Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
J Nephrol. 2021 Apr;34(2):305-314. doi: 10.1007/s40620-021-00997-0. Epub 2021 Mar 3.
In February 2020 the corona virus disease 2019 (COVID-19) infection started spreading throughout Italy, hitting the Lombardy region very hard. Despite the high diffusion, only a subset of patients developed severe COVID-19: around 25% of them developed acute kidney injury (AKI) and one-third of them died. Elderly patients and patients with high comorbidities were identified as being at higher risk of severe COVID-19.
Our prospective observational cohort study includes 392 consecutive patients hospitalized for COVID-19 in Milan (median age 67 years, 75% male). We evaluated the relationship between blood pressure at presentation, presence of AKI at Emergency Department admission and during hospitalization, and total in-hospital mortality (24%).
Although 58% of our study patients reported a history of hypertension (HYP) (86% on treatment), 30% presented with low blood pressure levels. Only 5.5% were diagnosed with AKI on admission; 75% of hypertensive patients discontinued therapy during hospitalization (only 20% were on treatment at discharge). Gender and hypertension were strongly associated with AKI at admission (odds ratio 11). Blood pressure was inversely correlated with increased risk of AKI upon admission, regardless of the severity of respiratory distress. Age over 65, history of hypertension, and severity of respiratory distress were the main predictors of AKI, which developed in 34.7% of cases during hospitalization. AKI was associated with increased in-hospital mortality. Hypertension and low blood pressure at presentation were the main predictors of in-hospital mortality, together with age over 65, baseline pulmonary involvement, and severity of illness.
In patients hospitalized for COVID-19, hypertension and low blood pressure at presentation are important risk factors for AKI and mortality. Early reduction of antihypertensive therapy may improve outcomes in patients with SARS-CoV-2 infection.
2020 年 2 月，2019 年冠状病毒病（COVID-19）感染开始在意大利各地蔓延，给伦巴第地区带来了沉重打击。尽管传播范围很广，但只有一部分患者出现严重的 COVID-19：其中约 25%的患者出现急性肾损伤（AKI），三分之一的患者死亡。老年患者和患有多种合并症的患者被认为是 COVID-19 严重感染的高危人群。
我们的前瞻性观察性队列研究包括在米兰因 COVID-19 住院的 392 例连续患者（中位年龄 67 岁，75%为男性）。我们评估了就诊时的血压、急诊就诊时和住院期间 AKI 的存在以及总住院死亡率（24%）之间的关系。
尽管我们研究的 58%的患者报告有高血压（HYP）病史（86%正在治疗），但 30%的患者血压水平较低。只有 5.5%的患者在入院时被诊断为 AKI；住院期间 75%的高血压患者停止了治疗（只有 20%在出院时接受治疗）。性别和高血压与入院时 AKI 强烈相关（比值比 11）。无论呼吸窘迫的严重程度如何，血压与入院时 AKI 的风险增加呈负相关。年龄超过 65 岁、高血压病史和呼吸窘迫的严重程度是 AKI 的主要预测因素，在住院期间 34.7%的患者中发生了 AKI。AKI 与住院死亡率增加相关。高血压和就诊时低血压是住院死亡率的主要预测因素，与年龄超过 65 岁、基线肺部受累和疾病严重程度有关。
在因 COVID-19 住院的患者中，高血压和就诊时低血压是 AKI 和死亡率的重要危险因素。早期减少抗高血压治疗可能会改善 SARS-CoV-2 感染患者的预后。
