Vardhan Harsh, Saigal Megha, Shyama Shyama, Krishna Amresh
Nephrology, Patna Medical College, Patna, IND.
Nephrology, All India Institute of Medical Sciences, Patna, Patna, IND.
Cureus. 2024 Dec 9;16(12):e75363. doi: 10.7759/cureus.75363. eCollection 2024 Dec.
During the COVID-19 pandemic, it has been observed that acute kidney injury (AKI) especially requiring intervention support of hemodialysis has notably increased mortality rates among COVID-19-positive critically ill patients; however, comprehensive data regarding this from India, especially the eastern territory, remains sparse. This study aims to outline the demographic, clinical, and biochemical characteristics, along with the outcomes, of these patients.
A retrospective study was performed at the All India Institute of Medical Sciences (AIIMS), Patna, from March 1, 2020, to March 31, 2021. Included were patients diagnosed with COVID-19 and AKI necessitating hemodialysis during their intensive care unit (ICU) stay. These patients tested positive for COVID-19 and met the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI stages 1-3, requiring ICU admission and hemodialysis. Medical history, clinical features, laboratory results, comorbidities, and demographic data were collected and analyzed. Patients were tracked from admission to discharge or death. Gaussian-distributed values were compared using the unpaired t-test or Pearson's test, while non-Gaussian continuous variables were analyzed using the Mann-Whitney test or Spearman's test. The study employed the Kolmogorov-Smirnov test to assess Gaussian distribution, while categorical data were compared using the Chi-square test.
Among 773 patients with positive COVID-19 tests who were admitted to the ICU, 236 patients developed AKI, and among them, 139 patients required hemodialysis. The total mortality rate was 167 (70.7%) among people who had AKI and 102 (77%) in patients with AKI who required hemodialysis. AKI was also a risk factor associated with higher mortality rates in older patients (>45 years) (n=150 (73.2%)), those needing invasive ventilation (n=163 (88.1%)), and patients with elevated total leucocyte count (TLC) (n=130 (79.3%)), lactate dehydrogenase (LDH) (n=159 (72.9%)), interleukin-6 (IL-6) (n=153 (72.2%)), and serum ferritin (n=51 (73.7%)) and hypoalbuminemia (n=152 (73.1%)).
AKI requiring hemodialysis significantly increases mortality risk in COVID-19 patients. Other risk factors for mortality with AKI in COVID-19-positive patients include age, elevated leucocyte count, invasive ventilation, and deranged inflammatory markers.
在新冠疫情期间，人们观察到急性肾损伤（AKI），尤其是需要血液透析干预支持的情况，显著增加了新冠病毒检测呈阳性的危重症患者的死亡率；然而，来自印度的相关综合数据，特别是东部地区的数据，仍然很少。本研究旨在概述这些患者的人口统计学、临床和生化特征以及预后情况。
于2020年3月1日至2021年3月31日在巴特那全印度医学科学研究所（AIIMS）进行了一项回顾性研究。纳入的患者为在重症监护病房（ICU）住院期间被诊断为新冠病毒感染且患有需要血液透析的急性肾损伤患者。这些患者新冠病毒检测呈阳性，并符合改善全球肾脏病预后组织（KDIGO）制定的1-3期急性肾损伤标准，需要入住ICU并进行血液透析。收集并分析了患者的病史、临床特征、实验室检查结果、合并症和人口统计学数据。对患者从入院到出院或死亡进行跟踪。使用不成对t检验或Pearson检验比较呈高斯分布的值，而使用Mann-Whitney检验或Spearman检验分析非高斯连续变量。该研究采用Kolmogorov-Smirnov检验评估高斯分布，使用卡方检验比较分类数据。
在773名入住ICU且新冠病毒检测呈阳性的患者中，236名患者发生了急性肾损伤，其中139名患者需要血液透析。发生急性肾损伤的患者总死亡率为167例（70.7%），需要血液透析的急性肾损伤患者死亡率为102例（77%）。急性肾损伤也是老年患者（>45岁）（n = 150例（73.2%））、需要有创通气的患者（n = 163例（88.1%））以及白细胞总数（TLC）升高（n = 130例（79.3%））、乳酸脱氢酶（LDH）升高（n = 159例（72.9%））、白细胞介素-6（IL-6）升高（n = 153例（72.2%））、血清铁蛋白升高（n = 51例（73.7%））和低白蛋白血症患者（n = 152例（73.1%））死亡率较高的危险因素。
需要血液透析的急性肾损伤显著增加了新冠病毒感染患者的死亡风险。新冠病毒检测呈阳性患者发生急性肾损伤时的其他死亡危险因素包括年龄、白细胞计数升高、有创通气和炎症标志物紊乱。
