肾移植受者与非肾移植受者中严重急性呼吸综合征冠状病毒 2 的比较分析:来自东南亚 2019 年冠状病毒病第二次浪潮的最大单中心报告。

Comparative Analysis of Kidney Transplant Recipients with Severe Acute Respiratory Syndrome Coronavirus 2 Compared with Nonkidney Transplant Recipients: A Largest Single-center Report from the Second Wave of Coronavirus Disease 2019 Pandemic in South East Asia.

机构信息

Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India.

出版信息

Saudi J Kidney Dis Transpl. 2022 Jan-Feb;33(1):46-57. doi: 10.4103/1319-2442.367825.

Abstract

Outcomes of severe acute respiratory syndrome coronavirus 2 in kidney transplant recipients (KTR) compared with matched cohort are certainly lacking for different pandemic waves and geographic regions. In this single-center retrospective study of coronavirus disease-2019 (COVID-19) cases admitted during March 26, 2021 to June 7, 2021, a propensity-matched analysis in a 1:1 ratio was performed to compare the clinical profile and outcomes between KTR and non-KTR. A Cox proportional hazard model from the whole study population to analyze risk factors for severe disease and mortality was calculated. We identified 1052 COVID-19 cases, of which 107 (10.1%) were KTR. In propensity-matched analysis, KTR had higher fever (81.6 % vs. 60%; P = 0.01), lymphopenia (30% vs. 11.7%; P = 0.02), higher neutrophil-to-lymphocyte ratio (43.3% vs. 25%; P = 0.05), and acute kidney injury (66.6% vs. 36.7%; P = 0.001). In Kaplan-Meier survival analysis, there was no difference in mortality or severity of COVID-19. In Cox hazard proportional analysis, the European cooperative oncology group (ECOG) score of 1 to 2 [Hazard ratio (HR) 95% lower confidence interval (CI), upper CI = 4.9 (1.8-13.5); P <0.01], ECOG of >2 [HR = 20 (7.5, 54.7); P <0.01] and waitlisted status [HR = 1.9 (1.1-3.3); P = 0.02] was associated with significant mortality. Kidney transplantation [HR = 0.8 (0.47-1.44); P = 0.5] was not associated with mortality in the analysis. In our report, kidney transplantation status had a different spectrum but was not found to be independently associated with COVID-19 severity or mortality.

摘要

在不同的大流行浪潮和地理区域,与匹配队列相比,严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2)在肾移植受者(KTR)中的结局肯定缺乏。在这项对 2021 年 3 月 26 日至 2021 年 6 月 7 日期间因 2019 年冠状病毒病(COVID-19)住院的病例进行的单中心回顾性研究中,采用 1:1 的倾向评分匹配分析比较了 KTR 和非 KTR 之间的临床特征和结局。使用整个研究人群的 Cox 比例风险模型分析严重疾病和死亡率的危险因素。我们共发现 1052 例 COVID-19 病例,其中 107 例(10.1%)为 KTR。在倾向评分匹配分析中,KTR 发热的比例更高(81.6% vs. 60%;P = 0.01)、淋巴细胞减少的比例更高(30% vs. 11.7%;P = 0.02)、中性粒细胞与淋巴细胞比值更高(43.3% vs. 25%;P = 0.05)和急性肾损伤的比例更高(66.6% vs. 36.7%;P = 0.001)。在 Kaplan-Meier 生存分析中,COVID-19 的死亡率或严重程度无差异。在 Cox 风险比例分析中,ECOG 评分 1-2(危险比 95%置信区间(CI)的下限和上限= 4.9(1.8-13.5);P <0.01)、ECOG >2(HR = 20(7.5,54.7);P <0.01)和等待移植状态(HR = 1.9(1.1-3.3);P = 0.02)与死亡率显著相关。肾移植(HR = 0.8(0.47-1.44);P = 0.5)与分析中的死亡率无关。在我们的报告中,肾移植状态具有不同的特征,但未发现与 COVID-19 的严重程度或死亡率独立相关。

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