Renal Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
Faculty of Life Sciences and Medicine, King's College London, London, UK.
BMC Nephrol. 2021 Nov 1;22(1):359. doi: 10.1186/s12882-021-02557-x.
Acute kidney injury (AKI) is common among patients hospitalised with COVID-19 and associated with worse prognosis. The aim of this study was to investigate the epidemiology, risk factors and outcomes of AKI in patients with COVID-19 in a large UK tertiary centre.
We analysed data of consecutive adults admitted with a laboratory-confirmed diagnosis of COVID-19 across two sites of a hospital in London, UK, from 1st January to 13th May 2020.
Of the 1248 inpatients included, 487 (39%) experienced AKI (51% stage 1, 13% stage 2, and 36% stage 3). The weekly AKI incidence rate gradually increased to peak at week 5 (3.12 cases/100 patient-days), before reducing to its nadir (0.83 cases/100 patient-days) at the end the study period (week 10). Among AKI survivors, 84.0% had recovered renal function to pre-admission levels before discharge and none required on-going renal replacement therapy (RRT). Pre-existing renal impairment [odds ratio (OR) 3.05, 95%CI 2.24-4,18; p < 0.0001], and inpatient diuretic use (OR 1.79, 95%CI 1.27-2.53; p < 0.005) were independently associated with a higher risk for AKI. AKI was a strong predictor of 30-day mortality with an increasing risk across AKI stages [adjusted hazard ratio (HR) 1.59 (95%CI 1.19-2.13) for stage 1; p < 0.005, 2.71(95%CI 1.82-4.05); p < 0.001for stage 2 and 2.99 (95%CI 2.17-4.11); p < 0.001for stage 3]. One third of AKI3 survivors (30.7%), had newly established renal impairment at 3 to 6 months.
This large UK cohort demonstrated a high AKI incidence and was associated with increased mortality even at stage 1. Inpatient diuretic use was linked to a higher AKI risk. One third of survivors with AKI3 exhibited newly established renal impairment already at 3-6 months.
急性肾损伤（AKI）在 COVID-19 住院患者中很常见，与预后较差相关。本研究旨在调查英国一家大型三级中心 COVID-19 住院患者 AKI 的流行病学、危险因素和结局。
我们分析了 2020 年 1 月 1 日至 5 月 13 日期间，英国伦敦两家医院连续确诊 COVID-19 的成年住院患者的数据。
在纳入的 1248 例住院患者中，487 例（39%）发生 AKI（51%为 1 期，13%为 2 期，36%为 3 期）。每周 AKI 发生率逐渐增加，在第 5 周达到峰值（3.12 例/100 患者天），然后在研究结束时（第 10 周）降至最低点（0.83 例/100 患者天）。在 AKI 幸存者中，84.0%的患者在出院前恢复到入院前的肾功能水平，无患者需要持续肾脏替代治疗（RRT）。预先存在的肾功能损害（比值比 [OR] 3.05，95%置信区间 [CI] 2.24-4.18；p<0.0001）和住院期间利尿剂的使用（OR 1.79，95%CI 1.27-2.53；p<0.005）与 AKI 的发生风险增加独立相关。AKI 是 30 天死亡率的强预测因素，AKI 各期的风险逐渐增加[1 期的校正风险比（HR）为 1.59（95%CI 1.19-2.13）；p<0.005，2 期为 2.71（95%CI 1.82-4.05）；p<0.001，3 期为 2.99（95%CI 2.17-4.11）；p<0.001]。AKI3 幸存者中有三分之一（30.7%）在 3 至 6 个月时出现新的肾功能损害。
这项英国大型队列研究显示 AKI 发病率较高，即使在 1 期，死亡率也增加。住院期间利尿剂的使用与 AKI 风险增加相关。AKI3 幸存者中有三分之一在 3-6 个月时已经出现新的肾功能损害。
