Renal & Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
Centre of Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK.
Nephrology (Carlton). 2024 Jun;29(6):325-337. doi: 10.1111/nep.14297. Epub 2024 Mar 28.
Acute kidney injury (AKI) associated with COVID-19 is associated with poor prognosis. This study assessed the hitherto uninvestigated impact of COVID-19 on the progression and clinical outcomes of patients with AKI.
Data from 576 patients with AKI admitted between 13/3/20 and 13/5/20 were studied. Increasingly complex analyses, from logistic regressions to competing-risk and multi-state models, have revealed insights into AKI progression dynamics associated with PCR-confirmed COVID-19 acquisition and death. Meta-analyses of case fatality ratios among patients with AKI were also conducted.
The overall case-fatality ratio was 0.33 [95% CI (0.20-0.36)]; higher in COVID-19 positive (COVID+) patients 0.52 [95% CI (0.46-0.58)] than in their negative (COVID-) counterparts 0.16 [95% CI (0.12-0.20)]. In AKI Stage-3 patients, that was 0.71 [95% CI (0.64-0.79)] among COVID+ patients with 45% dead within 14 days and 0.35 [95% CI (0.25-0.44)] in the COVID- group and 28% died within 14 days. Among patients diagnosed with AKI Stage-1 within 24 h, the probability of progression to AKI Stage-3 on day 7 post admission was 0.22 [95% CI (0.17-0.27)] among COVID+ patients, and 0.06 [95% CI (0.03, 0.09)] among those who tested negative. The probability of discharge by day 7 was 0.71 [95% CI (0.66, 0.75)] in COVID- patients, and 0.27 [95% CI (0.21, 0.32)] in COVID+ patients. By day 14, in AKI Stage-3 COVID+ patients, that was 0.35 [95% CI (0.25, 0.44)] with little change by day 10, that is, 0.38 [95% CI (0.29, 0.47)].
These results are consistent with either a rapid progression in severity, prolonged hospital care, or high case fatality ratio among AKI Stage-3 patients, significantly exacerbated by COVID-19 infection.
与 COVID-19 相关的急性肾损伤（AKI）与预后不良有关。本研究评估了 COVID-19 对 AKI 患者的进展和临床结局的迄今为止尚未研究的影响。
研究了 2020 年 3 月 13 日至 5 月 13 日期间入院的 576 名 AKI 患者的数据。越来越复杂的分析，从逻辑回归到竞争风险和多状态模型，揭示了与 PCR 确诊的 COVID-19 获得和死亡相关的 AKI 进展动态的见解。还对 AKI 患者的病死率进行了荟萃分析。
总的病死率为 0.33[95%置信区间（0.20-0.36）]；COVID+患者（COVID+）为 0.52[95%置信区间（0.46-0.58）]，高于 COVID-患者（COVID-）为 0.16[95%置信区间（0.12-0.20）]。在 AKI 第 3 阶段患者中，COVID+患者中有 45%在 14 天内死亡，病死率为 0.71[95%置信区间（0.64-0.79）]，而 COVID-组中有 35%在 14 天内死亡，病死率为 0.35[95%置信区间（0.25-0.44）]。在 24 小时内诊断为 AKI 第 1 阶段的患者中，COVID+患者在入院后第 7 天进展为 AKI 第 3 阶段的概率为 0.22[95%置信区间（0.17-0.27）]，而 COVID-组为 0.06[95%置信区间（0.03，0.09）]。COVID-患者在第 7 天出院的概率为 0.71[95%置信区间（0.66，0.75）]，而 COVID+患者为 0.27[95%置信区间（0.21，0.32）]。在第 14 天，AKI 第 3 阶段的 COVID+患者中，病死率为 0.35[95%置信区间（0.25-0.44）]，第 10 天几乎没有变化，即 0.38[95%置信区间（0.29-0.47）]。
这些结果与 AKI 第 3 阶段患者的严重程度迅速恶化、延长住院时间或高病死率一致，COVID-19 感染显著加重了这种情况。
