Waldauf Petr, Jurisinova Ivana, Svobodova Eva, Diblickova Michaela, Tencer Tomas, Zavora Jan, Smela Gabriela, Kupidlovska Lenka, Adamkova Vaclava, Fridrichova Marta, Jerabkova Karolina, Mikes Jakub, Duska Frantisek, Dusek Ladislav, Balik Martin
Department of Anaesthesiology and Intensive Care, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic.
Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 2, 12800, Prague 2, Czech Republic.
Sci Rep. 2025 Jul 1;15(1):20900. doi: 10.1038/s41598-025-05541-9.
The impact of remdesivir on renal and liver functions remains a matter of concern in advanced COVID-19 patients with high illness severity and presence of viral load. The laboratory results of the 114 patients (males 55.8%, age 71 (59; 77) years) with a detectable viral load treated with remdesivir were compared with the controls. Baseline plasmatic creatinine (PCr) < 150 µmol/l in patients on remdesivir decreased equally to controls (- 6 (- 20; 9) vs. - 8 (- 24; 2) µmol/l, n = 170, p = 0.11). The similar trends were found for baseline PCr ≥ 150 µmol/l (- 57 (- 129; - 15) µmol/l for remdesivir group vs. - 65 (- 111; - 7) µmol/l, p > 0.9). Changes of PCr were independent of the remdesivir therapy, the statistically significant confounders were baseline PCr levels (p < 0.001), hospital length-of-stay (p < 0.001), leukocyte-to-lymphocyte ratio (p = 0.025). The plasmatic urea (PU) mildly increased in the remdesivir group (1 (- 2; 5) mmol/l vs. 0 (- 3; 2) mmol/l in the controls, p = 0.009), its levels were related to remdesivir (p = 0.026), age (p = 0.002), PCr (p < 0.001), hospital length-of-stay (p < 0.001), IPPV (p = 0.035). Regarding the liver function tests the significant relationships to remdesivir therapy were found only for GGT (p = 0.007) and ALT (p = 0.044). The levels of PCr were decreasing over the hospitalisation period including patients with mild-to-moderate renal insufficiency. The multivariate regression analysis excluded an impact of remdesivir on the PCr changes yet admitted an impact on the levels of urea, GGT and ALT.
对于病情严重且存在病毒载量的晚期新冠肺炎患者，瑞德西韦对其肾功能和肝功能的影响仍是一个值得关注的问题。将114例接受瑞德西韦治疗且病毒载量可检测的患者（男性占55.8%，年龄71（59；77）岁）的实验室检查结果与对照组进行比较。接受瑞德西韦治疗的患者基线血肌酐（PCr）<150µmol/l时，其下降幅度与对照组相同（-6（-20；9）µmol/l对-8（-24；2）µmol/l，n=170，p=0.11）。基线PCr≥150µmol/l时也发现了类似趋势（瑞德西韦组为-57（-129；-15）µmol/l，对照组为-65（-111；-7）µmol/l，p>0.9）。PCr的变化与瑞德西韦治疗无关，具有统计学意义的混杂因素为基线PCr水平（p<0.001）、住院时间（p<0.001）、白细胞与淋巴细胞比值（p=0.025）。瑞德西韦组血尿素（PU）略有升高（1（-2；5）mmol/l，对照组为0（-3；2）mmol/l，p=0.009），其水平与瑞德西韦（p=0.026）、年龄（p=0.002）、PCr（p<0.001）、住院时间（p<0.001）、机械通气（p=0.035）有关。关于肝功能检查，仅发现与瑞德西韦治疗有显著关系的指标为γ-谷氨酰转移酶（GGT）（p=0.007）和丙氨酸转氨酶（ALT）（p=0.044）。包括轻度至中度肾功能不全患者在内，住院期间PCr水平均呈下降趋势。多因素回归分析排除了瑞德西韦对PCr变化的影响，但承认其对尿素、GGT和ALT水平有影响。
