COVID-19 住院患者急性肾损伤的发病率及预后：一项回顾性队列研究
Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study.
作者信息
Pitre Tyler, Dong Angela Hong Tian, Jones Aaron, Kapralik Jessica, Cui Sonya, Mah Jasmine, Helmeczi Wryan, Su Johnny, Patel Vivek, Zia Zaka, Mallender Michael, Tang Xinxin, Webb Cooper, Patro Nivedh, Junek Mats, Duong MyLinh, Ho Terence, Beauchamp Marla K, Costa Andrew P, Kruisselbrink Rebecca, Tsang Jennifer L Y, Walsh Michael
机构信息
Department of Internal Medicine, McMaster University, Hamilton, ON, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
出版信息
Can J Kidney Health Dis. 2021 Jul 11;8:20543581211027759. doi: 10.1177/20543581211027759. eCollection 2021.
BACKGROUND
The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population.
OBJECTIVE
To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI.
DESIGN
Retrospective cohort study from a registry of patients with COVID-19.
SETTING
Three community and 3 academic hospitals.
PATIENTS
A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021.
MEASUREMENTS
Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality.
METHODS
We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality.
RESULTS
Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]).
LIMITATIONS
Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences.
CONCLUSIONS
Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification.
TRIAL REGISTRATION
The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.
背景
在加拿大人群中，新型冠状病毒肺炎（COVID-19）患者急性肾损伤（AKI）的发病率及其与死亡率和疾病严重程度的关联尚未得到充分研究。
目的
确定入住内科和重症监护病房（ICU）的COVID-19患者队列中AKI的发病率、其与住院死亡率及疾病严重程度的关联。我们的目的是按院外AKI和院内AKI对这些结果进行分层。
设计
一项基于COVID-19患者登记册的回顾性队列研究。
地点
3家社区医院和3家学术医院。
患者
2020年3月4日至2021年4月23日期间因COVID-19入院的815例患者。
测量指标
AKI分期、入住ICU、机械通气和住院死亡率。
方法
我们通过比较患者住院期间记录的最高血清肌酐水平与最低血清肌酐水平来对AKI进行分类，并根据改善全球肾脏病预后（KDIGO）系统对AKI进行分期。我们计算了AKI分期以及入住ICU、机械通气和住院死亡率结果的未调整和调整后的比值比。
结果
在登记的815例患者中，439例（53.9%）发生了AKI，253例（57.6%）入院时即存在AKI，186例（42.4%）在住院期间发生AKI。随着AKI分期加重，入住ICU、机械通气和死亡的几率增加。住院期间发生的3期AKI增加了死亡几率（比值比[OR]=7.87[4.35，14.23]）。住院前发生的3期AKI也增加了死亡几率（OR=5.28[2.60，10.73]）。
局限性
观察性研究，样本量小限制了估计的精确度。缺乏未感染COVID-19的非住院患者以及感染COVID-而未住院的患者作为对照，限制了因果推断。
结论
急性肾损伤，无论发生在住院前还是住院后，均与COVID-19患者不良预后的高风险相关。对COVID-19患者进行肾功能的常规评估可能会改善风险分层。
试验注册
该研究未在公开可访问的注册机构注册，因为它不涉及对人类参与者的任何医疗干预。
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