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非透析慢性肾脏病住院患者的新冠病毒病结局

Outcomes of COVID-19 Among Hospitalized Patients With Non-dialysis CKD.

作者信息

Coca Armando, Burballa Carla, Centellas-Pérez Francisco Javier, Pérez-Sáez María José, Bustamante-Munguira Elena, Ortega Agustín, Dueñas Carlos, Arenas María Dolores, Pérez-Martínez Juan, Ruiz Guadalupe, Crespo Marta, Llamas Francisco, Bustamante-Munguira Juan, Pascual Julio

机构信息

Department of Nephrology, Hospital Clínico Universitario Valladolid, Valladolid, Spain.

Grupo de Trabajo de Jóvenes Nefrólogos de la Sociedad Española de Nefrología (JovSEN), Madrid, Spain.

出版信息

Front Med (Lausanne). 2020 Dec 3;7:615312. doi: 10.3389/fmed.2020.615312. eCollection 2020.

Abstract

Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome-Corona Virus 2 has generated significant impact on global health worldwide. COVID-19 can cause pneumonia and organ injury. Chronic kidney disease (CKD) has been associated with increased mortality in previous epidemics, but there is a paucity of data regarding actual risks for non-dialysis CKD patients with COVID-19. Multicenter, observational cohort study including 136 non-dialysis CKD patients and 136 age- and sex-matched controls that required hospitalization due to COVID-19. Patients with end-stage renal disease, a kidney transplant or without registered baseline glomerular filtration rate prior to COVID-19 infection were excluded. CKD and acute kidney injury (AKI) were defined according to KDIGO criteria. CKD patients had higher white blood cell count and D-dimer and lower lymphocyte percentage. No differences were found regarding symptoms on admission. CKD was associated with higher rate of AKI (61 vs. 24.3%) and mortality (40.4 vs. 24.3%). Patients with AKI had the highest hazard for death (AKI/non-CKD HR:7.04, 95% CI:2.87-17.29; AKI/CKD HR:5.25, 95% CI: 2.29-12.02), followed by CKD subjects without AKI (HR:3.39, 95% CI:1.36-8.46). CKD status did not condition ICU admission or length of in-hospital stay. CKD patients that require hospitalization due to COVID-19 are exposed to higher risk of death and AKI.

摘要

2019冠状病毒病(COVID-19)由严重急性呼吸综合征冠状病毒2引起,已对全球健康产生重大影响。COVID-19可导致肺炎和器官损伤。慢性肾脏病(CKD)在既往疫情中与死亡率增加有关,但关于COVID-19非透析CKD患者的实际风险数据匮乏。一项多中心观察性队列研究纳入了136例非透析CKD患者和136例因COVID-19需要住院治疗的年龄及性别匹配的对照。排除了终末期肾病患者、肾移植患者或在COVID-19感染前未登记基线肾小球滤过率的患者。CKD和急性肾损伤(AKI)根据KDIGO标准定义。CKD患者白细胞计数和D-二聚体较高,淋巴细胞百分比较低。入院时症状方面未发现差异。CKD与较高的AKI发生率(61%对24.3%)和死亡率(40.4%对24.3%)相关。AKI患者死亡风险最高(AKI/非CKD风险比:7.04,95%置信区间:2.87 - 17.29;AKI/CKD风险比:5.25,95%置信区间:2.29 - 12.02),其次是无AKI的CKD患者(风险比:3.39,95%置信区间:1.36 - 8.46)。CKD状态不影响入住重症监护病房或住院时间。因COVID-19需要住院治疗的CKD患者面临更高的死亡和AKI风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c6e3/7744802/8b65846c6d91/fmed-07-615312-g0001.jpg

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