新型冠状病毒 2019 成年患者急性肾损伤的发生率、危险因素和预后。
The Incidence, Risk Factors, and Prognosis of Acute Kidney Injury in Adult Patients with Coronavirus Disease 2019.
机构信息
Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Laboratory Medicine, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Clin J Am Soc Nephrol. 2020 Oct 7;15(10):1394-1402. doi: 10.2215/CJN.04650420. Epub 2020 Sep 22.
BACKGROUND AND OBJECTIVES
Since December 2019, coronavirus disease 2019 (COVID-19) outbreak occurred and has rapidly spread worldwide. However, little information is available about the AKI in COVID-19. We aimed to evaluate the incidence, risk factors, and prognosis of AKI in adult patients with COVID-19.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a retrospective cohort study of 1392 patients with COVID-19 admitted to a tertiary teaching hospital. Clinical characteristics and laboratory data were extracted from electronic hospitalization and laboratory databases. AKI was defined and staged according to the 2012 Kidney Disease: Improving Global Outcomes criteria. Risk factors for AKI and the association of AKI with in-hospital mortality were assessed.
RESULTS
A total of 7% (99 of 1392) of patients developed AKI during hospitalization, 40% (40 of 99) of which occurred within 1 week of admission. Factors associated with a higher risk of AKI include severe disease (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.37 to 3.67), higher baseline serum creatinine (OR, 2.19; 95% CI, 1.17 to 4.11), lymphopenia (OR, 1.99; 95% CI, 1.12 to 3.53), and elevated D-dimer level (OR, 2.68; 95% CI, 1.07 to 6.70). The in-hospital mortality in patients with AKI stage 1, stage 2, and stage 3 was 62%, 77%, and 80%, respectively. AKI was associated with in-hospital mortality even after adjustment for confounders (OR, 5.12; 95% CI, 2.70 to 9.72).
CONCLUSIONS
AKI is uncommon but carries high in-hospital mortality in patients with COVID-19.
背景与目的
自 2019 年 12 月以来，新型冠状病毒病 2019（COVID-19）爆发并迅速在全球范围内蔓延。然而，关于 COVID-19 导致的急性肾损伤（AKI）的信息较少。本研究旨在评估成人 COVID-19 患者 AKI 的发生率、危险因素和预后。
设计、地点、参与者和测量方法：这是一项对 1392 例在一家三级教学医院住院的 COVID-19 患者进行的回顾性队列研究。从电子住院和实验室数据库中提取临床特征和实验室数据。根据 2012 年肾脏病：改善全球结局（KDIGO）标准定义和分期 AKI。评估 AKI 的危险因素以及 AKI 与住院死亡率的关系。
结果
共有 7%（99/1392）的患者在住院期间发生 AKI，其中 40%（40/99）发生在入院后 1 周内。与 AKI 风险较高相关的因素包括严重疾病（比值比[OR]，2.25；95%置信区间[CI]，1.37 至 3.67）、基线血清肌酐升高（OR，2.19；95%CI，1.17 至 4.11）、淋巴细胞减少症（OR，1.99；95%CI，1.12 至 3.53）和升高的 D-二聚体水平（OR，2.68；95%CI，1.07 至 6.70）。AKI 1 期、2 期和 3 期患者的住院死亡率分别为 62%、77%和 80%。即使在调整混杂因素后，AKI 与住院死亡率相关（OR，5.12；95%CI，2.70 至 9.72）。
结论
AKI 在 COVID-19 患者中并不常见，但住院死亡率高。
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