General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, England.
NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton / University of Southampton, Tremona Road, Southampton, SO16 6YD, England.
BMC Nephrol. 2021 Mar 15;22(1):92. doi: 10.1186/s12882-021-02296-z.
Acute kidney injury (AKI) is a common manifestation among patients critically ill with SARS-CoV-2 infection (Coronavirus 2019) and is associated with significant morbidity and mortality. The pathophysiology of renal failure in this context is not fully understood, but likely to be multifactorial. The intensive care unit outcomes of patients following COVID-19 acute critical illness with associated AKI have not been fully explored. We conducted a cohort study to investigate the risk factors for acute kidney injury in patients admitted to and intensive care unit with COVID-19, its incidence and associated outcomes.
We reviewed the medical records of all patients admitted to our adult intensive care unit suffering from SARS-CoV-2 infection from 14th March 2020 until 12th May 2020. Acute kidney injury was defined using the Kidney Disease Improving Global Outcome (KDIGO) criteria. The outcome analysis was assessed up to date as 3rd of September 2020.
A total of 81 patients admitted during this period. All patients had acute hypoxic respiratory failure and needed either noninvasive or invasive mechanical ventilatory support. Thirty-six patients (44%) had evidence of AKI (Stage I-33%, Stage II-22%, Renal Replacement Therapy (RRT)-44%). All patients with AKI stage III had RRT. Age, diabetes mellitus, immunosuppression, lymphopenia, high D-Dimer levels, increased APACHE II and SOFA scores, invasive mechanical ventilation and use of inotropic or vasopressor support were significantly associated with AKI. The peak AKI was at day 4 and mean duration of RRT was 12.5 days. The mortality was 25% for the AKI group compared to 6.7% in those without AKI. Among those received RRT and survived their illness, the renal function recovery is complete and back to baseline in all patients.
Acute kidney injury and renal replacement therapy is common in critically ill patients presenting with COVID-19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay. Recovery of renal function was complete in all survived patients.
急性肾损伤（AKI）是严重感染 SARS-CoV-2（2019 年冠状病毒）的危重病患者的常见表现，与显著的发病率和死亡率相关。这种情况下肾功能衰竭的病理生理学尚未完全了解，但可能是多因素的。COVID-19 急性危重病患者的 ICU 结局及其相关 AKI 尚未得到充分探讨。我们进行了一项队列研究，以调查 COVID-19 患者 AKI 的危险因素、发病率和相关结局。
我们回顾了 2020 年 3 月 14 日至 5 月 12 日期间我院成人 ICU 收治的所有 SARS-CoV-2 感染患者的病历。使用肾脏病改善全球结局（KDIGO）标准定义急性肾损伤。截至 2020 年 9 月 3 日进行了结果分析。
共有 81 例患者在此期间入院。所有患者均有急性低氧性呼吸衰竭，需要无创或有创机械通气支持。36 例（44%）有 AKI 证据（I 期-33%、II 期-22%、肾脏替代治疗（RRT）-44%）。所有 AKI Ⅲ期患者均接受 RRT。年龄、糖尿病、免疫抑制、淋巴细胞减少、D-二聚体水平升高、APACHE II 和 SOFA 评分增加、有创机械通气以及使用正性肌力或血管加压药物支持与 AKI 显著相关。AKI 的峰值出现在第 4 天，RRT 的平均持续时间为 12.5 天。AKI 组死亡率为 25%，无 AKI 组为 6.7%。在接受 RRT 并存活的患者中，所有患者的肾功能均完全恢复并回到基线。
急性肾损伤和肾脏替代治疗在 COVID-19 危重病患者中很常见。它与 ICU 入院时疾病严重程度增加、死亡率增加以及 ICU 和住院时间延长相关。所有存活患者的肾功能均完全恢复。
