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Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol
Published on: July 28, 2018
Increased thoracic fluid content is associated with higher risk for pneumonia in patients undergoing maintenance
Lijuan Yan1,2, Yumei Qiu1, Jin Liu1
1Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, China.
Background:
Pneumonia is the most common infectious disease in patients undergoing maintenance hemodialysis (MHD). The aim of this study is to determine the possible predictive value of thoracic fluid content (TFC) for pneumonia in this population.
Method:
Clinical data were recorded for 1412 MHD patients who were hospitalized for certain comorbidities or complications. Each patient underwent an impedance cardiography (ICG) examination before next dialysis session after admission. Patients were divided into Having-, Will-have-, and Non-pneumonia groups based on whether they had pneumonia at the time of ICG examination after the admission and within five months after the examination. Hemodynamic parameters and other clinical data were compared and analyzed.
Results:
Patients who were going to develop pneumonia were older, and had a higher proportion of diabetes, poorer nutritional status, a higher level of inflammatory, poorer cardiac function, and more fluid volume load than those who did not develop pneumonia. Multivariate binary logistic analysis revealed that for each 1/KΩ increase in TFC and 1 increase in neutrophil-to-lymphocyte ratio (NLR), the risk of the development of pneumonia increased by 3.1% (p ˂ 0.01) and 7.2% (p = 0.035), respectively, whereas for each 1 g/L increase in hemoglobin and 1 g/L increase in serum albumin, the risk of the development of pneumonia decreased by 1.3% (p = 0.034) and 5% (p = 0.048), respectively.
Conclusions:
TFC, NLR, hemoglobin, and serum albumin were independent risk factors for the development of pneumonia in MHD patients. Given the advantages of ICG, TFC can be used clinically as a helpful predictor of pneumonia in MHD patients.
Insights
Thoracic fluid content (TFC), measured by impedance cardiography, can predict pneumonia in maintenance hemodialysis (MHD) patients. Higher TFC and neutrophil-to-lymphocyte ratio (NLR) increase pneumonia risk, while hemoglobin and albumin levels decrease it.
Area of Science:
- Nephrology
- Pulmonology
- Medical Diagnostics
Background:
- Pneumonia is the most frequent infection in maintenance hemodialysis (MHD) patients.
- Identifying predictive markers for pneumonia in MHD patients is crucial for early intervention.
Purpose of the Study:
- To evaluate the predictive value of thoracic fluid content (TFC) for pneumonia development in MHD patients.
- To identify clinical and biochemical factors associated with pneumonia risk in this population.
Main Methods:
- A cohort of 1412 MHD patients hospitalized for comorbidities was studied.
- Impedance cardiography (ICG) was used to measure TFC and other hemodynamic parameters.
- Patients were categorized into Having-, Will-have-, and Non-pneumonia groups based on pneumonia occurrence.
Main Results:
- Increased TFC and neutrophil-to-lymphocyte ratio (NLR) were significantly associated with a higher risk of pneumonia development.
- Higher levels of hemoglobin and serum albumin were independently associated with a reduced risk of pneumonia.
- Older age, diabetes, poorer nutritional status, and impaired cardiac function were also linked to increased pneumonia risk.
Conclusions:
- TFC, NLR, hemoglobin, and serum albumin are independent risk factors for pneumonia in MHD patients.
- ICG-derived TFC offers a valuable, non-invasive tool for predicting pneumonia in MHD patients.
- Clinical application of TFC measurement can aid in proactive pneumonia management for MHD patients.
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