Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Kidney Int. 2020 May;97(5):829-838. doi: 10.1016/j.kint.2020.03.005. Epub 2020 Mar 20.
In December 2019, a coronavirus 2019 (COVID-19) disease outbreak occurred in Wuhan, Hubei Province, China, and rapidly spread to other areas worldwide. Although diffuse alveolar damage and acute respiratory failure were the main features, the involvement of other organs needs to be explored. Since information on kidney disease in patients with COVID-19 is limited, we determined the prevalence of acute kidney injury (AKI) in patients with COVID-19. Further, we evaluated the association between markers of abnormal kidney function and death in patients with COVID-19. This was a prospective cohort study of 701 patients with COVID-19 admitted in a tertiary teaching hospital that also encompassed three affiliates following this major outbreak in Wuhan in 2020 of whom 113 (16.1%) died in hospital. Median age of the patients was 63 years (interquartile range, 50-71), including 367 men and 334 women. On admission, 43.9% of patients had proteinuria and 26.7% had hematuria. The prevalence of elevated serum creatinine, elevated blood urea nitrogen and estimated glomerular filtration under 60 ml/min/1.73m were 14.4, 13.1 and 13.1%, respectively. During the study period, AKI occurred in 5.1% patients. Kaplan-Meier analysis demonstrated that patients with kidney disease had a significantly higher risk for in-hospital death. Cox proportional hazard regression confirmed that elevated baseline serum creatinine (hazard ratio: 2.10, 95% confidence interval: 1.36-3.26), elevated baseline blood urea nitrogen (3.97, 2.57-6.14), AKI stage 1 (1.90, 0.76-4.76), stage 2 (3.51, 1.49-8.26), stage 3 (4.38, 2.31-8.31), proteinuria 1+ (1.80, 0.81-4.00), 2+∼3+ (4.84, 2.00-11.70), and hematuria 1+ (2.99, 1.39-6.42), 2+∼3+ (5.56,2.58- 12.01) were independent risk factors for in-hospital death after adjusting for age, sex, disease severity, comorbidity and leukocyte count. Thus, our findings show the prevalence of kidney disease on admission and the development of AKI during hospitalization in patients with COVID-19 is high and is associated with in-hospital mortality. Hence, clinicians should increase their awareness of kidney disease in patients with severe COVID-19.
2019 年 12 月，一种 2019 年冠状病毒（COVID-19）疾病在湖北省武汉市爆发，并迅速蔓延到世界其他地区。尽管弥漫性肺泡损伤和急性呼吸衰竭是主要特征，但需要探索其他器官的受累情况。由于有关 COVID-19 患者肾脏疾病的信息有限，我们确定了 COVID-19 患者中急性肾损伤（AKI）的患病率。此外，我们评估了 COVID-19 患者中异常肾功能标志物与死亡之间的关联。这是一项对 2020 年武汉疫情后在一家三级教学医院住院的 701 例 COVID-19 患者进行的前瞻性队列研究，其中包括三家附属医院，其中 113 例（16.1%）患者死亡。患者的中位年龄为 63 岁（四分位间距，50-71），包括 367 名男性和 334 名女性。入院时，43.9%的患者有蛋白尿，26.7%的患者有血尿。血清肌酐升高、血尿素氮升高和估计肾小球滤过率低于 60ml/min/1.73m 的患病率分别为 14.4%、13.1%和 13.1%。在研究期间，5.1%的患者发生 AKI。Kaplan-Meier 分析表明，有肾脏疾病的患者住院死亡风险显著增加。Cox 比例风险回归证实，基线时血清肌酐升高（危险比：2.10，95%置信区间：1.36-3.26）、基线时血尿素氮升高（3.97，2.57-6.14）、AKI 第 1 期（1.90，0.76-4.76）、第 2 期（3.51，1.49-8.26）、第 3 期（4.38，2.31-8.31）、蛋白尿 1+（1.80，0.81-4.00）、2+∼3+（4.84，2.00-11.70）和血尿 1+（2.99，1.39-6.42）、2+∼3+（5.56，2.58-12.01）是调整年龄、性别、疾病严重程度、合并症和白细胞计数后与住院死亡相关的独立危险因素。因此，我们的研究结果表明 COVID-19 患者入院时肾脏疾病的患病率以及住院期间 AKI 的发生均较高，并与住院死亡率相关。因此，临床医生应提高对严重 COVID-19 患者肾脏疾病的认识。
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