Neutrophil reactive oxygen formation, bacterial infections and mortality in malnourished hemodialysis patients: Evaluation of clinical outcomes.

IF 1.4 4区 医学 Q3 UROLOGY & NEPHROLOGY
Seminars in Dialysis Pub Date : 2023-09-01 Epub Date: 2023-07-09 DOI:10.1111/sdi.13168
Hadar Mudrik-Zohar, Danny Alon, Naomi Nacasch, Aviad Sternschuss, Meidad Greenberg, Sydney Benchetrit, Ronit Gavrieli, Tali Zitman-Gal, Keren Cohen-Hagai
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引用次数: 0

Abstract

Introduction: Patients with end stage kidney disease undergoing maintenance hemodialysis (MHD) are prone to malnutrition and infections.

Objective: The objective of this study was to evaluate the effect of polymorphonuclear (PMN) cell dysfunction on clinical outcomes of MHD patients, in association with nutritional status.

Methods: This prospective study investigated 39 MHD patients by evaluating the oxidative activity of their PMN cells using Phorbol 12-Myristate-13-Acetate (PMA) stimulation. Blood samples were taken from each participant at dialysis initiation. Demographics, laboratory data, and clinical outcomes during a 24-month follow-up period were obtained from electronic medical records.

Results: Phagocytic activity was described in percentiles of mean fluorescence intensity (MFI) of PMA levels. There were no differences in comorbidities between patients with low or high MFI-PMA percentiles. Patients in the lowest (25th) MFI-PMA percentile (N = 10) had poorer nutritional status and more frequent severe infections compared to the other 29 patients (4.3 ± 3.4 events versus 2 ± 2.2 events, p = 0.017). Furthermore, they had more frequent hospitalizations (>3) due to infections (70% versus 41%, p = 0.073) and their mortality rate was higher (80% versus 31%, p = 0.007). The odds ratio for all-cause mortality was 8.85. In multivariate analysis, the MFI-PMA percentile and ischemic heart disease were the strongest predictors of all-cause mortality (p = 0.02 and p = 0.005, respectively).

Conclusions: Low MFI-PMA levels were associated with poor nutritional status and adverse clinical outcomes and might serve as a prognostic biomarker, predicting severe infections and mortality among malnourished MHD patients.

营养不良血液透析患者中性粒细胞活性氧形成、细菌感染和死亡率:临床结果评估。
引言:接受维持性血液透析(MHD)的终末期肾病患者容易营养不良和感染。目的:本研究的目的是评估多形核细胞(PMN)功能障碍对MHD患者临床结果的影响,以及与营养状况的关系。方法:本前瞻性研究通过使用佛波醇12-肉豆蔻酸酯-13-乙酸酯(PMA)刺激评估其PMN细胞的氧化活性来调查39名MHD患者。在透析开始时从每个参与者身上采集血样。从电子医疗记录中获得24个月随访期间的人口统计、实验室数据和临床结果。结果:吞噬细胞活性以PMA水平的平均荧光强度(MFI)的百分位数来描述。MFI-PMA百分位数低或高的患者之间的合并症没有差异。MFI-PMA最低(第25)百分位(N = 10) 与其他29名患者相比,营养状况较差,严重感染频率更高(4.3 ± 3.4个事件与2个事件 ± 2.2事件,p = 0.017)。此外,他们因感染而住院的频率更高(>3)(70%对41%,p = 0.073),死亡率较高(80%对31%,p = 0.007)。全因死亡率的比值比为8.85。在多变量分析中,MFI-PMA百分位数和缺血性心脏病是全因死亡率的最强预测因素(p = 0.02和p = 结论:低MFI-PMA水平与不良营养状况和不良临床结果相关,可能作为预后生物标志物,预测营养不良MHD患者的严重感染和死亡率。
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来源期刊
Seminars in Dialysis
Seminars in Dialysis 医学-泌尿学与肾脏学
CiteScore
3.00
自引率
6.20%
发文量
91
审稿时长
4-8 weeks
期刊介绍: Seminars in Dialysis is a bimonthly publication focusing exclusively on cutting-edge clinical aspects of dialysis therapy. Besides publishing papers by the most respected names in the field of dialysis, the Journal has unique useful features, all designed to keep you current: -Fellows Forum -Dialysis rounds -Editorials -Opinions -Briefly noted -Summary and Comment -Guest Edited Issues -Special Articles Virtually everything you read in Seminars in Dialysis is written or solicited by the editors after choosing the most effective of nine different editorial styles and formats. They know that facts, speculations, ''how-to-do-it'' information, opinions, and news reports all play important roles in your education and the patient care you provide. Alternate issues of the journal are guest edited and focus on a single clinical topic in dialysis.
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