预测肾移植受者 COVID-19 感染的结局。
Predicting the outcome of COVID-19 infection in kidney transplant recipients.
机构信息
Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
Department of Nephrology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey.
出版信息
BMC Nephrol. 2021 Mar 19;22(1):100. doi: 10.1186/s12882-021-02299-w.
BACKGROUND
We aimed to present the demographic characteristics, clinical presentation, and outcomes of our multicenter cohort of adult KTx recipients with COVID-19.
METHODS
We conducted a multicenter, retrospective study using data of patients hospitalized for COVID-19 collected from 34 centers in Turkey. Demographic characteristics, clinical findings, laboratory parameters (hemogram, CRP, AST, ALT, LDH, and ferritin) at admission and follow-up, and treatment strategies were reviewed. Predictors of poor clinical outcomes were analyzed. The primary outcomes were in-hospital mortality and the need for ICU admission. The secondary outcome was composite in-hospital mortality and/or ICU admission.
RESULTS
One hundred nine patients (male/female: 63/46, mean age: 48.4 ± 12.4 years) were included in the study. Acute kidney injury (AKI) developed in 46 (42.2%) patients, and 4 (3.7%) of the patients required renal replacement therapy (RRT). A total of 22 (20.2%) patients were admitted in the ICU, and 19 (17.4%) patients required invasive mechanical ventilation. 14 (12.8%) of the patients died. Patients who were admitted in the ICU were significantly older (age over 60 years) (38.1% vs 14.9%, p = 0.016). 23 (21.1%) patients reached to composite outcome and these patients were significantly older (age over 60 years) (39.1% vs. 13.9%; p = 0.004), and had lower serum albumin (3.4 g/dl [2.9-3.8] vs. 3.8 g/dl [3.5-4.1], p = 0.002), higher serum ferritin (679 μg/L [184-2260] vs. 331 μg/L [128-839], p = 0.048), and lower lymphocyte counts (700/μl [460-950] vs. 860 /μl [545-1385], p = 0.018). Multivariable analysis identified presence of ischemic heart disease and initial serum creatinine levels as independent risk factors for mortality, whereas age over 60 years and initial serum creatinine levels were independently associated with ICU admission. On analysis for predicting secondary outcome, age above 60 and initial lymphocyte count were found to be independent variables in multivariable analysis.
CONCLUSION
Over the age of 60, ischemic heart disease, lymphopenia, poor graft function were independent risk factors for severe COVID-19 in this patient group. Whereas presence of ischemic heart disease and poor graft function were independently associated with mortality.
背景
本研究旨在展示我们多中心队列中 COVID-19 成年肾移植受者的人口统计学特征、临床表现和结局。
方法
我们进行了一项多中心、回顾性研究，使用了来自土耳其 34 个中心收集的 COVID-19 住院患者的数据。回顾了入院时和随访时的人口统计学特征、临床发现、实验室参数（血常规、CRP、AST、ALT、LDH 和铁蛋白）以及治疗策略。分析了不良临床结局的预测因素。主要结局为住院死亡率和需要 ICU 入院。次要结局为复合住院死亡率和/或 ICU 入院。
结果
研究共纳入 109 例患者（男/女：63/46，平均年龄：48.4±12.4 岁）。46 例（42.2%）患者发生急性肾损伤（AKI），4 例（3.7%）患者需要肾脏替代治疗（RRT）。共有 22 例（20.2%）患者入住 ICU，19 例（17.4%）患者需要有创机械通气。14 例（12.8%）患者死亡。入住 ICU 的患者年龄明显较大（年龄超过 60 岁）（38.1% vs. 14.9%，p=0.016）。23 例（21.1%）患者达到复合结局，这些患者年龄明显较大（年龄超过 60 岁）（39.1% vs. 13.9%；p=0.004），且血清白蛋白水平较低（3.4 g/dl [2.9-3.8] vs. 3.8 g/dl [3.5-4.1]，p=0.002），血清铁蛋白水平较高（679 μg/L [184-2260] vs. 331 μg/L [128-839]，p=0.048），淋巴细胞计数较低（700/μl [460-950] vs. 860 /μl [545-1385]，p=0.018）。多变量分析确定缺血性心脏病和初始血清肌酐水平是死亡的独立危险因素，而年龄超过 60 岁和初始血清肌酐水平与 ICU 入院独立相关。在分析预测次要结局时，多变量分析发现年龄大于 60 岁和初始淋巴细胞计数是独立变量。
结论
在该患者群体中，年龄超过 60 岁、缺血性心脏病、淋巴细胞减少、移植物功能不良是 COVID-19 重症的独立危险因素。而存在缺血性心脏病和移植物功能不良与死亡率独立相关。
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