Lai S, Gigante A, Pellicano C, Mariani I, Iannazzo F, Concistrè A, Letizia C, Muscaritoli M
Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2023 Mar;27(6):2706-2714. doi: 10.26355/eurrev_202303_31809.
In this study, we aimed to evaluate the kidney involvement assessed by estimated glomerular filtration rate (eGFR), the associations with specific clinical disease variables and laboratory findings, and the predictive role of eGFR on clinical outcomes of patients admitted with COVID-19 in Internal Medicine ward in the first wave.
Clinical data of 162 consecutive patients hospitalized in the University Hospital Policlinico Umberto I in Rome, Italy, between December 2020 to May 2021 were collected and retrospectively analyzed.
The median eGFR was significantly lower in patients with worse outcomes than in patients with favorable outcomes [56.64 ml/min/1.73 m2 (IQR 32.27-89.73) vs. 83.39 ml/min/1.73 m2 (IQR 69.59-97.08), p<0.001]. Patients with eGFR < 60 ml/min/1.73 m2 (n=38) were significantly older compared to patients with normal eGFR [82 years (IQR 74-90) vs. 61 years (IQR 53-74), p<0.001] and they had fever less frequently [39.5% vs. 64.2%, p<0.01]. Kaplan-Meier curves demonstrated that overall survival was significantly shorter in patients with eGFR < 60 ml/min/1.73 m2 (p<0.001). In multivariate analysis, only eGFR < 60 ml/min/1.73 m2 [HR=2.915 (95% CI=1.110-7.659), p<0.05] and platelet to lymphocyte ratio [HR=1.004 (95% CI=1.002-1.007), p<0.01] showed a significant predictive value for death or transfer to intensive care unit (ICU).
Kidney involvement on admission was an independent predictor for death or transfer to ICU among hospitalized COVID-19 patients. The presence of chronic kidney disease could be regarded as a relevant factor in risk stratification for COVID-19.
在本研究中，我们旨在评估通过估计肾小球滤过率（eGFR）评估的肾脏受累情况、与特定临床疾病变量和实验室检查结果的关联，以及eGFR对第一波疫情期间内科病房收治的COVID-19患者临床结局的预测作用。
收集并回顾性分析了2020年12月至2021年5月期间在意大利罗马翁贝托一世综合大学医院连续住院的162例患者的临床资料。
预后较差的患者的eGFR中位数显著低于预后良好的患者[56.64 ml/min/1.73 m²（四分位间距32.27 - 89.73）vs. 83.39 ml/min/1.73 m²（四分位间距69.59 - 97.08），p<0.001]。eGFR<60 ml/min/1.73 m²的患者（n = 38）与eGFR正常的患者相比显著年龄更大[82岁（四分位间距74 - 90）vs. 61岁（四分位间距53 - 74），p<0.001]，且发热频率更低[39.5% vs. 64.2%，p<0.01]。Kaplan-Meier曲线显示，eGFR<60 ml/min/1.73 m²的患者总体生存期显著更短（p<0.001）。在多变量分析中，只有eGFR<60 ml/min/1.73 m²[风险比（HR）=2.915（95%置信区间[CI]=1.110 - 7.659），p<0.05]和血小板与淋巴细胞比值[HR=1.004（95%CI=1.002 - 1.007），p<0.01]对死亡或转入重症监护病房（ICU）显示出显著的预测价值。
入院时的肾脏受累是住院COVID-19患者死亡或转入ICU的独立预测因素。慢性肾脏病的存在可被视为COVID-19风险分层中的一个相关因素。
