Journal article
Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice
Transplant international, Vol.29(2), pp.241-252
02/2016
DOI: 10.1111/tri.12711
PMCID: PMC4805426
PMID: 26563524
Abstract
We examined United States Renal Data System registry records for Medicare-insured kidney transplant recipients in 2000-2011 to study the clinical and cost impacts of urinary tract infections (UTI), pneumonia, and sepsis in the first year post-transplant among a contemporary, national cohort. Infections were identified by billing diagnostic codes. Among 60 702 recipients, 45% experienced at least one study infection in the first year post-transplant, including UTI in 32%, pneumonia in 13%, and sepsis in 12%. Older recipient age, female sex, diabetic kidney failure, nonstandard criteria organs, sirolimus-based immunosuppression, and steroids at discharge were associated with increased risk of first-year infections. By time-varying, multivariate Cox regression, all study infections predicted increased first-year mortality, ranging from 41% (aHR 1.41, 95% CI 1.25-1.56) for UTI alone, 6- to 12-fold risk for pneumonia or sepsis alone, to 34-fold risk (aHR 34.38, 95% CI 30.35-38.95) for those with all three infections. Infections also significantly increased first-year costs, from $17 691 (standard error (SE) $591) marginal cost increase for UTI alone, to approximately $40 000-$50 000 (SE $1054-1238) for pneumonia or sepsis alone, to $134 773 (SE $1876) for those with UTI, pneumonia, and sepsis. Clinical and economic impacts persisted in years 2-3 post-transplant. Early infections reflect important targets for management protocols to improve post-transplant outcomes and reduce costs of care.
Details
- Title: Subtitle
- Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice
- Creators
- Abhijit S Naik - University of MichiganVikas R Dharnidharka - Washington University in St. LouisMark A Schnitzler - Saint Louis University HospitalDaniel C Brennan - Washington University in St. LouisDorry L Segev - Johns Hopkins UniversityDavid Axelrod - Dartmouth–Hitchcock Medical CenterHuiling Xiao - Saint Louis University HospitalLauren Kucirka - Johns Hopkins UniversityJiajing Chen - Saint Louis UniversityKrista L Lentine - Saint Louis University Hospital
- Resource Type
- Journal article
- Publication Details
- Transplant international, Vol.29(2), pp.241-252
- DOI
- 10.1111/tri.12711
- PMID
- 26563524
- PMCID
- PMC4805426
- NLM abbreviation
- Transpl Int
- ISSN
- 0934-0874
- eISSN
- 1432-2277
- Grant note
- F30 DK095545 / NIDDK NIH HHS RC1 DK086450 / NIDDK NIH HHS R01 DK102981 / NIDDK NIH HHS
- Language
- English
- Date published
- 02/2016
- Academic Unit
- Surgery
- Record Identifier
- 9984322798502771
Metrics
11 Record Views