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Predicting the risk of pulmonary infection in patients with chronic kidney failure: A-C2GH2S risk score—a retrospective study

  • Nephrology - Original Paper
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Abstract

Purpose

The objective of this study is to investigate the associated risk factors of pulmonary infection in individuals diagnosed with chronic kidney disease (CKD). The primary goal is to develop a predictive model that can anticipate the likelihood of pulmonary infection during hospitalization among CKD patients.

Methods

This retrospective cohort study was conducted at two prominent tertiary teaching hospitals. Three distinct models were formulated employing three different approaches: (1) the statistics-driven model, (2) the clinical knowledge-driven model, and (3) the decision tree model. The simplest and most efficient model was obtained by comparing their predictive power, stability, and practicability.

Results

This study involved a total of 971 patients, with 388 individuals comprising the modeling group and 583 individuals comprising the validation group. Three different models, namely Models A, B, and C, were utilized, resulting in the identification of seven, four, and eleven predictors, respectively. Ultimately, a statistical knowledge-driven model was selected, which exhibited a C-statistic of 0.891 (0.855–0.927) and a Brier score of 0.012. Furthermore, the Hosmer–Lemeshow test indicated that the model demonstrated good calibration. Additionally, Model A displayed a satisfactory C-statistic of 0.883 (0.856–0.911) during external validation. The statistical-driven model, known as the A-C2GH2S risk score (which incorporates factors such as albumin, C2 [previous COPD history, blood calcium], random venous blood glucose, H2 [hemoglobin, high-density lipoprotein], and smoking), was utilized to determine the risk score for the incidence rate of lung infection in patients with CKD. The findings revealed a gradual increase in the occurrence of pulmonary infections, ranging from 1.84% for individuals with an A-C2GH2S Risk Score ≤ 6, to 93.96% for those with an A-C2GH2S Risk Score ≥ 18.5.

Conclusion

A predictive model comprising seven predictors was developed to forecast pulmonary infection in patients with CKD. This model is characterized by its simplicity, practicality, and it also has good specificity and sensitivity after verification.

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Data availability

The data that support the findings of this study are available in this journal.

References

  1. Pallos D, Leão MVP, Togeiro FCFB et al (2015) Salivary markers in patients with chronic renal failure [J]. Arch Oral Biol 60(12):1784–1788

    Article  CAS  PubMed  Google Scholar 

  2. Rogan A, Mccarthy K, Mcgregor G et al (2017) Quality of life measures predict cardiovascular health and physical performance in chronic renal failure patients [J]. PLoS One 12(9):e0183926

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Na L, Zhou L, Kun D et al (2017) Influence of high flux hemodialysis on microinflammatory and nutritional status of uremic patients[in chinese] [J]. J Clinl Nephrol 17(11):667–70

    Google Scholar 

  4. Razzaghi H, Tempczyk-Russell A, Haubold K et al (2013) Genetic and structure-function studies of missense mutations in human endothelial lipase [J]. PLoS One 8(3):e55716

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Jianfeng Y, Peirui Q, Yongmei L et al (2019) A review of machine learning classification problems and algorithm research [J]. Statd Decision-Making 35(06):36–40

    Google Scholar 

  6. Yan BD, Meng SS, Ren J et al (2016) Asthma control and severe exacerbations in patients with moderate or severe asthma in Jilin Province, China: a multicenter cross-sectional survey [J]. BMC Pulm Med 16(1):130

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cobo G, Lindholm B, Stenvinkel P (2018) Chronic inflammation in end-stage renal disease and dialysis [J]. Nephrol Dial Transplant 33(3):iii35–iii40

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Jankowska M, Cobo G, Lindholm B et al (2017) Inflammation and protein-energy wasting in the uremic milieu [J]. Contrib Nephrol 191:58–71

    Article  CAS  PubMed  Google Scholar 

  9. Zeng H, Safratowich BD, Liu Z et al (2021) Adequacy of calcium and vitamin D reduces inflammation, β-catenin signaling, and dysbiotic Parasutterela bacteria in the colon of C57BL/6 mice fed a western-style diet [J]. J Nutr Biochem 92:108613

    Article  CAS  PubMed  Google Scholar 

  10. Lijun X, Lijie Q, Longan W et al (2020) Influence of hypocalcemia on prognosis of patients with severe pneumonia [in chinese] [J]. Med Forum J 41(06):5–7

    Google Scholar 

  11. Hann J, Bueb JL, Tolle F et al (2020) Calcium signaling and regulation of neutrophil functions: still a long way to go [J]. J Leukoc Biol 107(2):285–297

    Article  CAS  PubMed  Google Scholar 

  12. Lew PD, Monod A, Waldvogel FA et al (1986) Quantitative analysis of the cytosolic free calcium dependency of exocytosis from three subcellular compartments in intact human neutrophils [J]. J Cell Biol 102(6):2197–2204

    Article  CAS  PubMed  Google Scholar 

  13. Ye J, Wang Y, Li X et al (2022) Synergistic antifungal effect of a combination of iron deficiency and calcium supplementation [J]. Microbiol Spectr 10(3):e0112122

