Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
J Am Soc Nephrol. 2021 Jan;32(1):151-160. doi: 10.1681/ASN.2020050615. Epub 2020 Sep 3.
Early reports indicate that AKI is common among patients with coronavirus disease 2019 (COVID-19) and associated with worse outcomes. However, AKI among hospitalized patients with COVID-19 in the United States is not well described.
This retrospective, observational study involved a review of data from electronic health records of patients aged ≥18 years with laboratory-confirmed COVID-19 admitted to the Mount Sinai Health System from February 27 to May 30, 2020. We describe the frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aORs) with mortality.
Of 3993 hospitalized patients with COVID-19, AKI occurred in 1835 (46%) patients; 347 (19%) of the patients with AKI required dialysis. The proportions with stages 1, 2, or 3 AKI were 39%, 19%, and 42%, respectively. A total of 976 (24%) patients were admitted to intensive care, and 745 (76%) experienced AKI. Of the 435 patients with AKI and urine studies, 84% had proteinuria, 81% had hematuria, and 60% had leukocyturia. Independent predictors of severe AKI were CKD, men, and higher serum potassium at admission. In-hospital mortality was 50% among patients with AKI versus 8% among those without AKI (aOR, 9.2; 95% confidence interval, 7.5 to 11.3). Of survivors with AKI who were discharged, 35% had not recovered to baseline kidney function by the time of discharge. An additional 28 of 77 (36%) patients who had not recovered kidney function at discharge did so on posthospital follow-up.
AKI is common among patients hospitalized with COVID-19 and is associated with high mortality. Of all patients with AKI, only 30% survived with recovery of kidney function by the time of discharge.
早期报告表明，急性肾损伤（AKI）在 2019 年冠状病毒病（COVID-19）患者中很常见，并且与预后较差有关。然而，美国住院 COVID-19 患者的 AKI 情况尚不清楚。
这项回顾性观察性研究涉及对 2020 年 2 月 27 日至 5 月 30 日期间在西奈山卫生系统住院的年龄≥18 岁、实验室确诊 COVID-19 患者的电子健康记录数据进行审查。我们描述 AKI 的频率和透析需求、AKI 恢复情况以及与死亡率相关的调整比值比（aOR）。
在 3993 名住院 COVID-19 患者中，1835 名（46%）患者发生 AKI；347 名（19%）AKI 患者需要透析。AKI 分期 1、2 或 3 的比例分别为 39%、19%和 42%。共有 976 名（24%）患者入住重症监护病房，其中 745 名（76%）发生 AKI。在 435 名有 AKI 和尿液研究的患者中，84%有蛋白尿，81%有血尿，60%有白细胞尿。CKD、男性和入院时血清钾升高是严重 AKI 的独立预测因素。AKI 患者的院内死亡率为 50%，无 AKI 患者为 8%（aOR，9.2；95%置信区间，7.5 至 11.3）。出院时 AKI 存活者中有 35%未恢复到基线肾功能。在出院时未恢复肾功能的 77 名患者中，又有 28 名在出院后随访时恢复了肾功能。
AKI 在住院 COVID-19 患者中很常见，与高死亡率相关。在所有 AKI 患者中，只有 30%的患者在出院时肾功能恢复而存活。
