Infectious Disease and Clinical Microbiology Department, Gazi University School of Medicine, Ankara, Turkey.
Nephrology Department, Gazi University School of Medicine, Ankara, Turkey.
Nephrology (Carlton). 2021 Jun;26(6):513-521. doi: 10.1111/nep.13856. Epub 2021 Feb 9.
This study aims to determine the frequency of COVID-19 related AKI and to identify the early predictors of AKI.
This study is a single-center, retrospective, observational study. Hospitalized COVID-19 patients between 24/03/2020 and 31/05/2020 were included in the study. All patients were evaluated for renal dysfunctions with urine dipstick, protein/creatinine ratio, albumin/creatinine ratio in spot urine, serum cystatin C, serum creatinine level on hospital admission, and 28th day of hospital admission. To assess the utility of these parameters to predict AKI, a receiver-operating characteristic curve was generated and the area under the curve (AUC) was calculated.
348 patients were included. The average incidence of AKI was 4.9% (n = 17). The incidence of AKI in mild, moderate and severe COVID-19 cases was 1.3% (n = 4), 9.0% (n = 3) and 76.9% (n = 10), respectively. Proteinuria was detected in 7.8% (n = 27) of patients with a urine dipstick test. In spot urine analysis, proteinuria was found in 20.1% (n = 70) of patients. The frequency of persistent proteinuria was 5.2% (n = 18). The AUC alue of serum cystatin C, D-dimer and albumin/creatinine ratio to predict COVID-19 related AKI were 0.96 (0.90 to 1.0), 0.94 (0.89-0.98), and 0.95 (0.91-0.98).
In COVID-19 patients with normal serum creatinine levels on hospital admission, albuminuria, serum cystatin C and D-dimer levels may be an early predictor of COVID-19 related AKI and these patients should be monitored closely for AKI. Since the sample size in the AKI group was small, our study results should be confirmed with larger cohort studies.
本研究旨在确定 COVID-19 相关急性肾损伤（AKI）的发生率，并确定 AKI 的早期预测指标。
这是一项单中心、回顾性、观察性研究。纳入 2020 年 3 月 24 日至 5 月 31 日期间住院的 COVID-19 患者。所有患者均通过尿试纸、尿蛋白/肌酐比值、尿白蛋白/肌酐比值、血清胱抑素 C、入院时血清肌酐水平和入院后第 28 天评估肾功能障碍。为评估这些参数预测 AKI 的效用，生成了受试者工作特征曲线并计算了曲线下面积（AUC）。
共纳入 348 例患者。AKI 的平均发生率为 4.9%（n = 17）。轻度、中度和重度 COVID-19 患者 AKI 的发生率分别为 1.3%（n = 4）、9.0%（n = 3）和 76.9%（n = 10）。尿试纸检测到 7.8%（n = 27）的患者存在蛋白尿。在尿微量白蛋白分析中，20.1%（n = 70）的患者存在蛋白尿。持续性蛋白尿的频率为 5.2%（n = 18）。血清胱抑素 C、D-二聚体和白蛋白/肌酐比值预测 COVID-19 相关 AKI 的 AUC 值分别为 0.96（0.90-1.0）、0.94（0.89-0.98）和 0.95（0.91-0.98）。
在入院时血清肌酐正常的 COVID-19 患者中，白蛋白尿、血清胱抑素 C 和 D-二聚体水平可能是 COVID-19 相关 AKI 的早期预测指标，这些患者应密切监测 AKI。由于 AKI 组的样本量较小，我们的研究结果需要更大的队列研究来证实。
