Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Zhejiang, Hangzhou, China.
BMC Pulm Med. 2020 Nov 9;20(1):290. doi: 10.1186/s12890-020-01305-5.
The clinical correlates, prognosis and determinants of acute kidney injury (AKI) in patients with coronavirus disease 2019 (Covid-19) remain largely unclear.
We retrospectively reviewed medical records of all adult patients with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University.
Among 210 patients, 131 were males (62.4%). The median Age was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) were classified as being at stage 1, 2 and 3, respectively. 54 patients (58.7%) received continuous renal replacement therapy. Age, sepsis, nephrotoxic drug, invasive mechanical ventilation and elevated baseline serum creatinine levels were associated with the occurrence of AKI. Renal recovery during hospitalization was identified among 16 patients with AKI (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure and higher ratio of partial pressure of oxygen to the fraction of inspired oxygen. Of 210 patients, 93 deceased within 28 days of ICU admission. AKI stage 3, critical disease, greater Age and the lowest ratio of partial pressure of oxygen to the fraction of inspired oxygen being < 150 mmHg were independently associated with death.
Among patients with Covid-19, the incidence of AKI was high. Our findings of the risk factors of the development of AKI and factors associated with renal function recovery may inform clinical management of patients with critical illness of Covid-19.
新型冠状病毒肺炎（COVID-19）患者急性肾损伤（AKI）的临床相关性、预后和决定因素仍很大程度上不清楚。
我们回顾性分析了 2020 年 1 月 23 日至 2020 年 4 月 6 日期间入住武汉金银潭医院和广州医科大学第一附属医院重症监护病房（ICU）的所有经实验室确诊的 COVID-19 成年患者的病历资料。
在 210 例患者中，131 例为男性（62.4%）。中位年龄为 64 岁（IQR：56-71）。92 例（43.8%）住院期间发生 AKI 的患者中，分别有 13 例（14.1%）、15 例（16.3%）和 64 例（69.6%）为 1 期、2 期和 3 期。54 例（58.7%）患者接受连续性肾脏替代治疗。年龄、脓毒症、肾毒性药物、有创机械通气和基线血清肌酐升高与 AKI 的发生相关。在 16 例 AKI 患者（17.4%）中发现了住院期间的肾功能恢复，这些患者从入院到 AKI 诊断的时间明显缩短，右心衰竭的发生率较低，氧分压与吸入氧分数的比值较高。在 210 例患者中，93 例在 ICU 入住后 28 天内死亡。AKI 3 期、危重症、年龄较大和最低氧分压与吸入氧分数比值<150mmHg 与死亡独立相关。
在 COVID-19 患者中，AKI 的发生率较高。我们发现 AKI 发生的危险因素和与肾功能恢复相关的因素，可能为 COVID-19 危重症患者的临床管理提供信息。
