Abstract：
OBJECTIVE: Bloodstream infections (BSI) and sepsis are important causes of hospitalization, loss of health, and death globally. Targetable risk factors need to be identified to improve prevention and treatment. In this study, we aimed to evaluate the association of chronic kidney disease (CKD) and risk of and mortality from BSI and sepsis in the general population during a 22-year period.
METHODS: We conducted a prospective cohort study among participants in the population-based Norwegian HUNT Study, where 68,438 participated. The median follow-up time was 17.4 years. The exposures were estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) in urine. The outcomes were hazard ratios (HR) of hospital admission or death due to BSI or sepsis. The associations were adjusted for age, sex, diabetes, obesity, systolic blood pressure, smoking status, and cardiovascular disease.
RESULTS: Participants with eGFR < 30 ml/min/1.732 had HR 3.35 for BSI (95% confidence intervals (CI) 2.12-5.3) and HR 2.94 for sepsis (95% CI 1.82-4.8) compared to normal eGFR (≥ 90 ml/min/1.732). HRs of death from BSI and sepsis were 4.2 (95% CI 1.71-10.4) and 4.1 (95% CI 1.88-8.9), respectively. Participants with severely increased albuminuria (ACR > 30 mg/mmol) had HR 3.60 for BSI (95% CI 2.30-5.6) and 3.14 for sepsis (95% CI 1.94-5.1) compared to normal albumin excretion (ACR < 3 mg/mmol). HRs of death were 2.67 (95% CI 0.82-8.7) and 2.16 (95% CI 0.78-6.0), respectively.
CONCLUSIONS: In this large population-based cohort study, CKD was clearly associated with an increased risk of BSI and sepsis and related death.
METHODS: We conducted a prospective cohort study among participants in the population-based Norwegian HUNT Study, where 68,438 participated. The median follow-up time was 17.4 years. The exposures were estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) in urine. The outcomes were hazard ratios (HR) of hospital admission or death due to BSI or sepsis. The associations were adjusted for age, sex, diabetes, obesity, systolic blood pressure, smoking status, and cardiovascular disease.
RESULTS: Participants with eGFR < 30 ml/min/1.732 had HR 3.35 for BSI (95% confidence intervals (CI) 2.12-5.3) and HR 2.94 for sepsis (95% CI 1.82-4.8) compared to normal eGFR (≥ 90 ml/min/1.732). HRs of death from BSI and sepsis were 4.2 (95% CI 1.71-10.4) and 4.1 (95% CI 1.88-8.9), respectively. Participants with severely increased albuminuria (ACR > 30 mg/mmol) had HR 3.60 for BSI (95% CI 2.30-5.6) and 3.14 for sepsis (95% CI 1.94-5.1) compared to normal albumin excretion (ACR < 3 mg/mmol). HRs of death were 2.67 (95% CI 0.82-8.7) and 2.16 (95% CI 0.78-6.0), respectively.
CONCLUSIONS: In this large population-based cohort study, CKD was clearly associated with an increased risk of BSI and sepsis and related death.
摘要：
目的：血流感染（BSI）和败血症是住院的重要原因，失去健康,全球死亡。需要确定针对性的风险因素，以改善预防和治疗。在这项研究中,我们旨在评估22年期间普通人群中慢性肾脏病(CKD)与BSI和脓毒症风险和死亡率的相关性.
方法：我们在基于人群的挪威HUNT研究的参与者中进行了一项前瞻性队列研究，其中68,438人参加。中位随访时间为17.4年。暴露量为估算的肾小球滤过率（eGFR）和尿中白蛋白-肌酐比值（ACR）。结果为因BSI或败血症入院或死亡的风险比（HR）。协会根据年龄进行了调整，性别,糖尿病,肥胖，收缩压,吸烟状况,和心血管疾病。
结果：eGFR<30ml/min/1.732的参与者BSI的HR为3.35（95％置信区间（CI）2.12-5.3），脓毒症的HR为2.94（95％CI1.82-4.8）与正常eGFR（≥90ml/min/1.732）相比。BSI和脓毒症死亡的HR分别为4.2（95%CI1.71-10.4）和4.1（95%CI1.88-8.9），分别。与正常白蛋白排泄（ACR<3mg/mmol）相比，蛋白尿严重增加（ACR>30mg/mmol）的受试者BSIHR为3.60（95％CI2.30-5.6），脓毒症HR为3.14（95％CI1.94-5.1）。死亡的HR分别为2.67（95%CI0.82-8.7）和2.16（95%CI0.78-6.0），分别。
结论：在这项基于人群的大型队列研究中，CKD与BSI和败血症以及相关死亡的风险增加明显相关。
方法：我们在基于人群的挪威HUNT研究的参与者中进行了一项前瞻性队列研究，其中68,438人参加。中位随访时间为17.4年。暴露量为估算的肾小球滤过率（eGFR）和尿中白蛋白-肌酐比值（ACR）。结果为因BSI或败血症入院或死亡的风险比（HR）。协会根据年龄进行了调整，性别,糖尿病,肥胖，收缩压,吸烟状况,和心血管疾病。
结果：eGFR<30ml/min/1.732的参与者BSI的HR为3.35（95％置信区间（CI）2.12-5.3），脓毒症的HR为2.94（95％CI1.82-4.8）与正常eGFR（≥90ml/min/1.732）相比。BSI和脓毒症死亡的HR分别为4.2（95%CI1.71-10.4）和4.1（95%CI1.88-8.9），分别。与正常白蛋白排泄（ACR<3mg/mmol）相比，蛋白尿严重增加（ACR>30mg/mmol）的受试者BSIHR为3.60（95％CI2.30-5.6），脓毒症HR为3.14（95％CI1.94-5.1）。死亡的HR分别为2.67（95%CI0.82-8.7）和2.16（95%CI0.78-6.0），分别。
结论：在这项基于人群的大型队列研究中，CKD与BSI和败血症以及相关死亡的风险增加明显相关。
