Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
Pediatr Nephrol. 2024 Mar;39(3):867-877. doi: 10.1007/s00467-023-06125-3. Epub 2023 Sep 7.
Data on the characteristics of acute kidney injury (AKI) in pediatric COVID-19 and MIS-C are limited. We aimed to define the frequency, associated factors and early outcome of AKI in moderate, severe or critical COVID-19 and MIS-C; and to present a tertiary referral center experience from Türkiye.
Hospitalized patients ≤ 18 years of age with confirmed COVID-19 or MIS-C at İhsan Doğramacı Children's Hospital, Hacettepe University, between March 2020-December 2021 were enrolled. The characteristics of AKI in the COVID-19 group were investigated in moderate, severe and critically ill patients; patients with mild COVID-19 were excluded.
The median (Q1-Q3) age in the COVID-19 (n = 66) and MIS-C (n = 111) groups was 10.7 years (3.9-15.2) and 8.7 years (4.5-12.7), respectively. The frequency of AKI was 22.7% (15/66) in COVID-19 and 15.3% (17/111) in MIS-C; all MIS-C patients with AKI and 73.3% (11/15) of COVID-19 patients with AKI had AKI at the time of admission. Multivariate analyses revealed need for vasoactive/inotropic agents [Odds ratio (OR) 19.233, p = 0.002] and presence of vomiting and/or diarrhea (OR 4.465, p = 0.036) as independent risk factors of AKI in COVID-19 patients; and need for vasoactive/inotropic agents (OR 22.542, p = 0.020), procalcitonin and ferritin levels as independent risk factors of AKI in the MIS-C group. Age was correlated with lymphocyte count (r = -0.513, p < 0.001) and troponin level (r = 0.518, p < 0.001) in MIS-C patients. Length of hospital stay was significantly longer in both groups with AKI, compared to those without AKI. Mortality was 9.1% in the COVID-19 group; and was associated with AKI (p = 0.021). There was no mortality in MIS-C patients. AKI recovery at discharge was 63.6% in COVID-19 survivors and 100% in MIS-C patients.
Independent risk factors for AKI were need for vasoactive/inotropic agents and vomiting/diarrhea in moderate, severe or critical COVID-19 patients; and need for vasoactive/inotropic agents and severe inflammation in MIS-C patients. Our findings suggest that inflammation and cardiac dysfunction are associated with AKI in MIS-C patients; and the association with age in this group merits further studies in larger groups. Early outcome is favorable; long-term follow-up for kidney functions is needed.
儿科 COVID-19 和 MIS-C 患者急性肾损伤 (AKI) 的特征数据有限。我们旨在定义中度、重度或危重度 COVID-19 和 MIS-C 中 AKI 的频率、相关因素和早期结局；并介绍土耳其的一家三级转诊中心的经验。
在 2020 年 3 月至 2021 年 12 月期间，在哈塞特佩大学伊哈桑·多格拉奇儿童医院，对患有确诊 COVID-19 或 MIS-C 的 ≤ 18 岁住院患者进行了研究。在 COVID-19 组中，我们调查了中度、重度和危重症患者中 AKI 的特征；排除了轻度 COVID-19 患者。
COVID-19（n = 66）和 MIS-C（n = 111）组的中位（Q1-Q3）年龄分别为 10.7 岁（3.9-15.2）和 8.7 岁（4.5-12.7）。COVID-19 患者中 AKI 的发生率为 22.7%（15/66），MIS-C 患者中 AKI 的发生率为 15.3%（17/111）；所有 MIS-C 患者合并 AKI，73.3%（11/15）的 COVID-19 患者合并 AKI 时已存在 AKI。多变量分析显示，血管活性/正性肌力药物的需求（比值比 19.233，p = 0.002）和呕吐和/或腹泻的存在（比值比 4.465，p = 0.036）是 COVID-19 患者 AKI 的独立危险因素；血管活性/正性肌力药物的需求（比值比 22.542，p = 0.020）、降钙素原和铁蛋白水平是 MIS-C 组 AKI 的独立危险因素。年龄与 MIS-C 患者的淋巴细胞计数（r = -0.513，p < 0.001）和肌钙蛋白水平（r = 0.518，p < 0.001）相关。AKI 组的住院时间明显长于无 AKI 组。COVID-19 组的死亡率为 9.1%；与 AKI 相关（p = 0.021）。MIS-C 患者无死亡。COVID-19 幸存者出院时 AKI 恢复率为 63.6%，MIS-C 患者为 100%。
在中度、重度或危重度 COVID-19 患者中，AKI 的独立危险因素是血管活性/正性肌力药物的需求和呕吐/腹泻；在 MIS-C 患者中，AKI 的独立危险因素是血管活性/正性肌力药物的需求和严重炎症。我们的研究结果表明，炎症和心脏功能障碍与 MIS-C 患者的 AKI 相关；年龄与该组的相关性值得在更大的人群中进一步研究。早期结局良好；需要对肾功能进行长期随访。
