Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, MC 8516, Dallas, TX, 75390, USA.
University of Texas Southwestern College of Medicine, Dallas, TX, USA.
BMC Nephrol. 2022 Feb 1;23(1):50. doi: 10.1186/s12882-022-02677-y.
Acute kidney injury (AKI) is a common complication in patients hospitalized with COVID-19 and may require renal replacement therapy (RRT). Dipstick urinalysis is frequently obtained, but data regarding the prognostic value of hematuria and proteinuria for kidney outcomes is scarce.
Patients with positive severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) PCR, who had a urinalysis obtained on admission to one of 20 hospitals, were included. Nested models with degree of hematuria and proteinuria were used to predict AKI and RRT during admission. Presence of Chronic Kidney Disease (CKD) and baseline serum creatinine were added to test improvement in model fit.
Of 5,980 individuals, 829 (13.9%) developed an AKI during admission, and 149 (18.0%) of those with AKI received RRT. Proteinuria and hematuria degrees significantly increased with AKI severity (P < 0.001 for both). Any degree of proteinuria and hematuria was associated with an increased risk of AKI and RRT. In predictive models for AKI, presence of CKD improved the area under the curve (AUC) (95% confidence interval) to 0.73 (0.71, 0.75), P < 0.001, and adding baseline creatinine improved the AUC to 0.85 (0.83, 0.86), P < 0.001, when compared to the base model AUC using only proteinuria and hematuria, AUC = 0.64 (0.62, 0.67). In RRT models, CKD status improved the AUC to 0.78 (0.75, 0.82), P < 0.001, and baseline creatinine improved the AUC to 0.84 (0.80, 0.88), P < 0.001, compared to the base model, AUC = 0.72 (0.68, 0.76). There was no significant improvement in model discrimination when both CKD and baseline serum creatinine were included.
Proteinuria and hematuria values on dipstick urinalysis can be utilized to predict AKI and RRT in hospitalized patients with COVID-19. We derived formulas using these two readily available values to help prognosticate kidney outcomes in these patients. Furthermore, the incorporation of CKD or baseline creatinine increases the accuracy of these formulas.
急性肾损伤（AKI）是 COVID-19 住院患者的常见并发症，可能需要肾脏替代治疗（RRT）。经常进行尿试纸分析，但关于血尿和蛋白尿对肾脏结局的预后价值的数据很少。
纳入了 SARS-CoV2 PCR 阳性并在 20 家医院之一获得尿分析的患者。使用尿蛋白和血尿程度的嵌套模型来预测住院期间的 AKI 和 RRT。加入慢性肾脏病（CKD）和基线血清肌酐以检验模型拟合度的改善。
在 5980 名个体中，829 名（13.9%）在住院期间发生 AKI，其中 149 名（18.0%）发生 AKI 的患者接受了 RRT。蛋白尿和血尿程度与 AKI 严重程度显著相关（两者均 P<0.001）。任何程度的蛋白尿和血尿均与 AKI 和 RRT 的风险增加相关。在 AKI 的预测模型中，CKD 的存在提高了曲线下面积（AUC）（95%置信区间）至 0.73（0.71，0.75），P<0.001，并且与仅使用蛋白尿和血尿的基础模型 AUC 相比，基线肌酐的加入提高了 AUC 至 0.85（0.83，0.86），P<0.001。在 RRT 模型中，CKD 状态提高了 AUC 至 0.78（0.75，0.82），P<0.001，并且与基础模型 AUC 相比，基线肌酐的加入提高了 AUC 至 0.84（0.80，0.88），P<0.001。当同时包括 CKD 和基线血清肌酐时，模型的区分度没有显著改善。
住院 COVID-19 患者的尿试纸分析中的蛋白尿和血尿值可用于预测 AKI 和 RRT。我们使用这两个现成的值推导出了公式，以帮助预测这些患者的肾脏结局。此外，加入 CKD 或基线肌酐可提高这些公式的准确性。
