Associated factors and impact on hospitalization outcomes of acute kidney injury (AKI) in pneumonia patients in Sanam Chai Khet Community Hospital, Chachoengsao province, Thailand, 2025: An observational cross-sectional study

Abstract

 Background: Acute Kidney Injury (AKI) is a rapid decline in kidney function that increases the risk of chronic kidney disease (CKD) and the healthcare burden. In pneumonia patients, AKI exacerbates systemic inflammation and organ dysfunction, heightening the risk of multi-organ failure and death. This study aimed to identify risk factors for AKI and assess its impact on outcomes in a community hospital. Methods: A cross-sectional study was conducted between February and April 2025 at Sanam Chai Khet Hospital, Thailand. Data were obtained from community-acquired pneumonia patients aged ≥18 years. Exclusion criteria included hospital - acquired pneumonia, thoracic malignancy, and end-stage renal disease. Statistical analyses employed the chi-square, t-tests, generalized linear models, and multivariate logistic regression (Stata 17.0). Results: The study included 3,210 patients, with 147 diagnosed with AKI. The mean age of patients with AKI was 70.03 years, compared to 51.24 years among non-AKI patients. Risk factors associated with AKI in pneumonia patients included age ≥60 years (OR = 3.72, 95% CI: 2.35-5.88, p<0.001), sepsis (OR = 2.51, 95% CI: 1.54-4.10, p<0.001), acidosis (OR = 11.82, 95% CI: 3.90-35.84, p<0.001), alcohol abuse (OR = 3.71, 95% CI: 1.32-10.45, p=0.013), hypernatremia (OR = 63.30, 95% CI: 10.83-369.93, p<0.001), Charlson Comorbidity Index (CCI) score ≥2 (OR = 3.86, 95% CI: 2.41-6.19, p = 6.192), and ICU admission (OR = 5.74, 95% CI: 1.77-18.58, p = 0.004). The study also found that patients with AKI had significantly higher mortality rates (27.66% vs. 72.34%, p<0.001) and higher healthcare costs (THB 30,678.80 vs. THB 26,218.50, p<0.001) compared to non-AKI patients. ICU admission and mechanical ventilation were also significantly associated with AKI. Conclusion: AKI significantly worsens outcomes in pneumonia patients, with increased mortality, ICU admission, and healthcare costs. Early recognition of risk factors such as advanced age, sepsis, acidosis, and hypernatremia is crucial for timely intervention and improved patient care in community hospitals.