Department of Nephrology, University Hospitals of Derby and Burton, Royal Derby Hospital, Derby, United Kingdom.
Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, United Kingdom.
PLoS Med. 2020 Oct 30;17(10):e1003406. doi: 10.1371/journal.pmed.1003406. eCollection 2020 Oct.
Initial reports indicate a high incidence of acute kidney injury (AKI) in Coronavirus Disease 2019 (COVID-19), but more data are required to clarify if COVID-19 is an independent risk factor for AKI and how COVID-19-associated AKI may differ from AKI due to other causes. We therefore sought to study the relationship between COVID-19, AKI, and outcomes in a retrospective cohort of patients admitted to 2 acute hospitals in Derby, United Kingdom.
We extracted electronic data from 4,759 hospitalised patients who were tested for COVID-19 between 5 March 2020 and 12 May 2020. The data were linked to electronic patient records and laboratory information management systems. The primary outcome was AKI, and secondary outcomes included in-hospital mortality, need for ventilatory support, intensive care unit (ICU) admission, and length of stay. As compared to the COVID-19-negative group (n = 3,374), COVID-19 patients (n = 1,161) were older (72.1 ± 16.1 versus 65.3 ± 20.4 years, p < 0.001), had a greater proportion of men (56.6% versus 44.9%, p < 0.001), greater proportion of Asian ethnicity (8.3% versus 4.0%, p < 0.001), and lower proportion of white ethnicity (75.5% versus 82.5%, p < 0.001). AKI developed in 304 (26.2%) COVID-19-positive patients (COVID-19 AKI) and 420 (12.4%) COVID-19-negative patients (AKI controls). COVID-19 patients aged 65 to 84 years (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.11 to 2.50), needing mechanical ventilation (OR 8.74, 95% CI 5.27 to 14.77), having congestive cardiac failure (OR 1.72, 95% CI 1.18 to 2.50), chronic liver disease (OR 3.43, 95% CI 1.17 to 10.00), and chronic kidney disease (CKD) (OR 2.81, 95% CI 1.97 to 4.01) had higher odds for developing AKI. Mortality was higher in COVID-19 AKI versus COVID-19 patients without AKI (60.5% versus 27.4%, p < 0.001), and AKI was an independent predictor of mortality (OR 3.27, 95% CI 2.39 to 4.48). Compared with AKI controls, COVID-19 AKI was observed in a higher proportion of men (58.9% versus 51%, p = 0.04) and lower proportion with white ethnicity (74.7% versus 86.9%, p = 0.003); was more frequently associated with cerebrovascular disease (11.8% versus 6.0%, p = 0.006), chronic lung disease (28.0% versus 19.3%, p = 0.007), diabetes (24.7% versus 17.9%, p = 0.03), and CKD (34.2% versus 20.0%, p < 0.001); and was more likely to be hospital acquired (61.2% versus 46.4%, p < 0.001). Mortality was higher in the COVID-19 AKI as compared to the control AKI group (60.5% versus 27.6%, p < 0.001). In multivariable analysis, AKI patients aged 65 to 84 years, (OR 3.08, 95% CI 1.77 to 5.35) and ≥85 years of age (OR 3.54, 95% CI 1.87 to 6.70), peak AKI stage 2 (OR 1.74, 95% CI 1.05 to 2.90), AKI stage 3 (OR 2.01, 95% CI 1.13 to 3.57), and COVID-19 (OR 3.80, 95% CI 2.62 to 5.51) had higher odds of death. Limitations of the study include retrospective design, lack of urinalysis data, and low ethnic diversity of the region.
We observed a high incidence of AKI in patients with COVID-19 that was associated with a 3-fold higher odds of death than COVID-19 without AKI and a 4-fold higher odds of death than AKI due to other causes. These data indicate that patients with COVID-19 should be monitored for the development of AKI and measures taken to prevent this.
ClinicalTrials.gov NCT04407156.
最初的报告表明，2019 年冠状病毒病（COVID-19）患者中急性肾损伤（AKI）的发病率很高，但需要更多的数据来阐明 COVID-19 是否是 AKI 的独立危险因素，以及 COVID-19 相关 AKI 是否与其他原因引起的 AKI 不同。因此，我们试图在英国德比的 2 家急性医院住院的患者回顾性队列中研究 COVID-19、AKI 和结局之间的关系。
我们从 2020 年 3 月 5 日至 5 月 12 日期间接受 COVID-19 检测的 4759 名住院患者中提取了电子数据。这些数据与电子病历和实验室信息管理系统相关联。主要结局是 AKI，次要结局包括院内死亡率、需要通气支持、入住重症监护病房（ICU）和住院时间。与 COVID-19 阴性组（n=3374）相比，COVID-19 患者（n=1161）年龄更大（72.1±16.1 岁 vs. 65.3±20.4 岁，p<0.001），男性比例更高（56.6% vs. 44.9%，p<0.001），亚洲人种比例更高（8.3% vs. 4.0%，p<0.001），白人比例更低（75.5% vs. 82.5%，p<0.001）。304 例 COVID-19 阳性患者（COVID-19 AKI）和 420 例 COVID-19 阴性患者（AKI 对照组）发生 AKI。65 至 84 岁的 COVID-19 患者（优势比[OR]1.67，95%置信区间[CI]1.11 至 2.50）、需要机械通气（OR 8.74，95%CI 5.27 至 14.77）、充血性心力衰竭（OR 1.72，95%CI 1.18 至 2.50）、慢性肝病（OR 3.43，95%CI 1.17 至 10.00）和慢性肾脏病（CKD）（OR 2.81，95%CI 1.97 至 4.01）发生 AKI 的几率更高。COVID-19 AKI 患者的死亡率高于 COVID-19 无 AKI 患者（60.5% vs. 27.4%，p<0.001），AKI 是死亡率的独立预测因子（OR 3.27，95%CI 2.39 至 4.48）。与 AKI 对照组相比，COVID-19 AKI 患者中男性比例更高（58.9% vs. 51%，p=0.04），白人比例更低（74.7% vs. 86.9%，p=0.003）；更常与脑血管疾病（11.8% vs. 6.0%，p=0.006）、慢性肺部疾病（28.0% vs. 19.3%，p=0.007）、糖尿病（24.7% vs. 17.9%，p=0.03）和 CKD（34.2% vs. 20.0%，p<0.001）相关；更有可能是医院获得性的（61.2% vs. 46.4%，p<0.001）。与 AKI 对照组相比，COVID-19 AKI 患者的死亡率更高（60.5% vs. 27.6%，p<0.001）。在多变量分析中，65 至 84 岁的 AKI 患者（OR 3.08，95%CI 1.77 至 5.35）和≥85 岁的患者（OR 3.54，95%CI 1.87 至 6.70）、AKI 第 2 期高峰（OR 1.74，95%CI 1.05 至 2.90）、AKI 第 3 期（OR 2.01，95%CI 1.13 至 3.57）和 COVID-19（OR 3.80，95%CI 2.62 至 5.51）的死亡风险更高。研究的局限性包括回顾性设计、缺乏尿分析数据以及该地区种族多样性低。
我们观察到 COVID-19 患者中 AKI 的发病率很高，与 COVID-19 无 AKI 患者相比，死亡风险增加了 3 倍，与其他原因引起的 AKI 患者相比，死亡风险增加了 4 倍。这些数据表明，COVID-19 患者应监测 AKI 的发生，并采取措施预防 AKI。
ClinicalTrials.gov NCT04407156。
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