Alfano Gaetano, Ferrari Annachiara, Fontana Francesco, Mori Giacomo, Magistroni Riccardo, Meschiari Marianna, Franceschini Erica, Menozzi Marianna, Cuomo Gianluca, Orlando Gabriella, Santoro Antonella, Digaetano Margherita, Puzzolante Cinzia, Carli Federica, Bedini Andrea, Milic Jovana, Coloretti Irene, Raggi Paolo, Mussini Cristina, Girardis Massimo, Cappelli Gianni, Guaraldi Giovanni
Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
Clin Exp Nephrol. 2021 Nov;25(11):1203-1214. doi: 10.1007/s10157-021-02092-x. Epub 2021 Jul 1.
Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in patients with COVID-19.
We reviewed the health medical records of 307 consecutive patients with COVID-19 hospitalized at the University Hospital of Modena, Italy.
AKI was diagnosed in 69 out of 307 (22.4%) COVID-19 patients. Stages 1, 2, or 3 AKI accounted for 57.9%, 24.6% and 17.3%, respectively. AKI patients had a mean age of 74.7 ± 9.9 years. These patients showed higher serum levels of the main markers of inflammation and higher rate of severe pneumonia than non-AKI patients. Kidney injury was associated with a higher rate of urinary abnormalities including proteinuria (0.44 ± 0.85 vs 0.18 ± 0.29 mg/mg; P = < 0.0001) and microscopic hematuria (P = 0.032) compared to non-AKI patients. Hemodialysis was performed in 7.2% of the subjects and 33.3% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were age, male sex, CKD and higher non-renal SOFA score. Patients with AKI had a mortality rate of 56.5%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (hazard ratio [HR] = 4.82; CI 95%, 1.36-17.08) compared to non-AKI patients.
AKI was a common and harmful consequence of COVID-19. It manifested with urinary abnormalities (proteinuria, microscopic hematuria) and conferred an increased risk for death. Given the well-known short-term sequelae of AKI, prevention of kidney injury is imperative in this vulnerable cohort of patients.
急性肾损伤（AKI）是2019冠状病毒病（COVID-19）的一种严重并发症。本研究旨在评估COVID-19患者中AKI的发病率、危险因素和病死率。
我们回顾了意大利摩德纳大学医院连续收治的307例COVID-19患者的健康医疗记录。
307例COVID-19患者中有69例（22.4%）被诊断为AKI。1、2或3期AKI分别占57.9%、24.6%和17.3%。AKI患者的平均年龄为74.7±9.9岁。与非AKI患者相比，这些患者的炎症主要标志物血清水平更高，重症肺炎发生率更高。与非AKI患者相比，肾损伤与更高的尿液异常发生率相关，包括蛋白尿（尿蛋白/肌酐比值：0.44±0.85 vs 0.18±0.29mg/mg；P＜0.0001）和镜下血尿（P = 0.032）。7.2%的受试者接受了血液透析，33.3%的幸存者在AKI后肾功能未恢复。肾损伤的危险因素包括年龄、男性、慢性肾脏病（CKD）和更高的非肾序贯器官衰竭评估（SOFA）评分。AKI患者的死亡率为56.5%。校正后的Cox回归分析显示，与非AKI患者相比，COVID-19相关的AKI与院内死亡独立相关（风险比[HR] = 4.82；95%置信区间，1.36 - 17.08）。
AKI是COVID-19常见且有害的后果。它表现为尿液异常（蛋白尿、镜下血尿），并增加死亡风险。鉴于AKI众所周知的短期后遗症，在这一脆弱的患者群体中预防肾损伤势在必行。
