估算肾小球滤过率升高与 SARS-CoV-2 感染和正常至轻度降低水平内的重度 COVID-19 风险呈负相关：巢式病例对照研究。

Increased Estimated GFR Is Negatively Associated With the Risk of SARS-CoV-2 Infection and Severe COVID-19 Within Normal to Mildly Decreased Levels: Nested Case-Control Study.

机构信息

Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea.

Institute of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Korea.

出版信息

J Korean Med Sci. 2023 Dec 18;38(49):e415. doi: 10.3346/jkms.2023.38.e415.

DOI:10.3346/jkms.2023.38.e415

PMID:38111284

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10727919/

Abstract

BACKGROUND

While accumulating evidence indicates chronic kidney disease as a risk factor for coronavirus disease 2019 (COVID-19), the association between normal or mildly decreased kidney function and COVID-19 is unaddressed. Here, we have examined the association of an increase in estimated glomerular filtration rate (eGFR) with the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe COVID-19 outcomes among patients within normal to mildly decreased kidney function.

METHODS

The patients who participated in both health screenings from period I (2017-2018) to II (2019-2020) were enrolled to our study. All participants were categorized into four groups according to the changes in eGFR stage from period I to II: 1) persistently stage G1, 2) from stage G2 to G1, 3) from stage G1 to G2, 4) persistently stage G2. In addition, the changes in eGFR value were defined by subtracting its value of period I from II. Patients were followed up for SARS-CoV-2 infection from January 1, 2021 to any diagnosis of COVID-19 or December 31, 2021, whichever happened first. In addition, those with SARS-CoV-2 infection were followed-up for one month after diagnosis to analyze severe COVID-19. Adjusted odds ratio (aOR) was calculated using multivariable-adjusted logistic regression.

RESULTS

We identified 159,427 patients with and 1,804,798 patients without SARS-CoV-2 infection. The risk of SARS-CoV-2 infection decreased when eGFR stage changed from G2 to G1 (aOR, 0.957; 95% confidence interval [CI], 0.938-0.977) and persistently maintained at G1 (aOR, 0.966; 95% CI, 0.943-0.990), compared with the persistently stage G2 group. In addition, the risk showed an inverse relationship with changes in eGFR value, which was depicted by restricted cubic spline curves. For the overall risk of severe COVID-19, the persistently stage G1 showed the lowest risk (aOR, 0.897; 95% CI, 0.827-0.972), followed by those from stage G1 to G2 (aOR, 0.900; 95% CI, 0.828-0.978) and those from stage G2 to G1 (aOR, 0.931; 95% CI, 0.871-0.995), compared with the persistently stage G2 group.

CONCLUSION

An increase in eGFR was negatively associated with the risk of SARS-CoV-2 infection and severe COVID-19 among normal or mildly decreased kidney function. For severe COVID-19, maintaining higher baseline eGFR may act as a protective factor against its risk.

摘要

背景

虽然越来越多的证据表明慢性肾脏病是 2019 年冠状病毒病（COVID-19）的一个危险因素，但正常或轻度降低的肾功能与 COVID-19 之间的关联尚未得到解决。在这里，我们研究了估算肾小球滤过率（eGFR）增加与正常至轻度肾功能下降患者中严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染和严重 COVID-19 结局之间的关联。

方法

参加了 I 期（2017-2018 年）至 II 期（2019-2020 年）健康筛查的患者被纳入本研究。所有参与者根据 eGFR 阶段从 I 期到 II 期的变化分为四组：1）持续 G1 期，2）从 G2 期到 G1 期，3）从 G1 期到 G2 期，4）持续 G2 期。此外，eGFR 值的变化通过从 I 期到 II 期减去其值来定义。从 2021 年 1 月 1 日起，对患者进行 SARS-CoV-2 感染随访，直至首次出现 COVID-19 或 2021 年 12 月 31 日。此外，对感染 SARS-CoV-2 的患者进行诊断后一个月的随访，以分析严重 COVID-19。使用多变量调整的逻辑回归计算调整后的优势比（aOR）。

结果

我们确定了 159427 名 SARS-CoV-2 感染患者和 1804798 名无 SARS-CoV-2 感染患者。与持续 G2 期组相比，eGFR 期从 G2 期变为 G1 期（aOR，0.957；95%置信区间[CI]，0.938-0.977）和持续保持在 G1 期（aOR，0.966；95%CI，0.943-0.990）时，SARS-CoV-2 感染的风险降低。此外，风险与 eGFR 值的变化呈负相关，这由限制立方样条曲线表示。对于严重 COVID-19 的总体风险，持续 G1 期的风险最低（aOR，0.897；95%CI，0.827-0.972），其次是从 G1 期到 G2 期（aOR，0.900；95%CI，0.828-0.978）和从 G2 期到 G1 期（aOR，0.931；95%CI，0.871-0.995）的患者，与持续 G2 期组相比。