Diebold Matthias, Zimmermann Tobias, Dickenmann Michael, Schaub Stefan, Bassetti Stefano, Tschudin-Sutter Sarah, Bingisser Roland, Heim Corin, Siegemund Martin, Osswald Stefan, Kuster Gabriela M, Rentsch Katharina M, Breidthardt Tobias, Twerenbold Raphael
Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland.
Department of Intensive Care Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland.
J Clin Med. 2021 May 25;10(11):2288. doi: 10.3390/jcm10112288.
Previous studies have indicated an association between coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI) but lacked a control group. The prospective observational COronaVIrus-surviVAl (COVIVA) study performed at the University Hospital, Basel, Switzerland consecutively enrolled patients with symptoms suggestive of COVID-19. We compared patients who tested positive for SARS-CoV-2 with patients who tested negative but with an adjudicated diagnosis of a respiratory tract infection, including pneumonia. The primary outcome measure was death at 30 days, and the secondary outcomes were AKI incidence and a composite endpoint of death, intensive care treatment or rehospitalization at 30 days. Five hundred and seven patients were diagnosed with respiratory tract infections, and of those, 183 (36%) had a positive PCR swab test for SARS-CoV-2. The incidence of AKI was higher in patients with COVID-19 (30% versus 12%, < 0.001), more severe (KDIGO stage 3, 22% versus 13%, = 0.009) and more often required renal replacement therapy (4.4% versus 0.93%; = 0.03). The risk of 30-day mortality and a composite endpoint was higher in patients with COVID-19-associated AKI (adjusted hazard ratio (aHR) mortality 3.98, 95% confidence interval (CI) 1.10-14.46, = 0.036; composite endpoint aHR 1.84, 95% CI 1.02-3.31, = 0.042). The mortality risk was attenuated when adjusting for disease severity (aHR 3.60, 95% CI 0.93-13.96, = 0.062). AKI occurs more frequently and with a higher severity in patients with COVID-19 and is associated with worse outcomes.
以往研究表明2019冠状病毒病（COVID-19）与急性肾损伤（AKI）之间存在关联，但缺乏对照组。在瑞士巴塞尔大学医院进行的前瞻性观察性冠状病毒生存（COVIVA）研究连续纳入有COVID-19疑似症状的患者。我们将严重急性呼吸综合征冠状病毒2（SARS-CoV-2）检测呈阳性的患者与检测呈阴性但经裁定诊断为呼吸道感染（包括肺炎）的患者进行了比较。主要结局指标为30天死亡率，次要结局为AKI发病率以及30天死亡、重症监护治疗或再次住院的复合终点。507例患者被诊断为呼吸道感染，其中183例（36%）SARS-CoV-2核酸拭子检测呈阳性。COVID-19患者的AKI发病率更高（30%对12%，<0.001），病情更严重（肾脏病改善全球预后（KDIGO）3期，22%对13%，P = 0.009），且更常需要肾脏替代治疗（4.4%对0.93%；P = 0.03）。COVID-19相关AKI患者的30天死亡率和复合终点风险更高（调整后风险比（aHR）死亡率3.98，95%置信区间（CI）1.10 - 14.46，P = 0.036；复合终点aHR 1.84，95%CI 1.02 - 3.31，P = 0.042）。调整疾病严重程度后，死亡风险降低（aHR 3.60，95%CI 0.93 - 13.96，P = 0.062）。COVID-19患者中AKI发生更频繁且病情更严重，并与更差的结局相关。
