Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
PLoS One. 2024 Oct 24;19(10):e0309655. doi: 10.1371/journal.pone.0309655. eCollection 2024.
The objective of this study was to determine the impact of the timing of KRT, dichotomized by a temporal criterion or by creatinine level, in patients with COVID-19-related AKI. This was a retrospective study involving 512 adult patients admitted to the ICU. All participants had laboratory-confirmed COVID-19 and a confirmed diagnosis of AKI. The potential predictors were the determination of the timing of KRT based on a temporal criterion (days since hospital admission) and that based on a serum creatinine cutoff criterion. Covariates included age, sex, and the SOFA score, as well as the need for mechanical ventilation and vasopressors. The main outcome measure was in-hospital mortality. We evaluated 512 patients, of whom 69.1% were men. The median age was 64 years. Of the 512 patients, 76.6% required dialysis after admission. The overall in-hospital mortality rate was 72.5%. When the timing of KRT was determined by the temporal criterion, the risk of in-hospital mortality was significantly higher for later KRT than for earlier KRT-84% higher in the univariate analysis (OR = 1.84, 95%, [CI]: 1.10-3.09) and 140% higher after adjustment for age, sex, and SOFA score (OR = 2.40, 95% CI: 1.36-4.24). When it was determined by the creatinine cutoff criterion, there was no such difference between high and low creatinine at KRT initiation. In patients with COVID-19-related AKI, earlier KRT might be associated with lower in-hospital mortality.
本研究旨在确定以时间标准或肌酐水平为标准对 COVID-19 相关 AKI 患者进行 KRT 的时机对其的影响。这是一项回顾性研究，共纳入 512 名入住 ICU 的成年患者。所有参与者均经实验室确诊为 COVID-19，且 AKI 诊断明确。潜在预测因子为基于时间标准（入院后天数）和基于血清肌酐截止值标准确定 KRT 的时机。协变量包括年龄、性别和 SOFA 评分，以及是否需要机械通气和血管加压药。主要结局指标为住院死亡率。我们评估了 512 例患者，其中 69.1%为男性。中位年龄为 64 岁。在 512 例患者中，76.6%在入院后需要透析。总的住院死亡率为 72.5%。当根据时间标准确定 KRT 时机时，与早期 KRT 相比，晚期 KRT 的住院死亡率风险显著更高，单因素分析中高出 84%（OR=1.84，95%[CI]：1.10-3.09），调整年龄、性别和 SOFA 评分后高出 140%（OR=2.40，95%CI：1.36-4.24）。当根据肌酐截止值标准确定时，在开始 KRT 时肌酐高低之间没有这种差异。在 COVID-19 相关 AKI 患者中，早期 KRT 可能与较低的住院死亡率相关。
