危重新冠肺炎患者的新发肾脏衰竭与临床结局。

De Novo Renal Failure and Clinical Outcomes of Patients With Critical Coronavirus Disease 2019.

机构信息

Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY.

Department of Pathology, Montefiore Medical Center, Bronx, NY.

出版信息

Crit Care Med. 2021 Feb 1;49(2):e161-e169. doi: 10.1097/CCM.0000000000004785.

DOI:10.1097/CCM.0000000000004785

PMID:33186136

Abstract

OBJECTIVES

To describe the characteristics and outcomes associated with concomitant renal and respiratory failure in patients with critical coronavirus disease 2019.

DESIGN, SETTING, AND PATIENTS: This is a case series of patients from a U.S. healthcare system in New York City. All adult patients (≥ 18 yr) admitted to the hospital with positive coronavirus disease 2019 testing between March 10, 2020, and March 31, 2020, who required mechanical ventilatory support were included. Patients who remained hospitalized were followed through May 1, 2020.

INTERVENTIONS

Renal replacement therapy included at least one session of dialysis, continued venovenous hemofiltration, or peritoneal dialysis.

MEASUREMENTS AND MAIN RESULTS

Baseline characteristics, laboratory markers, 30-day in-hospital outcomes, ventilator days, and survival to discharge were included. Multivariate predictors for mortality and need for renal replacement therapy were identified. A total of 330 patients were included in this analysis and were most commonly greater than or equal to 70 years (40%), male (61%), Black or African American (41%), and Hispanic or Latino (38%). Renal replacement therapy was required in 101 patients (29%), most commonly among Blacks or African Americans (50%). Elevated d-dimer, C-reactive protein, and procalcitonin were associated with renal replacement therapy, compared with the nondialysis cohort. Overall, 243 patients (74%) died and 56 (17%) were discharged from the hospital, of which 9 (3%) required renal replacement therapy. Male sex (odds ratio, 2.0; 1.1-3.5; p = 0.020), Black race (odds ratio, 1.8; 1.0-3.1; p = 0.453), and history of hypertension (odds ratio, 2.7; 1.3-5.4; p = 0.005) were predictors for requiring renal replacement therapy. Risk factors for in-hospital mortality included age greater than or equal to 60 years (odds ratio, 6.2; 3.0-13.0; p < 0.0001), male sex (odds ratio, 3.0; 1.4-6.4; p = 0.004), and body mass index greater than or equal to 30 kg/m2 (odds ratio, 2.1; 1.0-4.4; p = 0.039). Concomitant renal failure in critical coronavirus disease 2019 was not a significant predictor of death (odds ratio, 2.3; 0.98-5.5; p = 0.057).

CONCLUSIONS

This case series concludes that respiratory failure conveys significant mortality risk in patients with coronavirus disease 2019 and that survival with concomitant renal failure is rare.

摘要

目的

描述伴有急危重症 2019 冠状病毒病（COVID-19）的患者同时出现肾和呼吸衰竭的特征和结局。

设计、地点和患者：这是一项来自美国纽约市某医疗保健系统的病例系列研究。纳入 2020 年 3 月 10 日至 3 月 31 日期间因 COVID-19 检测阳性而入住医院、需要机械通气支持的所有成年患者（≥18 岁）。直至 2020 年 5 月 1 日，对仍在住院的患者进行随访。

干预措施

肾脏替代治疗包括至少 1 次透析、持续静脉-静脉血液滤过或腹膜透析。

测量和主要结果

纳入了基线特征、实验室标志物、30 天院内结局、呼吸机使用天数和出院时的生存情况。确定了死亡和需要肾脏替代治疗的多变量预测因素。本分析共纳入 330 例患者，最常见的特征为年龄≥70 岁（40%）、男性（61%）、黑种人或非裔美国人（41%）和西班牙裔或拉丁裔（38%）。101 例（29%）患者需要肾脏替代治疗，其中黑种人或非裔美国人最常见（50%）。与非透析组相比，升高的 D-二聚体、C 反应蛋白和降钙素原与肾脏替代治疗相关。总体而言，243 例（74%）患者死亡，56 例（17%）出院，其中 9 例（3%）需要肾脏替代治疗。男性（比值比，2.0；1.1-3.5；p=0.020）、黑种人（比值比，1.8；1.0-3.1；p=0.453）和高血压史（比值比，2.7；1.3-5.4；p=0.005）是需要肾脏替代治疗的预测因素。院内死亡的危险因素包括年龄≥60 岁（比值比，6.2；3.0-13.0；p<0.0001）、男性（比值比，3.0；1.4-6.4；p=0.004）和体重指数≥30kg/m2（比值比，2.1；1.0-4.4；p=0.039）。急危重症 COVID-19 患者同时出现肾衰竭并非死亡的显著预测因素（比值比，2.3；0.98-5.5；p=0.057）。