Department of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Department of Infectious Disease, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
Am J Trop Med Hyg. 2023 Jun 26;109(2):404-412. doi: 10.4269/ajtmh.22-0803. Print 2023 Aug 2.
Acute kidney injury (AKI) can occur in adult patients with severe dengue (SD) and have serious clinical outcomes. This study aimed to determine the prevalence, characteristics, risk factors, and clinical outcomes of AKI in adult patients with SD; the correlation of dengue virus (DENV) serological and virological profiles with AKI; and the clinical features of patients with severe AKI who received renal replacement treatment (RRT). This multicenter study was conducted in Guangdong Province, China, between January 2013 and November 2019. A total of 242 patients were evaluated, of which 85 (35.1%) developed AKI and 32 (13.2%) developed severe AKI (stage 3). Patients with AKI had a higher fatality rate (22.4% versus 5.7%; P < 0.001) and longer length of hospital stay (median: 13 versus 9 days; P < 0.001). Independent risk factors for AKI were hypertension (odds ratio [OR]: 2.03; 95% CI: 1.10-3.76), use of nephrotoxic drugs (OR: 1.90; 95% CI: 1.00-3.60), respiratory distress (OR: 4.15; 95% CI: 1.787-9.632), high international normalized ratio (INR) levels (OR: 6.44; 95% CI: 1.89-21.95), and hematuria (OR: 2.12; 95% CI: 1.14-3.95). There was no significant association between DENV serological and virological profiles and the presence or absence of AKI. Among patients with severe AKI, those who received RRT had a longer length of hospital stay and similar fatality rate. Hence, adult patients with SD should be closely monitored for the development of AKI to enable timely and appropriate therapy.
急性肾损伤（AKI）可发生于重症登革热（SD）成年患者，并有严重的临床结局。本研究旨在确定成人 SD 患者 AKI 的流行率、特征、危险因素和临床结局；登革热病毒（DENV）血清学和病毒学特征与 AKI 的相关性；以及接受肾脏替代治疗（RRT）的重症 AKI 患者的临床特征。这项多中心研究于 2013 年 1 月至 2019 年 11 月在中国广东省进行。共评估了 242 例患者，其中 85 例（35.1%）发生 AKI，32 例（13.2%）发生严重 AKI（3 期）。AKI 患者的死亡率（22.4%比 5.7%；P<0.001）和住院时间（中位数：13 天比 9 天；P<0.001）均更高。AKI 的独立危险因素包括高血压（比值比[OR]：2.03；95%置信区间[CI]：1.10-3.76）、使用肾毒性药物（OR：1.90；95% CI：1.00-3.60）、呼吸窘迫（OR：4.15；95% CI：1.787-9.632）、国际标准化比值（INR）水平升高（OR：6.44；95% CI：1.89-21.95）和血尿（OR：2.12；95% CI：1.14-3.95）。DENV 血清学和病毒学特征与 AKI 的有无之间无显著关联。在严重 AKI 患者中，接受 RRT 的患者住院时间更长，死亡率相似。因此，SD 成年患者应密切监测 AKI 的发生，以便及时进行适当的治疗。
