奥地利蒂罗尔州危重症 COVID-19 患者急性肾损伤的发生率、风险因素和结局：一项前瞻性多中心登记研究。
Incidence, risk factors and outcome of acute kidney injury in critically ill COVID-19 patients in Tyrol, Austria: a prospective multicenter registry study.
机构信息
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Internal Medicine II, Gastroenterology, Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, St. Pölten, Austria.
出版信息
J Nephrol. 2023 Dec;36(9):2531-2540. doi: 10.1007/s40620-023-01760-3. Epub 2023 Oct 14.
INTRODUCTION
Acute kidney injury is a frequent complication in critically ill patients with and without COVID-19. The aim of this study was to evaluate the incidence of, and risk factors for, acute kidney injury and its effect on clinical outcomes of critically ill COVID-19 patients in Tyrol, Austria.
METHODS
This multicenter prospective registry study included adult patients with a SARS-CoV-2 infection confirmed by polymerase chain reaction, who were treated in one of the 12 dedicated intensive care units during the COVID-19 pandemic from February 2020 until May 2022.
RESULTS
In total, 1042 patients were included during the study period. The median age of the overall cohort was 66 years. Of the included patients, 267 (26%) developed acute kidney injury during their intensive care unit stay. In total, 12.3% (n = 126) required renal replacement therapy with a median duration of 9 (IQR 3-18) days. In patients with acute kidney injury the rate of invasive mechanical ventilation was significantly higher with 85% (n = 227) compared to 41% (n = 312) in the no acute kidney injury group (p < 0.001). The most important risk factors for acute kidney injury were invasive mechanical ventilation (OR = 4.19, p < 0.001), vasopressor use (OR = 3.17, p < 0.001) and chronic kidney disease (OR = 2.30, p < 0.001) in a multivariable logistic regression analysis. Hospital and intensive care unit mortality were significantly higher in patients with acute kidney injury compared to patients without acute kidney injury (Hospital mortality: 52.1% vs. 17.2%, p < 0.001, ICU-mortality: 47.2% vs. 14.7%, p < 0.001).
CONCLUSION
As in non-COVID-19 patients, acute kidney injury is clearly associated with increased mortality in critically ill COVID-19 patients. Among known risk factors, invasive mechanical ventilation has been identified as an independent and strong predictor of acute kidney injury.
简介
急性肾损伤是伴有和不伴有 COVID-19 的危重症患者的常见并发症。本研究旨在评估奥地利蒂罗尔州危重症 COVID-19 患者急性肾损伤的发生率、危险因素及其对临床结局的影响。
方法
这是一项多中心前瞻性登记研究，纳入了经聚合酶链反应证实的 SARS-CoV-2 感染的成年患者，这些患者在 2020 年 2 月至 2022 年 5 月期间 COVID-19 大流行期间在 12 个专用重症监护病房之一接受治疗。
结果
在研究期间共纳入了 1042 名患者。总体队列的中位年龄为 66 岁。在纳入的患者中，267 名（26%）在重症监护病房期间发生急性肾损伤。共有 12.3%（n=126）需要肾脏替代治疗，中位持续时间为 9（IQR 3-18）天。在发生急性肾损伤的患者中，接受有创机械通气的比例明显更高，为 85%（n=227），而无急性肾损伤的患者比例为 41%（n=312）（p<0.001）。多变量逻辑回归分析显示，急性肾损伤的最重要危险因素是有创机械通气（OR=4.19，p<0.001）、血管加压素使用（OR=3.17，p<0.001）和慢性肾脏病（OR=2.30，p<0.001）。与无急性肾损伤的患者相比，发生急性肾损伤的患者的医院和重症监护病房死亡率明显更高（医院死亡率：52.1%比 17.2%，p<0.001；重症监护病房死亡率：47.2%比 14.7%，p<0.001）。
结论
与非 COVID-19 患者一样，急性肾损伤与危重症 COVID-19 患者的死亡率增加明显相关。在已知的危险因素中，有创机械通气已被确定为急性肾损伤的独立且强烈的预测因素。
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