Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona and REDinREN, Villarroel 170, 08036, Barcelona, Spain.
Surgical Intensive Care Unit, Anesthesiology Department, Hospital Clínic, IDIBAPS, Univesitat de Barcelona, Barcelona, Spain.
J Nephrol. 2021 Apr;34(2):285-293. doi: 10.1007/s40620-020-00918-7. Epub 2021 Jan 2.
Acute kidney injury (AKI) is frequent in Coronavirus Infection Disease 2019 (COVID-19) patients. Factors associated with AKI in COVID-19 intensive care unit (ICU) patients and their outcomes have not been previously explored.
Prospective observational study of COVID-19 patients admitted to the ICUs of the Hospital Clínic of Barcelona (Spain), from March 25th to April 21st, 2020, who developed AKI stage 2 or higher (AKIN classification). The primary goal was to describe the characteristics of moderate-severe AKI of COVID-19 patients in an ICU context. As a secondary goal, we aimed to find independent predictors of AKI progression, Renal Replacement Therapy (RRT) requirement and mortality among these patients.
During the study period, 52 out of 237 ICU patients, developed AKIN stage 2 or higher and were included in the study. A Sequential Organ Failure Assessment (SOFA) score at AKI diagnosis of 8 or higher was associated with RRT, OR 5.2, p 0.032. At the time of AKI diagnosis, patients had a worse liver profile and higher inflammation markers than at admission. Fifty per cent of the patients presented AKI progression from AKIN 2 to 3 and 28.85% required RRT. The use of corticosteroids in 69.2% of patients was associated with a reduced requirement of RRT, OR 0.13 (CI 95% 0.02-0.89), p 0.037. AKI was associated with high mortality (50%) and a longer hospital stay, median 35 vs 18 days (p 0.024).
The prevalence of moderate/severe AKI in COVID-19 patients admitted to the ICU is high and has a strong correlation with mortality and length of hospital stay.
急性肾损伤（AKI）在 2019 年冠状病毒病（COVID-19）患者中很常见。COVID-19 重症监护病房（ICU）患者发生 AKI 的相关因素及其结局尚未被探索。
这是一项对 2020 年 3 月 25 日至 4 月 21 日期间入住巴塞罗那临床医院 ICU 的 COVID-19 患者进行的前瞻性观察性研究，这些患者出现 AKIN 分期 2 级或更高（AKIN 分类）。主要目标是描述 ICU 中 COVID-19 患者中中重度 AKI 的特征。作为次要目标，我们旨在寻找这些患者 AKI 进展、肾脏替代治疗（RRT）需求和死亡率的独立预测因素。
在研究期间，237 名 ICU 患者中有 52 名患者发展为 AKIN 分期 2 级或更高，被纳入研究。AKI 诊断时 SOFA 评分≥8 与 RRT 相关，OR 5.2，p=0.032。在 AKI 诊断时，患者的肝功能谱和炎症标志物比入院时更差。50%的患者从 AKIN 2 期进展到 3 期，28.85%需要 RRT。69.2%的患者使用皮质类固醇与 RRT 需求减少相关，OR 0.13（95%CI 0.02-0.89），p=0.037。AKI 与高死亡率（50%）和更长的住院时间相关，中位数分别为 35 天和 18 天（p=0.024）。
入住 ICU 的 COVID-19 患者中中重度 AKI 的患病率较高，与死亡率和住院时间呈强相关。
