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住院肾移植受者中严重 COVID-19 的临床特征和危险因素:一项多中心队列研究。

Clinical characteristics and risk factors for severe COVID-19 in hospitalized kidney transplant recipients: A multicentric cohort study.

机构信息

Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain.

Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain.

出版信息

Am J Transplant. 2020 Nov;20(11):3030-3041. doi: 10.1111/ajt.16246. Epub 2020 Sep 23.

Abstract

Kidney transplant recipients might be at higher risk for severe coronavirus disease 2019 (COVID-19). However, risk factors for relevant outcomes remain uncertain in this population. This is a multicentric kidney transplant cohort including 104 hospitalized patients between March 4 and April 17, 2020. Risk factors for death and acute respiratory distress syndrome (ARDS) were investigated, and clinical and laboratory data were analyzed. The mean age was 60 years. Forty-seven patients (54.8%) developed ARDS. Obesity was associated to ARDS development (OR 2.63; P = .04). Significant age differences were not found among patients developing and not developing ARDS (61.3 vs 57.8 years, P = .16). Seventy-six (73%) patients were discharged, and 28 (27%) died. Death was more common among the elderly (55 and 70.8 years, P < .001) and those with preexisting pulmonary disease (OR 2.89, P = .009). At admission, higher baseline lactate dehydrogenase (257 vs 358 IU/mL, P = .001) or ARDS conferred higher risk of death (HR 2.09, P = .044). In our cohort, ARDS was equally present among young and old kidney recipients. However, the elderly might be at higher risk of death, along with those showing higher baseline LDH at admission.

摘要

肾移植受者可能有更高的风险患上严重的 2019 年冠状病毒病(COVID-19)。然而,该人群相关结局的危险因素仍不确定。这是一项多中心肾移植队列研究,纳入了 2020 年 3 月 4 日至 4 月 17 日期间住院的 104 名患者。研究调查了死亡和急性呼吸窘迫综合征(ARDS)的危险因素,并分析了临床和实验室数据。患者的平均年龄为 60 岁。47 名患者(54.8%)发生了 ARDS。肥胖与 ARDS 的发生有关(OR 2.63;P =.04)。发生和未发生 ARDS 的患者之间的年龄差异无统计学意义(61.3 岁 vs 57.8 岁,P =.16)。76 名(73%)患者出院,28 名(27%)死亡。死亡更常见于老年人(55 岁和 70.8 岁,P <.001)和有基础肺部疾病的患者(OR 2.89,P =.009)。入院时,较高的基线乳酸脱氢酶(257 vs 358 IU/mL,P =.001)或 ARDS 预示着更高的死亡风险(HR 2.09,P =.044)。在我们的队列中,年轻和老年肾移植受者的 ARDS 发生率相当。然而,老年人可能有更高的死亡风险,以及那些入院时基础 LDH 较高的患者。

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