COVID-19 合并急性肾损伤患者的住院结局。
Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury.
机构信息
Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY.
Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY; Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY; Department of Information Services, Northwell Health, New Hyde Park, NY.
出版信息
Am J Kidney Dis. 2021 Feb;77(2):204-215.e1. doi: 10.1053/j.ajkd.2020.09.002. Epub 2020 Sep 19.
RATIONALE & OBJECTIVE: Outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI) are not well understood. The goal of this study was to investigate the survival and kidney outcomes of these patients.
STUDY DESIGN
Retrospective cohort study.
SETTING & PARTICIPANTS: Patients (aged≥18 years) hospitalized with COVID-19 at 13 hospitals in metropolitan New York between March 1, 2020, and April 27, 2020, followed up until hospital discharge.
EXPOSURE
AKI.
OUTCOMES
Primary outcome: in-hospital death.
SECONDARY OUTCOMES
requiring dialysis at discharge, recovery of kidney function.
ANALYTICAL APPROACH
Univariable and multivariable time-to-event analysis and logistic regression.
RESULTS
Among 9,657 patients admitted with COVID-19, the AKI incidence rate was 38.4/1,000 patient-days. Incidence rates of in-hospital death among patients without AKI, with AKI not requiring dialysis (AKI stages 1-3), and with AKI receiving dialysis (AKI 3D) were 10.8, 31.1, and 37.5/1,000 patient-days, respectively. Taking those without AKI as the reference group, we observed greater risks for in-hospital death for patients with AKI 1-3 and AKI 3D (HRs of 5.6 [95% CI, 5.0-6.3] and 11.3 [95% CI, 9.6-13.1], respectively). After adjusting for demographics, comorbid conditions, and illness severity, the risk for death remained higher among those with AKI 1-3 (adjusted HR, 3.4 [95% CI, 3.0-3.9]) and AKI 3D (adjusted HR, 6.4 [95% CI, 5.5-7.6]) compared with those without AKI. Among patients with AKI 1-3 who survived, 74.1% achieved kidney recovery by the time of discharge. Among those with AKI 3D who survived, 30.6% remained on dialysis at discharge, and prehospitalization chronic kidney disease was the only independent risk factor associated with needing dialysis at discharge (adjusted OR, 9.3 [95% CI, 2.3-37.8]).
LIMITATIONS
Observational retrospective study, limited to the NY metropolitan area during the peak of the COVID-19 pandemic.
CONCLUSIONS
AKI in hospitalized patients with COVID-19 was associated with significant risk for death.
背景与目的
患有 2019 年冠状病毒病（COVID-19）和急性肾损伤（AKI）的住院患者的预后尚不清楚。本研究旨在探讨这些患者的生存和肾脏结局。
研究设计
回顾性队列研究。
地点和参与者
2020 年 3 月 1 日至 4 月 27 日期间，在纽约大都市的 13 家医院因 COVID-19 住院的年龄≥18 岁的患者，随访至出院。
暴露因素
AKI。
结局
主要结局：住院期间死亡。
次要结局
出院时需要透析，肾功能恢复。
分析方法
单变量和多变量生存时间分析和逻辑回归。
结果
在 9657 例因 COVID-19 住院的患者中，AKI 的发生率为 38.4/1000 患者天。无 AKI、AKI 未透析（AKI 1-3 期）和 AKI 透析（AKI 3D）患者的住院期间死亡率分别为 10.8、31.1 和 37.5/1000 患者天。以无 AKI 为参照组，我们观察到 AKI 1-3 和 AKI 3D 患者的住院死亡风险更高（HR 分别为 5.6[95%CI，5.0-6.3]和 11.3[95%CI，9.6-13.1]）。在调整了人口统计学、合并症和疾病严重程度后，AKI 1-3（调整后的 HR，3.4[95%CI，3.0-3.9]）和 AKI 3D（调整后的 HR，6.4[95%CI，5.5-7.6]）患者的死亡风险仍高于无 AKI 患者。在 AKI 1-3 存活患者中，74.1%在出院时肾功能恢复。在 AKI 3D 存活患者中，30.6%在出院时仍需透析，而住院前慢性肾脏病是与出院时需要透析相关的唯一独立危险因素（调整后的 OR，9.3[95%CI，2.3-37.8]）。
局限性
观察性回顾性研究，仅局限于 COVID-19 大流行期间的纽约大都市区。
结论
COVID-19 住院患者的 AKI 与死亡风险显著相关。
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