Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, 751 85 Uppsala, Sweden.
Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden.
Int J Mol Sci. 2022 Dec 10;23(24):15687. doi: 10.3390/ijms232415687.
A selective decrease in the renal filtration of larger molecules is attributed to the shrinkage of glomerular pores, a condition termed Shrunken Pore Syndrome (SPS). SPS is associated with poor long-term prognosis. We studied SPS as a risk marker in a cohort of patients with COVID-19 treated in an intensive care unit. SPS was defined as a ratio < 0.7 when the estimated glomerular filtration rate (eGFR), determined by cystatin C, calculated by the Cystatin C Caucasian-Asian-Pediatric-Adult equation (CAPA), was divided by the eGFR determined by creatinine, calculated by the revised Lund−Malmö creatinine equation (LMR). Clinical data were prospectively collected. In total, SPS was present in 86 (24%) of 352 patients with COVID-19 on ICU admission. Patients with SPS had a higher BMI, Simplified Physiology Score (SAPS3), and had diabetes and/or hypertension more frequently than patients without SPS. Ninety-nine patients in the total cohort were women, 50 of whom had SPS. In dexamethasone-naïve patients, C-reactive protein (CRP ), TNF-alpha, and interleukin-6 did not differ between SPS and non-SPS patients. Demographic factors (gender, BMI) and illness severity (SAPS3) were independent predictors of SPS. Age and dexamethasone treatment did not affect the frequency of SPS after adjustments for age, sex, BMI, and acute severity. SPS is frequent in severely ill COVID-19 patients. Female gender was associated with a higher proportion of SPS. Demographic factors and illness severity were independent predictors of SPS.
选择性地减少对较大分子的肾脏滤过归因于肾小球孔的收缩，这种情况称为小孔收缩综合征（SPS）。SPS 与不良的长期预后相关。我们研究了 SPS 作为 COVID-19 患者在重症监护病房治疗的队列中的风险标志物。当通过半胱氨酸蛋白酶抑制剂 C 确定的估算肾小球滤过率（eGFR），通过半胱氨酸蛋白酶抑制剂 C 白种人-亚洲-儿科-成人方程（CAPA）计算，除以通过肌酐确定的 eGFR 时，定义为 SPS 比值 < 0.7 ，通过修订后的 Lund-Malmö 肌酐方程（LMR）计算。临床数据是前瞻性收集的。总共，352 名 COVID-19 患者中有 86 名（24％）在入住 ICU 时存在 SPS。患有 SPS 的患者的 BMI、简化生理学评分（SAPS3）较高，并且患有糖尿病和/或高血压的频率高于没有 SPS 的患者。在总共 99 名患者中，有 50 名女性患有 SPS。在接受地塞米松治疗的患者中，SPS 和非 SPS 患者之间的 C 反应蛋白（CRP）、TNF-α 和白细胞介素 6 没有差异。人口统计学因素（性别、BMI）和疾病严重程度（SAPS3）是 SPS 的独立预测因子。年龄和地塞米松治疗在调整年龄、性别、BMI 和急性严重程度后，不会影响 SPS 的频率。SPS 在患有严重 COVID-19 的患者中很常见。女性的 SPS 比例较高。人口统计学因素和疾病严重程度是 SPS 的独立预测因子。
