沙特阿拉伯重症监护病房中冠状病毒病-19相关肺炎患者的急性肾损伤：一项回顾性多中心研究
Acute kidney injury in Coronavirus disease-19 related pneumonia in the intensive care unit: a retrospective multicenter study, Saudi Arabia.
作者信息
Eldaboosy Safwat A M, Awad Amgad, Farouk Abdullah, Mahdy Waheed, Abdelsalam Eman, Nour Sameh O, Kabil Ahmed, Taha Ahmad, Makled Sameh, Lotfi Ahmed, Nabway Usama, Kanany Hatem
机构信息
Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.
出版信息
Multidiscip Respir Med. 2023 Mar 1;18:895. doi: 10.4081/mrm.2023.895. eCollection 2023 Jan 17.
BACKGROUND
Acute kidney injury (AKI) poses a significant morbidity and mortality risk to critically ill COVID-19 patients. The aim of this study was to investigate the incidence, predictors, and outcomes of AKI in patients admitted to the intensive care unit (ICU) with critically ill COVID-19 pneumonia.
METHODS
A multicenter retrospective study in Saudi Arabia of adult patients aged at least 18 years diagnosed with COVID-19 pneumonia and admitted to the intensive care unit between May 2020 and May 2021 was conducted. The occurrence of AKI and associated risk factors, the need for continous renal replacement therapy (CRRT), and the outcome were reported.
RESULTS
The study included 340 patients admitted to the ICU with COVID-19. Their mean age was 66.7±13.4 years, ranging from 49 to 84 years, and most of them were men (63.8%). The most common concomitant diseases were hypertension (71.5%), diabetes (62.4%), IHD (37.6%), CKD (20%), heart failure (19.4%), and 81.2% suffered from ARDS. AKI occurred in 60.3% of patients, 38% were stage 1, 16.6% were stage 2, and 45.4% were stage 3. Approximately, 39% of patients required CRRT, out of which 76.2% were stage 3, which was significantly higher than the other stages (p<0.001). AKI patients suffered significantly from asthma and had lower levels of C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and blood urea nitrogen (BUN) and higher creatinine levels than patients without AKI (p<0.05 all). The overall mortality rate was 39.4%, and the mortality rate was significantly higher in patients with AKI than in patients without AKI (48.3% 25.9%; p<0.001).
CONCLUSION
AKI is common in adults admitted to the ICU with COVID-19 and is associated with an increased risk of death. Early detection of AKI and appropriate treatment can positively impact COVID-19 outcome. CRRT is the preferred dialysis method in critically ill ICU patients with AKI.
背景
急性肾损伤（AKI）对危重症新型冠状病毒肺炎（COVID-19）患者构成了重大的发病和死亡风险。本研究的目的是调查入住重症监护病房（ICU）的危重症COVID-19肺炎患者中AKI的发生率、预测因素及预后情况。
方法
在沙特阿拉伯开展了一项多中心回顾性研究，纳入2020年5月至2021年5月期间确诊为COVID-19肺炎并入住重症监护病房的至少18岁成年患者。报告了AKI的发生情况及相关危险因素、持续肾脏替代治疗（CRRT）的需求及预后情况。
结果
该研究纳入了340例因COVID-19入住ICU的患者。他们的平均年龄为66.7±13.4岁，范围在49至84岁之间，其中大多数为男性（63.8%）。最常见的合并症为高血压（71.5%）、糖尿病（62.4%）、缺血性心脏病（IHD，37.6%）、慢性肾脏病（CKD，20%）、心力衰竭（19.4%），81.2%的患者患有急性呼吸窘迫综合征（ARDS）。60.3%的患者发生了AKI，其中38%为1期，16.6%为2期，45.4%为3期。约39%的患者需要CRRT，其中76.2%为3期，显著高于其他分期（p<0.001）。与未发生AKI的患者相比，AKI患者显著患有哮喘，且C反应蛋白（CRP）、铁蛋白、乳酸脱氢酶（LDH）和血尿素氮（BUN）水平较低，肌酐水平较高（所有p<0.05）。总体死亡率为39.4%，AKI患者的死亡率显著高于未发生AKI的患者（48.3%对25.9%；p<0.001）。
结论
AKI在因COVID-19入住ICU的成人患者中很常见，且与死亡风险增加相关。早期发现AKI并进行适当治疗可对COVID-19的预后产生积极影响。CRRT是危重症AKI的ICU患者首选透析方式。
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