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奥密克戎疫情期间未接种疫苗的终末期肾病患者的结局和相关风险因素:一项多中心回顾性研究。

The outcome and related risk factors of unvaccinated patients with end-stage kidney disease during the Omicron pandemic: a multicentre retrospective study.

机构信息

Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.

Department of Nephrology, Youyang Hospital, A Branch of the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

出版信息

BMJ Open. 2024 May 15;14(5):e084649. doi: 10.1136/bmjopen-2024-084649.

Abstract

OBJECTIVES

The study aims to identify the outcome and the related factors of unvaccinated patients with end-stage kidney disease during the Omicron pandemic.

DESIGN

A multicentre retrospective study of patients with end-stage kidney disease undergone maintenance haemodialysis (HD) in China.

SETTING

6 HD centres in China.

PARTICIPANTS

A total of 654 HD patients who tested positive for SARS-CoV-2 were ultimately included in the study.

OUTCOME MEASURES

The primary outcomes of interest were adverse outcomes, including hospitalisation due to COVID-19 and all-cause mortality.

RESULTS

The average age of the patients was 57 years, with 33.6% of them being over 65 years. Among the patients, 57.5% were male. During the follow-up period, 158 patients (24.2%) experienced adverse outcomes, and 93 patients (14.2%) died. The majority of patients (88/158) developed adverse outcomes within 30 days, and most deaths (77/93) occurred within 1 month. An advanced multivariable Cox regression analysis identified that adverse outcomes were associated with various factors while all-cause mortality was related to advanced age, male gender, high levels of C reactive protein (CRP) and low levels of prealbumin. The Kaplan-Meier curves demonstrated significantly higher all-cause mortality rates in the older, male, high CRP and low prealbumin subgroups.

CONCLUSIONS

Among unvaccinated HD patients with confirmed Omicron infections, various factors were found to be linked to adverse outcomes. Notably, age, sex, CRP and prealbumin had a substantial impact on the risk of all-cause mortality.

摘要

目的

本研究旨在确定奥密克戎大流行期间,终末期肾病未接种疫苗患者的结局及其相关因素。

设计

在中国进行的一项针对接受维持性血液透析(HD)的终末期肾病患者的多中心回顾性研究。

地点

中国的 6 个 HD 中心。

参与者

最终纳入本研究的是 654 名 SARS-CoV-2 检测呈阳性的接受 HD 的患者。

结局测量

主要结局指标为不良结局,包括因 COVID-19 住院和全因死亡率。

结果

患者的平均年龄为 57 岁,其中 33.6%的患者年龄超过 65 岁。在患者中,57.5%为男性。在随访期间,158 名患者(24.2%)出现不良结局,93 名患者(14.2%)死亡。大多数患者(158/158)在 30 天内出现不良结局,大多数死亡(93/93)发生在 1 个月内。一项先进的多变量 Cox 回归分析确定,不良结局与多种因素有关,而全因死亡率与年龄较大、男性、高水平 C 反应蛋白(CRP)和低水平前白蛋白有关。Kaplan-Meier 曲线表明,年龄较大、男性、高 CRP 和低前白蛋白亚组的全因死亡率显著较高。

结论

在确诊感染奥密克戎的未接种 HD 患者中,发现多种因素与不良结局相关。值得注意的是,年龄、性别、CRP 和前白蛋白对全因死亡率的风险有重大影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/540e/11097873/119cc95d7a0b/bmjopen-2024-084649f01.jpg

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