Feihu Zhou, Department of Critical Care Medicine, the First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China, Tel: +86 10 6693 8148; E-mail:
J Nutr Health Aging. 2021;25(4):492-500. doi: 10.1007/s12603-020-1550-x.
Patients with severe or critical COVID-19 are at higher risk for developing acute kidney injury (AKI). However, whether AKI is diagnosed in all the patients and the correlation between the outcomes of COVID-19 are not well understood.
This cohort study was conducted from February 4, 2020 to April 16, 2020 in Wuhan, China. All consecutive inpatients with laboratory-confirmed COVID-19 were included in this study. AKI was defined according to the KDIGO 2012 criteria. The outcomes of patients with and without AKI and whether AKI was or was not recognized were compared.
A total of 107 elderly patients were included in the final analysis. The median age was 70 (64-78) years, and 69 (64.5%) were men. Overall, 48 of 107 patients (44.9%) developed AKI during hospitalization. Meanwhile, 22 (45.8%) cases with AKI was not recognized (missed diagnosis) in this cohort. The Kaplan-Meier curves showed that survival was better in the non-AKI group than in the AKI group (log-rank, all P < 0.001); in the subgroups of the patients with AKI, the hospital survival rate decreased when AKI was not recognized. The survival of patients with recognized AKI was better than that of patients with unrecognized AKI (log-rank, all P < 0.001). According to the multivariate regression analysis, the independent risk factors for in-hospital mortality were AKI (recognized AKI vs non-AKI: HR = 2.413; 95% CI = 1.092-5.333; P = 0.030 and unrecognized AKI vs non-AKI: HR = 4.590; 95% CI = 2.070-10.175; P <0.001), C-reactive protein level (HR = 1.004; 95% CI = 1.000-1.008; P = 0.030), lactate level (HR = 1.236; 95% CI = 1.098-1.391; P < 0.001), and disease classification (critical vs severe: HR = 0.019; 95% CI = 1.347-26.396; P = 5.963).
AKI is not an uncommon complication in elderly patients with COVID-19 who admitted to ICU. Extremely high rates of underdiagnosis and undertreatment of AKI have resulted in an elevated in-hospital mortality rate. Kidney protection is an important issue that cannot be ignored, and intensive care kidney specialists should take responsibility for leading the battle against AKI.
患有严重或危重症 COVID-19 的患者发生急性肾损伤（AKI）的风险较高。然而，并非所有患者都诊断出 AKI，以及 COVID-19 的结局与 AKI 之间的相关性尚不清楚。
本队列研究于 2020 年 2 月 4 日至 4 月 16 日在中国武汉进行。纳入所有经实验室确诊的 COVID-19 连续住院患者。AKI 根据 KDIGO 2012 标准定义。比较了有和无 AKI 的患者的结局，以及 AKI 是否被识别或未被识别的患者的结局。
最终纳入 107 例老年患者进行分析。中位年龄为 70（64-78）岁，69 例（64.5%）为男性。总体而言，107 例患者中有 48 例（44.9%）在住院期间发生 AKI。同时，该队列中 22 例（45.8%）AKI 未被识别（漏诊）。Kaplan-Meier 曲线显示，无 AKI 组的生存率优于 AKI 组（对数秩检验，均 P<0.001）；在 AKI 亚组中，当 AKI 未被识别时，住院生存率下降。识别出 AKI 的患者的生存率优于未识别出 AKI 的患者（对数秩检验，均 P<0.001）。多因素回归分析显示，住院死亡率的独立危险因素为 AKI（识别 AKI 与非 AKI：HR=2.413；95%CI=1.092-5.333；P=0.030 和未识别 AKI 与非 AKI：HR=4.590；95%CI=2.070-10.175；P<0.001）、C 反应蛋白水平（HR=1.004；95%CI=1.000-1.008；P=0.030）、乳酸水平（HR=1.236；95%CI=1.098-1.391；P<0.001）和疾病分类（危重症与重症：HR=0.019；95%CI=1.347-26.396；P=5.963）。
AKI 在收入 ICU 的 COVID-19 老年患者中并非罕见并发症。AKI 的极高漏诊和治疗不足率导致住院死亡率升高。肾脏保护是一个不容忽视的重要问题，重症监护肾脏专家应负责领导 AKI 的防治工作。
