Der CRP-Wert zum Zeitpunkt der Dialysekatheter-Implantation als Risikofaktor für die Entwicklung einer Katheter-assoziierten Komplikation

Der CRP-Wert zum Zeitpunkt der Dialysekatheter-Implantation als Risikofaktor für die Entwicklung einer Katheter-assoziierten Komplikation

The CRP value at the time of implantation of permanent hemodialysis catheter as risk factor for the development of a catheter-related complication

Fani Delistefani

Doctoral thesis

Date of Examination: 2017-11-29

Date of issue: 2017-11-02

Advisor: Koziolek, Michael Prof. Dr.

Referee: Mansur, Ashham PD Dr.

Referee: Zautner, Andreas PD Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-0023-3F53-D

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Abstract

English

Abstract Background The prevalence of permanent hemodialysis catheters as hemodialysis access among patients with end-stage renal disease is increasing. Related complications, such as infection, have unfavorable effects on morbidity, mortality and costs. Therefore, identification of risk factors leading to those complications is required. Aims and objective The aim of this study was to investigate whether elevated C-reactive protein (CRP) values at the time of permanent hemodialysis catheter implantation is predictive for the development of a catheter-related complication and especially infection. Methods This retrospective study examined 151 permanent hemodialysis catheters implanted in 130 patients between January 2004 and December 2013. The following data were collected at the time of catheter implantation: CRP value, history of catheter related infection, microbiological results, immunosuppression and diabetes mellitus. The next primary outcomes were recorded over the 3 months following the implantation: catheter-related infection (local or systemic), days of hospital stay and death. Catheter removal or revision, rehospitalization and use of antibiotics were as secondary outcomes identified. Results Median value of CRP at the time of implantation was 24.7 mg/l (IQR 9.4-38.3 mg/l) (normal value range 0-5 mg/l). We identified a total of 29 (19.2 %) infections, 23 (15.2 %) of them were systemic and 6 (4 %) local. The development of an infection was independent of the CRP value (p=0.45) at the time of implantation as well as the presence of diabetes mellitus (p=0.23) or immunosuppression (p=0.75). Univariate analysis revealed that infection was more frequent in patients with MRSA-carriage (p<0.001), in patients with history of catheter related infection (p<0.05) and in case of bacteremia or bacteriuria in the period of 3 months before catheter implantation (p<0.001). Catheter removal or revision (p=0.002), hospitalization (p=0.001) and use of antibiotics (p=0.02) were also more often observed in patients with MRSA-carriage. Conclusions The CRP value at the time of implantation of permanent hemodialysis catheter does not take influence on the development of catheter related complication. Additionally, our study demonstrated that the individual history of catheter related infection, MRSA-carriage and bacteremia or bacteriuria in the period of 3 months before catheter implantation are significant risk factors for the development of catheter related complications.

Keywords: catheter related complication; CRP; germ carriage; hemodialysis; MRSA