Department of Renal Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore.
Nephron. 2021;145(3):256-264. doi: 10.1159/000514064. Epub 2021 Mar 29.
Acute kidney injury (AKI) in coronavirus infection disease (COVID-19) is associated with disease severity. We aimed to evaluate risk factors associated with AKI beyond COVID-19 severity.
A retrospective observational study of COVID-19 patients admitted to a tertiary hospital in Singapore. Logistic regression was used to evaluate associations between risk factors and AKI (based on Kidney Disease Improving Global Outcomes criteria). Dominance analysis was performed to evaluate the relative importance of individual factors.
Seven hundred seven patients were included. Median age was 46 years (interquartile range [IQR]: 29-57) and 57% were male with few comorbidities (93%, Charlson Comorbidity Index [CCI] <1). AKI occurred in 57 patients (8.1%); 39 were in AKI stage 1 (68%), 9 in stage 2 (16%), and 9 in stage 3 (16%). Older age (adjusted odds ratio [aOR] 1.04; 95% confidence interval [CI]: 1.01-1.07), baseline use of angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) (aOR 2.86; 95% CI: 1.20-6.83), exposure to vancomycin (aOR 5.84; 95% CI: 2.10-16.19), use of nonsteroidal anti-inflammatory drugs (NSAIDs) (aOR 3.04; 95% CI: 1.15-8.05), and severe COVID-19 with hypoxia (aOR 13.94; 95% CI: 6.07-31.98) were associated with AKI in the multivariable logistic regression model. The 3 highest ranked predictors were severe COVID-19 with hypoxia, vancomycin exposure, and age, accounting for 79.6% of the predicted variance (41.6, 23.1, and 14.9%, respectively) on dominance analysis.
Severe COVID-19 is independently associated with increased risk of AKI beyond premorbid conditions and age. Appropriate avoidance of vancomycin and NSAIDs are potentially modifiable means to prevent AKI in patients with COVID-19.
冠状病毒感染疾病（COVID-19）中的急性肾损伤（AKI）与疾病严重程度相关。我们旨在评估 COVID-19 严重程度以外与 AKI 相关的危险因素。
这是一项在新加坡一家三级医院进行的 COVID-19 患者回顾性观察性研究。使用逻辑回归评估危险因素与 AKI（基于肾脏病预后质量倡议标准）之间的关联。进行优势分析以评估各个因素的相对重要性。
共纳入 707 例患者。中位年龄为 46 岁（四分位间距[IQR]：29-57），57%为男性，合并症较少（93%，Charlson 合并症指数[CCI]＜1）。57 例患者发生 AKI（8.1%）；39 例为 AKI 1 期（68%），9 例为 AKI 2 期（16%），9 例为 AKI 3 期（16%）。年龄较大（调整后优势比[aOR]1.04；95%置信区间[CI]：1.01-1.07）、基线使用血管紧张素转换酶抑制剂（ACE-I）或血管紧张素受体阻滞剂（ARB）（aOR 2.86；95%CI：1.20-6.83）、万古霉素暴露（aOR 5.84；95%CI：2.10-16.19）、使用非甾体抗炎药（NSAIDs）（aOR 3.04；95%CI：1.15-8.05）以及严重 COVID-19 合并缺氧（aOR 13.94；95%CI：6.07-31.98）与多变量逻辑回归模型中的 AKI 相关。在优势分析中，预测方差的前 3 个最重要的预测因子分别是严重 COVID-19 合并缺氧、万古霉素暴露和年龄，分别占 79.6%（41.6%、23.1%和 14.9%）。
严重 COVID-19 与 AKI 风险增加独立相关，超出了疾病前状况和年龄的影响。适当避免使用万古霉素和 NSAIDs 可能是预防 COVID-19 患者 AKI 的一种可改变因素。