    Article  PubMed  Google Scholar 

  14. Halligan DN, Murphy SJ, Taylor CT (2016) The hypoxia-inducible factor (HIF) couples immunity with metabolism [J]. Semin Immunol 28(5):469–477

    Article  CAS  PubMed  Google Scholar 

  15. Taylor CT, Colgan SP (2017) Regulation of immunity and inflammation by hypoxia in immunological niches [J]. Nat Rev Immunol 17(12):774–785

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Musher DM (2004) Anemia and infection [J]. Clin Infect Dis 39(11):1731–2

    Article  PubMed  Google Scholar 

  17. Coates CJ, Decker H (2017) Immunological properties of oxygen-transport proteins: hemoglobin, hemocyanin and hemerythrin [J]. Cell Mol Life Sci 74(2):293–317

    Article  CAS  PubMed  Google Scholar 

  18. Talbot TR, D’Agata EM, Brinsko V et al (2004) Perioperative blood transfusion is predictive of poststernotomy surgical site infection: marker for morbidity or true immunosuppressant? [J]. Clin Infect Dis 38(10):1378–1382

    Article  PubMed  Google Scholar 

  19. D’Anna SE, Maniscalco M, Cappello F et al (2021) Bacterial and viral infections and related inflammatory responses in chronic obstructive pulmonary disease [J]. Ann Med 53(1):135–150

    Article  PubMed  Google Scholar 

  20. Su YC, Jalalvand F, Thegerström J et al (2018) The interplay between immune response and bacterial infection in COPD: focus upon non-typeable Haemophilus influenzae [J]. Front Immunol 9:2530

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fabbri LM, Luppi F, Beghé B et al (2008) Complex chronic comorbidities of COPD [J]. Eur Respir J 31(1):204–212

    Article  CAS  PubMed  Google Scholar 

  22. Huertas A, Palange P (2011) COPD: a multifactorial systemic disease [J]. Ther Adv Respir Dis 5(3):217–224

    Article  CAS  PubMed  Google Scholar 

  23. Wiedermann CJ (2021) Hypoalbuminemia as surrogate and culprit of infections [J]. Int J Mol Sci. https://doi.org/10.3390/ijms22094496

    Article  PubMed  PubMed Central  Google Scholar 

  24. Milford EM, Reade MC (2019) Resuscitation fluid choices to preserve the endothelial glycocalyx [J]. Crit Care 23(1):77

    Article  PubMed  PubMed Central  Google Scholar 

  25. Książek M, Chacińska M, Chabowski A et al (2015) Sources, metabolism, and regulation of circulating sphingosine-1-phosphate [J]. J Lipid Res 56(7):1271–1281

    Article  PubMed  PubMed Central  Google Scholar 

  26. Constantinou C, Karavia EA, Xepapadaki E et al (2016) Advances in high-density lipoprotein physiology: surprises, overturns, and promises [J]. Am J Physiol Endocrinol Metab 310(1):E1-e14

    Article  PubMed  Google Scholar 

  27. Wendel M, Paul R, Heller AR (2007) Lipoproteins in inflammation and sepsis. II. Clinical aspects [J]. Intensive Care Med 33(1):25–35

    Article  CAS  PubMed  Google Scholar 

  28. Strzelak A, Ratajczak A, Adamiec A et al (2018) Tobacco smoke induces and alters immune responses in the lung triggering inflammation, allergy, asthma and other lung diseases: a mechanistic review [J]. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph15051033

    Article  PubMed  PubMed Central  Google Scholar 

  29. Garnett JP, Baker EH, Baines DL (2012) Sweet talk: insights into the nature and importance of glucose transport in lung epithelium [J]. Eur Respir J 40(5):1269–1276

    Article  CAS  PubMed  Google Scholar 

  30. Baker EH, Baines DL (2018) Airway glucose homeostasis: a new target in the prevention and treatment of pulmonary infection [J]. Chest 153(2):507–514

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We want to thank all participants for their support and contribution to this study. Without their voluntary participation and their openness to discuss their personal experiences and opinions, it would not have been possible to achieve these results.

Funding

Medical Science and Technology Project of Zhejiang Province, 2023KY893,Chan Chen, Science and Technology Plan Project of Wenzhou Municipality, Y20220039, Chan Chen.

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Authors and Affiliations

  1. Department of Geriatric Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China

    Wenqian Deng, Chen Liu, Qianhui Cheng, Wenwen Chen, Yao Huang, Yu Hu, Jiangan Guan & Chan Chen

  2. Department of General Practice, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, China

    Jingwen Yang, Jie Weng & Zhiyi Wang

Authors
  1. Wenqian Deng
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  2. Chen Liu
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  3. Qianhui Cheng
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  6. Yao Huang
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  9. Jie Weng
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  10. Zhiyi Wang
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  11. Chan Chen
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Correspondence to Chan Chen.

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Deng, W., Liu, C., Cheng, Q. et al. Predicting the risk of pulmonary infection in patients with chronic kidney failure: A-C2GH2S risk score—a retrospective study. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-03953-6

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