Kidney Research and Clinical Practice 2020 Mar; 39(1): 54-59  
Clinical significance of abnormal chest radiographic findings for acute kidney injury in patients with scrub typhus
Hyun Ju Yang1 , Sung-Min Kim2 , Jin Sol Choi3 , Ju Hwan Oh2 , A Young Cho2 , Mi Sook Lee3 , Kwang Young Lee2 , In O Sun2
1Division of Pulmonology, Department of Internal Medicine, 2Division of Nephrology, Department of Internal Medicine, 3Department of Radiology, Presbyterian Medical Center, Jeonju, Republic of Korea
Correspondence to: In O Sun
Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, 365 Seowon-ro, Wansan-gu, Jeonju 54987, Republic of Korea. E-mail: inogood@catholic.ac.kr

Edited by Eun Hui Bae, Chonnam National University, Gwangju, Republic of Korea
Received: December 6, 2019; Revised: February 6, 2020; Accepted: February 6, 2020; Published online: March 31, 2020.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Abnormal chest radiographs are frequently encountered in patients with scrub typhus. This study aimed to investigate whether chest radiography on admission is significant as a predictive factor for acute kidney injury (AKI) in patients with scrub typhus.
Methods: From 2010 to 2016, 467 patients were diagnosed with scrub typhus in our hospital. We divided the patients into two groups: normal chest radiograph (NCR) and abnormal chest radiograph (AbNCR), based on chest radiography findings. The incidence, clinical characteristics, and severity of AKI were compared between AKI and non-AKI groups according to the RIFLE classification.
Results: Of the 467 patients, 96 (20.6%) constituted the AbNCR group. Compared with NCR patients, AbNCR patients were older (71 ± 11 vs. 62 ± 13 years, P < 0.001) and had higher total leukocyte counts (9.43 × 103/mL vs. 6.98 × 103/mL, P < 0.001). The AbNCR group had significantly longer duration of hospital stay (8.9 ± 5.5 vs. 6.3 ± 2.8 days, P < 0.001) and higher incidence of AKI (46.9% vs. 15.1%, P < 0.001). The common abnormal chest radiographic findings were pulmonary abnormalities, such as pulmonary congestion and pleural effusion. The overall AKI incidence was 21.6%, of which 12.4%, 7.9%, and 1.3% cases were classified as risk, injury, and failure, respectively. In a multivariable logistic regression analysis for association with AKI, old age, presence of chronic kidney disease or hypertension, leukocytosis, hypoalbuminemia, and chest radiographic abnormalities on admission were significant predictors of AKI.
Conclusion: Chest radiographic abnormalities on admission were independently associated with AKI in patients with scrub typhus.
Keywords: Acute kidney injury, Chronic kidney disease, Radiography, Scrub typhus


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