Teoh Jeremy Yuen-Chun, Yip Terry Cheuk-Fung, Lui Grace Chung-Yan, Wong Vincent Wai-Sun, Chow Viola Chi-Ying, Ho Tracy Hang-Yee, Li Timothy Chun-Man, Tse Yee-Kit, Chiu Peter Ka-Fung, Ng Chi-Fai, Hui David Shu-Cheong, Chan Henry Lik-Yuen, Szeto Cheuk-Chun, Wong Grace Lai-Hung
Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
J Am Soc Nephrol. 2021 Apr;32(4):961-971. doi: 10.1681/ASN.2020071097. Epub 2021 Jan 22.
Severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) are closely related. The effect of AKI on the clinical outcomes of these two conditions is unclear.
This retrospective, territory-wide cohort study used an electronic public healthcare database in Hong Kong to identify patients with SARS or COVID-19 by diagnosis codes, virologic results, or both. The primary endpoint was a composite of intensive care unit admission, use of invasive mechanical ventilation, and/or death.
We identified 1670 patients with SARS and 1040 patients with COVID-19 (median ages, 41 versus 35 years, respectively). Among patients with SARS, 26% met the primary endpoint versus 5.3% of those with COVID-19. Diabetes mellitus, abnormal liver function, and AKI were factors significantly associated with the primary endpoint among patients with either SARS or COVID-19. Among patients with SARS, 7.9%, 2.1%, and 3.7% developed stage 1, stage 2, and stage 3 AKI, respectively; among those with COVID-19, 6.6%, 0.4%, and 1.1% developed stage 1, stage 2, and stage 3 AKI, respectively. In both groups, factors significantly associated with AKI included diabetes mellitus and hypertension. Among patients with AKI, those with COVID-19 had a lower rate of major adverse clinical outcomes versus patients with SARS. Renal function recovery usually occurred within 30 days after an initial AKI event.
AKI rates were higher among patients with SARS than those with COVID-19. AKI was associated with major adverse clinical outcomes for both diseases. Patients with diabetes mellitus and abnormal liver function were also at risk of developing severe consequences after SARS and COVID-19 infection.
严重急性呼吸综合征（SARS）与2019冠状病毒病（COVID-19）密切相关。急性肾损伤（AKI）对这两种疾病临床结局的影响尚不清楚。
这项回顾性的全地区队列研究利用香港的一个电子公共医疗数据库，通过诊断编码、病毒学检测结果或两者来识别SARS或COVID-19患者。主要终点是重症监护病房入住、有创机械通气的使用和/或死亡的复合指标。
我们识别出1670例SARS患者和1040例COVID-19患者（中位年龄分别为41岁和35岁）。在SARS患者中，26%达到主要终点，而COVID-19患者中这一比例为5.3%。糖尿病、肝功能异常和AKI是SARS或COVID-19患者中与主要终点显著相关的因素。在SARS患者中，分别有7.9%、2.1%和3.7%发生1期、2期和3期AKI；在COVID-19患者中，分别有6.6%、0.4%和1.1%发生1期、2期和3期AKI。在两组中，与AKI显著相关的因素包括糖尿病和高血压。在AKI患者中，COVID-19患者的主要不良临床结局发生率低于SARS患者。肾功能恢复通常在首次发生AKI事件后的30天内出现。
SARS患者的AKI发生率高于COVID-19患者。AKI与这两种疾病的主要不良临床结局相关。糖尿病和肝功能异常的患者在感染SARS和COVID-19后也有发生严重后果的风险。
