Evaluation of Microbial and Endocrinological Parameters in Dialysis Patients With Sepsis

Rate of Positive Blood Cultures by Sampling Site Among Documented Bloodstream Infections (CVC, Dialysis Machine, Peripheral Vein)

This outcome measure will compare the proportion of positive blood cultures obtained from three different sampling sites-central venous catheter (CVC), dialysis machine, and peripheral vein-among all confirmed cases of bloodstream infection in dialysis patients. The goal is to evaluate the diagnostic yield of each site and identify the most sensitive and reliable source for detecting bloodstream infections. Findings will support evidence-based recommendations regarding the preferred site for blood culture collection in this population. Comparative analysis will include statistical evaluation of sensitivity, yield, and agreement between sites.

Change in Parathyroid Hormone (PTH) Levels During Infection and Rate of PTH Recovery Post-Discharge

This outcome measure will evaluate the change in parathyroid hormone (PTH) levels during acute infection and the monthly rate of recovery after hospital discharge in dialysis patients. PTH levels will be measured at three time points: (1) during the acute infection, (2) at discharge, and (3) monthly for up to 90 days post-discharge. The primary analysis will assess the magnitude of PTH suppression during infection and the trajectory of recovery over time. These parameters will be analyzed for their correlation with key 90-day outcomes, including infectious complications, cardiovascular events, and all-cause mortality. Statistical analyses will include repeated measures ANOVA and mixed-effects models to evaluate longitudinal changes and their association with clinical endpoints.

Rate of Recurrent Infections Within 90 Days of Hospital Discharge

This secondary outcome will assess the rate of recurrent infections occurring within 90 days of hospital discharge among dialysis patients who experienced an initial infectious episode. The analysis will examine whether the magnitude of PTH suppression during infection and the rate of PTH recovery post-discharge are associated with the risk of recurrent infection. Recurrent infections will be defined based on clinical and microbiological criteria. Statistical analysis will include logistic regression and time-to-event models.

Incidence of Cardiovascular Events Within 90 Days of Hospital Discharge

This secondary outcome will assess the incidence of cardiovascular events occurring within 90 days of discharge among dialysis patients following an infectious episode. The analysis will explore whether the degree of parathyroid hormone (PTH) suppression during infection and the rate of PTH recovery are associated with cardiovascular risk. Cardiovascular events will include acute coronary syndrome, arrhythmia, stroke, and heart failure exacerbation, confirmed by clinical documentation. Statistical models such as Cox proportional hazards or logistic regression will be used to evaluate associations.

All-Cause Mortality Within 180 Days of Hospital Discharge.

This secondary outcome will evaluate all-cause mortality within 180 days following hospital discharge in dialysis patients who experienced an infectious episode. The analysis will investigate whether the extent of parathyroid hormone (PTH) suppression during infection and the rate of PTH recovery post-discharge are associated with mortality risk. Deaths will be confirmed through clinical records or national registries. Cox proportional hazards models will be used to assess the relationship between PTH dynamics and mortality.