血液透析患者感染前营养状况、氧化应激与长达一年的新冠病毒持续感染：一项前瞻性队列研究

Pre-Infection Nutritional Status, Oxidative Stress, and One-Year-Long COVID Persistence in Patients Undergoing Hemodialysis: A Prospective Cohort Study.

作者信息

Stepanova Natalia, Korol Lesya, Ostapenko Tetyana, Marchenko Valeriia, Belousova Olga, Snisar Lyudmyla, Shifris Iryna, Kolesnyk Mykola

机构信息

State Institution "O.O. Shalimov National Scientific Center of Surgery and Transplantology of the National Academy of Medical Science of Ukraine", 03680 Kyiv, Ukraine.

Dialysis Medical Center LLC "Nephrocenter", 03057 Kyiv, Ukraine.

出版信息

Clin Pract. 2024 May 17;14(3):892-905. doi: 10.3390/clinpract14030070.

DOI:10.3390/clinpract14030070

PMID:38804402

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11130966/

Abstract

BACKGROUND

Nutritional status's role in long COVID is evident in the general population, yet unexplored in patients undergoing hemodialysis (HD), posing a research gap. We hypothesized that pre-infection undernutrition in HD patients might impact long COVID persistence by accelerating oxidative stress. The present study aimed to investigate the association between pre-infection nutritional status, oxidative stress, and one-year-long COVID persistence in HD patients.

METHODS

This prospective observational cohort study enrolled 115 HD patients with confirmed COVID-19. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score twice: before infection and three months post-infection. Oxidative markers included malondialdehyde (MDAs), ceruloplasmin, transferrin, and sulfhydryl groups. The endpoint was one-year-long COVID persistence.

RESULTS

Moderate pre-infection CONUT scores were associated with heightened severe undernutrition risk ( < 0.0001), elevated MDAs ( < 0.0001), and reduced ceruloplasmin levels ( = 0.0009) at three months post-COVID-19 compared to light CONUT scores. Pre-infection CONUT score independently predicted post-COVID oxidative damage [OR 2.3 (95% CI 1.2; 4.6), < 0.0001] and one-year-long COVID persistence [HR 4.6 (95% CI 1.4; 9.9), < 0.0001], even after adjusting for potential confounders.

CONCLUSION

Moderate pre-infection undernutrition heightens post-COVID oxidative stress and increases the risk of one-year-long COVID persistence in HD patients.

摘要

背景

营养状况在新冠长期症状（long COVID）中的作用在普通人群中已很明显，但在接受血液透析（HD）的患者中尚未得到探索，这构成了一个研究空白。我们假设HD患者感染前的营养不良可能通过加速氧化应激来影响新冠长期症状的持续时间。本研究旨在调查HD患者感染前营养状况、氧化应激与新冠长期症状持续一年之间的关联。

方法

这项前瞻性观察队列研究纳入了115例确诊新冠病毒感染的HD患者。使用控制营养状况（CONUT）评分在感染前和感染后三个月对营养状况进行了两次评估。氧化标志物包括丙二醛（MDA）、铜蓝蛋白、转铁蛋白和巯基。终点是新冠长期症状持续一年。

结果

与轻度CONUT评分相比，中度感染前CONUT评分与新冠感染后三个月时严重营养不良风险增加（<0.0001）、MDA升高（<0.0001）和铜蓝蛋白水平降低（=0.0009）相关。即使在调整潜在混杂因素后，感染前CONUT评分仍能独立预测新冠感染后的氧化损伤[比值比2.3（95%置信区间1.2；4.6），<0.0001]和新冠长期症状持续一年[风险比4.6（95%置信区间1.4；9.9），<0.0001]。