI scores. Our findings suggest that early detection and active prevention of AKI in elderly dengue fever patients are important in clinical practice to improve the prognosis.

Key words: Dengue fever, Acute kidney injury, Elderly patient, Clinical characteristics, Risk factors

CLC Number:

R512.8

WANG Changtai, YANG Huiqin, JIN Kanghong, LENG Xingyu, ZHANG Zhenhua, ZHANG Fuchun. Clinical characteristics of acute kidney injury in elderly patients with dengue fever[J]. Journal of Tropical Diseases and Parasitology, 2024, 22(4): 212-216.

Figures/Tables 3

Table 1

Comparison of clinical characteristics of elderly patients with and without AKI associated with dengue fever

特征	AKI组（n=30）	非AKI组（n=393）	Z/χ²值	P值
性别[n（%）]			2.394	>0.05
男	21（70.00）	218（55.47）
女	9（30.00）	175（44.53）
年龄（岁）[M（Q₁, Q₃）]	76（68, 82）	69（63, 77）	3.100	<0.05
发病到入院天数（d） [M（Q₁, Q₃）]	5（3, 6）	5（3, 6）	1.754	>0.05
基础疾病 [n（%）]
高血压	18（60.00）	180（45.80）	2.257	>0.05
糖尿病	3（10.00）	60（15.27）		>0.05*
慢性肺部疾病	3（10.00）	25（6.36）		>0.05*
自身免疫性疾病	1（3.33）	5（1.27）		>0.05*
恶性肿瘤	0（0.00）	7（1.78）		>0.05*
HBV/HCV	2（6.67）	18（4.58）		>0.05*
CCI评分（分）[n（%）]			7.709	<0.05
<3	19（63.33）	334（84.99）
≥3	11（36.67）	59（15.01）
实验室指标 [M（Q₁, Q₃）]
白细胞计数（×10⁹/L）	3.67（2.88, 6.57）	3.45（2.45, 5.12）	1.209	>0.05
血红蛋白（g/L）	127.00（115.50, 139.75）	134.00（124.00, 143.00）	-1.879	>0.05
血细胞比容（%）	37.40（33.58, 41.00）	39.70（36.60, 42.45）	-2.186	<0.05
血小板计数（×10⁹/L）	30.00（17.00, 87.00）	47.00（30.00, 77.00）	-1.906	>0.05
丙氨酸氨基转移酶（U/L）	42.00（32.00, 87.25）	42.00（28.00, 66.00）	0.876	>0.05
天冬氨酸氨基转移酶（U/L）	80.50（47.25, 121.75）	72.00（48.50, 107.50）	0.802	>0.05
血清白蛋白（g/L）	34.00（32.50, 36.00）	35.00（33.00, 37.00）	-1.333	>0.05
肌酸激酶（U/L）	255.50（156.00, 628.00）	217.75（130.25, 373.25）	1.300	>0.05
血钠（mmol/L）	136.75（133.50, 139.30）	136.50（134.40, 138.90）	-0.028	>0.05
血钾（mmol/L）	3.46（3.11, 3.79）	3.28（2.98, 3.58）	2.038	<0.05
乳酸脱氢酶（U/L）	457.00（353.25, 743.75）	404.50（305.00, 621.50）	1.598	>0.05
C反应蛋白（mg/L）	6.35（3.78, 28.17）	2.50（0.88, 5.93）	3.866	<0.05

Table 1

Table 2

Table 3

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指标	AKI组（n=30）	非AKI组（n=393）	χ²值	P值
重症登革热			65.765	<0.05
是	15（50.00）	21（5.34）
否	15（50.00）	372（94.66）
入住重症监护室				<0.05*
是	4（13.33）	0（0）
否	26（86.67）	393（100.00）
接受肾脏替代治疗				>0.05*
是	1（3.33）	0（0）
否	29（96.67）	393（100.00）
死亡				<0.05*
是	2（6.67）	0（0）
否	28（93.33）	393（100.00）

因素	β值	SE值	Wald χ²值	OR值	95% CI	P值
年龄	0.066	0.024	7.709	1.068	1.020，1.119	0.005
C反应蛋白	0.010	0.005	7.000	1.014	1.004，1.025	0.008
CCI<3分				1.000
CCI≥3分	0.983	0.419	5.514	2.672	1.176，6.069	0.019