Yazılıtaş Fatma, Çakıcı Evrim Kargın, Güngör Tülin, Karakaya Deniz, Çelikkaya Evra, Şen Zeynep Savaş, Gümüşer Rüveyda, Tanır Naciye Gönül, Bülbül Mehmet
Dr Sami Ulus Kadin Dogum Cocuk Sagligi ve Hastaliklari Egitim ve Arastirma. Hastanesi, Ankara, Turkey.
J Nephrol. 2024 Dec;37(9):2541-2550. doi: 10.1007/s40620-024-01986-9. Epub 2024 Jul 20.
Coronavirus disease 2019 (COVID-19) has been recognised as a risk factor for acute kidney injury (AKI). Our aim was to investigate the risk factors contributing to hospitalised and outpatient paediatric COVID-19-associated AKI.
A retrospective observational study was conducted on patients aged 1 month to 18 years with diagnosed COVID-19-associated AKI applied to a tertiary paediatric referral hospital between March 1, 2020 and March 1, 2022.
A total of 6683 patients were evaluated and 486 patients were included in the study. Acute kidney injury was observed in 3.7% of outpatients and 23.9% of hospitalised patients. Multivariate logistic regression analysis showed that, on admission, a history of contact with a COVID-19 positive person (p < 0.001), age below 12 months (p = 0.004), presence of comorbidities (p < 0.001), abdominal pain (p = 0.008), anorexia (p = 0.003), dyspnoea (p = 0.005), higher lactate dehydrogenase values (p = 0.004), neutrophilia (p < 0.001), higher neutrophil-to-lymphocyte ratio (NLR) (p = 0.003), higher white blood cell counts (p = 0.006), elevated C-reactive protein (CRP) levels (p = 0.002), anaemia (p = 0.015), hypoalbuminaemia (p < 0.001), hyperglycaemia (p = 0.006), and presence of proteinuria (p = 0.003) were independent predictors of AKI. Higher rates of hospitalisation (p < 0.001) and admission to the paediatric intensive care unit (PICU) (p < 0.001), longer length of hospitalisation (p < 0.001), and greater need for mechanical ventilation (p < 0.001) were associated with AKI.
This study reveals that not only hospitalised children, but also paediatric patients are at risk for AKI. The presence of comorbidities, abdominal pain, anorexia, dyspnoea, anaemia, inflammation, hypoalbuminaemia, proteinuria and history of contact with a COVID-19 positive person were the main risk factors for AKI. COVID-19-associated AKI was associated with worse outcomes.
2019冠状病毒病（COVID-19）已被确认为急性肾损伤（AKI）的一个风险因素。我们的目的是调查导致住院和门诊儿童COVID-19相关急性肾损伤的风险因素。
对2020年3月1日至2022年3月1日期间就诊于一家三级儿科转诊医院、诊断为COVID-19相关急性肾损伤的1个月至18岁患者进行了一项回顾性观察研究。
共评估了6683例患者，486例患者纳入研究。门诊患者中急性肾损伤的发生率为3.7%，住院患者中为23.9%。多因素逻辑回归分析显示，入院时，与COVID-19阳性患者有接触史（p<0.001）、年龄低于12个月（p=0.004）、存在合并症（p<0.001）、腹痛（p=0.008）、厌食（p=0.003）、呼吸困难（p=0.005）、乳酸脱氢酶值较高（p=0.004）、中性粒细胞增多（p<0.001）、中性粒细胞与淋巴细胞比值（NLR）较高（p=0.003）、白细胞计数较高（p=0.006）、C反应蛋白（CRP）水平升高（p=0.002）、贫血（p=0.015）、低白蛋白血症（p<0.001）、高血糖（p=0.006）以及存在蛋白尿（p=0.003）是急性肾损伤的独立预测因素。住院率较高（p<0.001）、入住儿科重症监护病房（PICU）（p<0.001）、住院时间较长（p<0.001）以及机械通气需求较大（p<0.001）与急性肾损伤相关。
本研究表明，不仅住院儿童，而且儿科门诊患者也有发生急性肾损伤的风险。合并症、腹痛、厌食、呼吸困难、贫血、炎症、低白蛋白血症、蛋白尿以及与COVID-19阳性患者的接触史是急性肾损伤的主要风险因素。COVID-19相关急性肾损伤与更差的预后相关。
