Russo Elisa, Tagliafico Alberto Stefano, Derchi Lorenzo, Bignotti Bianca, Tosto Simona, Martinoli Carlo, Signori Alessio, Brigati Francesca, Viazzi Francesca
Nephrology Unit, Ospedale San Luca, 55100 Lucca, Italy.
Department of Health Sciences (DISSAL), University of Genova, 16126 Genova, Italy.
J Clin Med. 2023 Jan 25;12(3):929. doi: 10.3390/jcm12030929.
Chest CT on coronavirus disease (COVID-19) has been extensively investigated. Acute kidney injury (AKI) has been widely described among COVID patients, but the role of kidney imaging has been poorly explored. The aim of this study is to clarify the role of opportunistic kidney assessment on non-enhanced chest CT.
We collected data on patients with COVID-19 consecutively admitted to our institution who underwent chest CT (including the upper parts of kidneys as per protocol). Three ROIs of 0.5-0.7 cm were positioned in every kidney. The values of renal parenchyma attenuation (RPA) and the presence of perirenal fat stranding (PFS) were analyzed. The primary and secondary outcomes were the occurrence of AKI and death.
86 patients with COVID-19 and unenhanced chest CT were analyzed. The cohort was split into CT RPA quartiles. Patients with a CT RPA <24 HU were more likely to develop AKI when compared with other patients (χ = 2.77, = 0.014): at multivariate logistic regression analysis, being in the first quartile of CT RPA was independently associated with a four times higher risk of AKI (HR 4.56 [95% CI 1.27-16.44, = 0.020). Within a mean 22 ± 15 days from admission, 32 patients died (37.2%). Patients with PFS were more likely to die as compared to patients without it (HR 3.90 [95% CI 1.12-13.48], = 0.031).
Detection of low RPA values and of PFS in COVID-19 patients independently predicts, respectively, the occurrence of AKI and an increased risk for mortality. Therefore, opportunistic kidney assessment during chest CT could help physicians in defining diagnostic and therapeutic strategies.
胸部CT在冠状病毒病（COVID-19）方面已得到广泛研究。急性肾损伤（AKI）在COVID患者中已有广泛描述，但肾脏成像的作用尚未得到充分探索。本研究的目的是阐明在非增强胸部CT上进行机会性肾脏评估的作用。
我们收集了连续入住我院并接受胸部CT（按照方案包括肾脏上部）的COVID-19患者的数据。在每个肾脏中放置三个0.5 - 0.7厘米的感兴趣区（ROI）。分析肾实质衰减（RPA）值和肾周脂肪条索（PFS）的存在情况。主要和次要结局分别是AKI的发生和死亡。
对86例接受非增强胸部CT的COVID-19患者进行了分析。该队列被分为CT RPA四分位数。与其他患者相比，CT RPA <24 HU的患者更有可能发生AKI（χ = 2.77，P = 0.014）：在多因素逻辑回归分析中，处于CT RPA的第一个四分位数与AKI风险高四倍独立相关（HR 4.56 [95% CI 1.27 - 16.44，P = 0.020]）。在入院后平均22±15天内，32例患者死亡（37.2%）。与没有PFS的患者相比，有PFS的患者死亡可能性更大（HR 3.90 [95% CI 1.12 - 13.48]，P = 0.031）。
在COVID-19患者中检测到低RPA值和PFS分别独立预测AKI的发生和死亡风险增加。因此，在胸部CT期间进行机会性肾脏评估可以帮助医生确定诊断和治疗策略。
