Gulhane Training and Research Hospital, Department of Intensive Care, Ankara, Türkiye.
University of Health Sciences, Gulhane Faculty of Medicine, Department of Public Health, Ankara, Türkiye.
J Infect Dev Ctries. 2024 Aug 31;18(8):1179-1184. doi: 10.3855/jidc.18310.
Critically ill patients with coronavirus disease 2019 (COVID-19) often face a heightened risk of morbidity and mortality, particularly due to complications such as acute kidney injury (AKI). While the persistent acute kidney injury risk index (PARI) has shown promise in predicting the risk of persistent AKI (pAKI) in non-COVID patients, its effectiveness in critically ill COVID-19 patients remains to be explored. We aimed to evaluate the predictive power of the PARI in identifying pAKI and its prognostic significance in terms of clinical outcomes.
This was a single-center retrospective study of patients with COVID-19 admitted at our 36-bed tertiary intensive care unit between April and December 2020.
There were 152 patients who fulfilled our inclusion criteria. Fifty seven (37.5%) had developed AKI and 16 (10.25%) had developed pAKI. Vasopressor, mechanical ventilation and renal replacement therapy (RRT) requirement, sequential organ failure assessment (SOFA), and PARI were significantly higher in patients who developed pAKI than those who did not. The PARI were significantly higher in patients with short-term mortality compared to survivors. The area under the receiver operating characteristic (ROC) curve (AUC) of the PARI score for predicting pAKI was 0.66 (95% CI: 0.53-0.79), whereas short-term mortality was 0.733 (95% CI, 0.65-0.81).
The PARI score was evaluated as simple, useful, and reliable in predicting pAKI in severe cases with COVID-19; and therefore, pAKI and its related RRT complications can be prevented with protective interventions. Further comprehensive studies are warranted to deepen our understanding of this relationship.
患有 2019 年冠状病毒病（COVID-19）的危重症患者往往面临更高的发病率和死亡率风险，尤其是由于急性肾损伤（AKI）等并发症。虽然持续急性肾损伤风险指数（PARI）已显示出在预测非 COVID 患者持续 AKI（pAKI）风险方面的潜力，但它在 COVID-19 危重症患者中的有效性仍有待探索。我们旨在评估 PARI 在识别 pAKI 方面的预测能力及其在临床结局方面的预后意义。
这是一项单中心回顾性研究，纳入了 2020 年 4 月至 12 月期间在我们 36 张床位的三级重症监护病房住院的 COVID-19 患者。
符合纳入标准的患者共 152 例。57 例（37.5%）发生 AKI，16 例（10.25%）发生 pAKI。发生 pAKI 的患者的血管加压素、机械通气和肾脏替代治疗（RRT）需求、序贯器官衰竭评估（SOFA）和 PARI 评分明显高于未发生 pAKI 的患者。与幸存者相比，短期死亡率患者的 PARI 评分明显更高。PARI 评分预测 pAKI 的受试者工作特征（ROC）曲线下面积（AUC）为 0.66（95%CI：0.53-0.79），而短期死亡率为 0.733（95%CI，0.65-0.81）。
PARI 评分被评估为简单、有用且可靠，可用于预测 COVID-19 重症患者的 pAKI；因此，可以通过保护性干预来预防 pAKI 及其相关的 RRT 并发症。需要进一步进行全面的研究，以加深我们对这种关系的理解。
