Clinical Characteristics And Risk Factors Of Severe Infections In Hospitalized Adult Patients With Primary Nephrotic Syndrome

Objective: To evaluate the clinical characteristics and risk factors of primary nephrotic syndrome(PNS)patients in adult with severe infections.Methodology: Medical charts of PNS patients administrated to the Kidney Intensive Care Unit of Jinling Hospital during June 2012 to June 2017 with infections were systematically reviewed,and the secondary nephrotic syndrome patients were excluded.Results: One hundred and eighty-seven patients were enrolled in this retrospective study with 53(28.3%)developed severe infections and 134(71.7%)developed non-severe infections.Pathological types included membranous nephropathy(47%),focal segmental glomerulosclerosis(11%),podocyte disease(16%).The commonest infection site was pulmonary(54.55%),followed by skin and soft tissue(29.41%).Severe infections mainly resulted from opportunistic infections such as Pneumocystis,invasive Aspergillus,Acinetobacter Bauman and others.Significantly lower CD4+ T-lymphocyte counts(P < 0.001),higher cumulative dose of prednisone 3 months before infection(P < 0.001),and the higher proportion of glucocorticoid(54.7% vs 47.7%)or glucocorticoid + immunosuppressive agents(41.5% vs.34.1%)were observed in severe infection patients.Low CD4+T cell count?250cells/ul(OR=29.451,P<0.001)and 2-4 months of immunosuppressive therapy(OR=4.1,P=0.043)were independent risk factors for severe infections with PNS.Low mean arterial pressure(OR=1.160,P=0.031)and low platelet count(OR=1.052,P=0.021)indicated worse outcome.Conclusion: These data indicated that pulmonary infection was the major infection type of nephrotic syndrome patients and an approximately three months' course of immunosuppressive therapy was a high risk factor of severe infections.Lower CD4+T cell count was an independent risk factor for severe infections in PNS patients.Lower mean arterial pressure and lower platelet count indicated worse outcome.During the follow-up of NS patients,it is necessary to closely monitor the patient's immune function status,especially on the approximately three months' course of immunosuppressive therapy,and do the best job in the prevention,diagnosis and treatment of infection to reduce the development of life-threatening critical infections.