Elkholi Mohamed Hamed, Alrais Zeyad Faoor, Algouhary Abdallah Reda, Al-Taie Muthana Salim, Sawwan Amr Abass, Khalafalla Abdelnasser Ahmed, Beniamein Maged Mohsen, Alkhouly Adel Elsaid, Shoaib Mohamed Ibrahim, Alkholy Hesham Elsaid, Abdel Hadi Ammar Mohamed, Abu Alkhair Ahmed Tarek
Department of Intensive Care, Rashid Hospital, Dubai, UAE.
Department of Anesthesia, Rashid Hospital, Dubai, UAE.
Int J Crit Illn Inj Sci. 2021 Jul-Sep;11(3):123-133. doi: 10.4103/IJCIIS.IJCIIS_194_20. Epub 2021 Sep 25.
Acute kidney injury (AKI) is repeatedly observed in ventilated critically ill patients with coronavirus disease-2019 (COVID-19) pneumonia. This study aimed to determine the incidence, risk factors, and consequences of AKI in the ventilated critically ill adult patients with COVID-19 pneumonia.
This retrospective study included all the ventilated critically ill adult patients with COVID-19 pneumonia from March 1, 2020, to June 1, 2020. Data were collected from the electronic medical system. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice definition. Patients were followed 90 days from the intensive care unit (ICU) admission time or to the date when they were discharged from the hospital.
AKI occurred in 65.1% of patients, with 26.6% of these started on continuous renal replacement therapy (CRRT). Patients with AKI had higher comorbidity and illness severity scores ( < 0.001). Age and the vasopressor requirements were predictors of AKI (P= 0.016 and = 0.041) and hypertension predicted AKI ( = 0.099) and its progression ( = 0.05). The renal recovery rate was 86.7% and was associated with the mean arterial pressure on ICU admission in the no-CRRT group ( = 0.014) and the hypoxic index in the CRRT group ( = 0.019). AKI was associated with higher mortality ( = 0.017) and significantly longer ICU length-of-stay ( = 0.001). Additionally, AKI patients were more often discharged to a long-term skilled nursing facility ( = 0.005).
COVID-19-associated AKI was common and associated with poor outcome, with the specific mechanisms being the main driving factors.
在患有2019冠状病毒病（COVID-19）肺炎的机械通气重症患者中，急性肾损伤（AKI）屡见不鲜。本研究旨在确定患有COVID-19肺炎的机械通气成年重症患者中AKI的发生率、危险因素及后果。
这项回顾性研究纳入了2020年3月1日至2020年6月1日期间所有患有COVID-19肺炎的机械通气成年重症患者。数据从电子医疗系统收集。AKI采用2012年改善全球肾脏病预后组织（KDIGO）临床实践定义进行诊断。从重症监护病房（ICU）入院时间起对患者进行90天随访，或随访至其出院日期。
65.1%的患者发生了AKI，其中26.6%开始接受持续肾脏替代治疗（CRRT）。发生AKI的患者合并症和疾病严重程度评分更高（P<0.001）。年龄和血管升压药需求是AKI的预测因素（P=0.016和P=0.041），高血压可预测AKI（P=0.099）及其进展（P=0.05）。肾脏恢复率为86.7%，在非CRRT组中与ICU入院时的平均动脉压相关（P=0.014），在CRRT组中与低氧指数相关（P=0.019）。AKI与更高的死亡率相关（P=0.017），且ICU住院时间显著更长（P=0.001）。此外，AKI患者更常被转至长期专业护理机构（P=0.005）。
COVID-19相关的AKI很常见且与不良预后相关，具体机制是主要驱动因素。
