Incidence, Associated Factors, and Clinical Prediction Criteria of Septicemia in End-Stage Renal Disease Patients Undergoing Hemodialysis at Wichian Buri Hospital, Phetchabun Province, Thailand

Abstract

Septicemia is a major complication among patients with end-stage renal disease (ESRD) receiving hemodialysis. This study aimed to determine the incidence, identify risk factors, and develop a clinical prediction criterion for septicemia in this population. A retrospective cohort study was conducted by reviewing medical records of 149 ESRD patients who underwent hemodialysis at Wichian Buri Hospital between October 2021 and September 2024. Data included demographic characteristics, comorbidities, dialysis duration, type and duration of vascular access, and laboratory parameters. Descriptive statistics and univariate and multivariate logistic regression analyses were performed, with significance defined as p-value <0.05. The overall incidence of septicemia was 18.0 per 100 patient-years, lowest among those with arteriovenous fistula (14.0 per 100 patient-years) and highest in patients with non-tunneled cuffed catheters (115.3 per 100 patient-years). Independent risk factors were hemodialysis performed outside the hospital (Adj. OR 3.54, p=0.003) and serum albumin ≤3.5 mg/dL (Adj. OR 4.34, p=0.002), while age >65 years (Adj. OR 0.27, p=0.004) and hematocrit ≤25% (Adj. OR 0.29, p=0.01) were protective factors. A clinical prediction score derived from β coefficients was established: age >65 years = -1, outpatient dialysis = +1, albumin ≤3.5 mg/dL = +1, and hematocrit ≤25% = -1. The score stratified patients into low, moderate, and high-risk groups. Apparent validation showed the highest AUC of 0.74 at cutoff ≥1. In conclusion, patients with ESRD on hemodialysis have an increased risk of septicemia, particularly those receiving dialysis outside the hospital and with low serum albumin. A clinical prediction criterion may help identify high-risk patients for early prevention, but further validation is needed.