Singh Bhupinder, Dogra Pavitra Manu, Sood Vivek, Singh Vishal, Katyal Amit, Dhawan Manish, Madabhushi Shyam, Kumar Krishna M, Singh Bhupendra, Sharma Abhishek
Department of Medicine, Army Hospital (Research & Referral), New Delhi, India.
Department of Nephrology, Army Hospital (Research & Referral), New Delhi, India.
Indian J Crit Care Med. 2023 Feb;27(2):119-126. doi: 10.5005/jp-journals-10071-24408.
The data of acute kidney injury (AKI), that is, community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI) among non-COVID patients from intensive care units (ICU) during the coronavirus disease-2019 (COVID-19) pandemic are scarce. We planned to study the change in the profile of such patients compared to the pre-pandemic era.
This prospective observational study was conducted at four ICUs dealing with non-COVID patients at a government hospital in North India, and was aimed at assessing outcomes, and mortality predictors of AKI among non-COVID patients during the COVID-19 pandemic. Renal and patient survival at ICU transfer-out and hospital discharge, ICU and hospital stay duration, mortality predictors, and dialysis requirement at discharge were evaluated. The current or previous COVID-19 infection, previous AKI or chronic kidney disease (CKD), organ donors, and organ transplant patients were excluded.
Among the 200 non-COVID-19 AKI patients, diabetes mellitus (DM), primary hypertension, and cardiovascular diseases were the predominant comorbidities in descending order. The commonest cause of AKI was severe sepsis, followed by systemic infections and post-surgery patients. Dialysis requirements at ICU admission during ICU stay and above 30 days were seen in 20.5, 47.5, and 6.5% of patients, respectively. Incidence of CA-AKI and HA-AKI was 1.24:1, whereas dialysis requirement above 30 days was 0.85:1, respectively. The 30-day mortality was 42%. Hepatic dysfunction [hazard ratio (HR): 3.471], septicemia (HR: 3.342), age above 60 years (HR: 4.000), higher sequential organ failure assessment (SOFA) score (HR: 1.107; = 0.001), anemia ( = 0.003), and low serum iron ( = 0.001) were important mortality predictors in AKI.
Compared to the pre-COVID era, CA-AKI was more common than HA-AKI due to restricted elective surgeries during the COVID-19 pandemic. Acute kidney injury with multiorgan involvement and hepatic dysfunction, elderly age with higher SOFA score and sepsis were predictors of adverse renal and patient outcomes.
Singh B, Dogra PM, Sood V, Singh V, Katyal A, Dhawan M, . Spectrum, Outcomes, and Mortality Predictors of Acute Kidney Injury among Non-COVID-19 Patients during COVID-19 Pandemic: Data from Four Intensive Care Units. Indian J Crit Care Med 2023;27(2):119-126.
在2019冠状病毒病（COVID-19）大流行期间，重症监护病房（ICU）中非COVID患者的急性肾损伤（AKI）数据，即社区获得性AKI（CA-AKI）和医院获得性AKI（HA-AKI）数据匮乏。我们计划研究与大流行前时代相比，此类患者情况的变化。
这项前瞻性观察性研究在印度北部一家政府医院的四个处理非COVID患者的ICU中进行，旨在评估COVID-19大流行期间非COVID患者中AKI的结局和死亡预测因素。评估了转出ICU和出院时的肾脏及患者生存率、ICU和住院时间、死亡预测因素以及出院时的透析需求。排除当前或既往感染COVID-19、既往AKI或慢性肾脏病（CKD）、器官捐献者以及器官移植患者。
在200例非COVID-19 AKI患者中，糖尿病（DM）、原发性高血压和心血管疾病是按降序排列的主要合并症。AKI最常见的原因是严重脓毒症，其次是全身感染和术后患者。分别有20.5%、47.5%和6.5%的患者在ICU住院期间、住院30天及以上时在ICU入院时需要透析。CA-AKI与HA-AKI的发生率为1.24:1，而30天以上透析需求的发生率为0.85:1。30天死亡率为42%。肝功能障碍[风险比（HR）：3.471]、败血症（HR：3.342）、60岁以上（HR：4.000）、较高的序贯器官衰竭评估（SOFA）评分（HR：1.107；P = 0.001）、贫血（P = 0.003）和低血清铁（P = 0.001）是AKI中重要的死亡预测因素。
与COVID-19大流行前时代相比，由于COVID-19大流行期间择期手术受限，CA-AKI比HA-AKI更常见。多器官受累和肝功能障碍的急性肾损伤、SOFA评分较高的老年患者以及败血症是不良肾脏和患者结局的预测因素。
Singh B, Dogra PM, Sood V, Singh V, Katyal A, Dhawan M, 。COVID-19大流行期间非COVID-19患者急性肾损伤的谱图、结局及死亡预测因素：来自四个重症监护病房的数据。《印度重症监护医学杂志》2023；27(2):119 - 126。
