Acute kidney injury associated with COVID-19: A retrospective cohort study.
Acute kidney injury associated with COVID-19: A retrospective cohort study.
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DOI：
10.1371/journal.pmed.1003406
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发表时间：
2020-10
期刊：
影响因子：
15.8
通讯作者：
Taal MW
中科院分区：
文献类型：
--
作者：
Kolhe NV;Fluck RJ;Selby NM;Taal MW
初步报告显示，2019冠状病毒病（COVID-19）中急性肾损伤（AKI）的发生率很高，但需要更多的数据来阐明COVID-19是否是AKI的独立危险因素，以及COVID-19相关的AKI与其他原因导致的AKI有何不同。因此，我们试图研究COVID-19、AKI和结局之间的关系，在英国德比的两家急性医院住院的患者中进行回顾性队列研究。我们提取了2020年3月5日至2020年5月12日期间接受COVID-19检测的4759名住院患者的电子数据。这些数据与电子病历和实验室信息管理系统相连。主要结局是AKI，次要结局包括住院死亡率、呼吸支持需求、重症监护病房（ICU）入院和住院时间。与COVID-19阴性组（n = 3,374）相比，COVID-19患者（n = 1,161）年龄较大（72.1±16.1岁对65.3±20.4岁，p < 0.001），男性比例较大（56.6%对44.9%,p < 0.001），亚裔比例较大（8.3%对4.0%,p < 0.001），白人比例较低（75.5%对82.5%,p < 0.001）。304例（26.2%）COVID-19阳性患者（COVID-19 AKI）和420例（12.4%）COVID-19阴性患者（AKI对照组）发生AKI。65 ~ 84岁的COVID-19患者（优势比[OR] 1.67, 95%可信区间[CI] 1.11 ~ 2.50）、需要机械通气（OR 8.74, 95% CI 5.27 ~ 14.77）、患有充血性心力衰竭（OR 1.72, 95% CI 1.18 ~ 2.50）、慢性肝病（OR 3.43, 95% CI 1.17 ~ 10.00）和慢性肾病（CKD） （OR 2.81, 95% CI 1.97 ~ 4.01）发生AKI的几率较高。COVID-19 AKI患者的死亡率高于无AKI的COVID-19患者（60.5%对27.4%,p < 0.001）， AKI是死亡率的独立预测因子（OR 3.27, 95% CI 2.39至4.48）。与AKI对照组相比，COVID-19 AKI在男性中的比例较高（58.9%对51%，p = 0.04），在白人中的比例较低（74.7%对86.9%,p = 0.003）；与脑血管疾病（11.8%比6.0%,p = 0.006）、慢性肺病（28.0%比19.3%,p = 0.007）、糖尿病（24.7%比17.9%,p = 0.03）和CKD（34.2%比20.0%,p < 0.001）的相关性更高；并且更有可能是医院获得性（61.2%比46.4%,p < 0.001）。与对照组相比，COVID-19 AKI的死亡率更高（60.5%对27.6%,p < 0.001）。在多变量分析中，65 ~ 84岁（OR 3.08, 95% CI 1.77 ~ 5.35）和≥85岁（OR 3.54, 95% CI 1.87 ~ 6.70）的AKI患者、AKI高峰期2期（OR 1.74, 95% CI 1.05 ~ 2.90）、AKI 3期（OR 2.01, 95% CI 1.13 ~ 3.57）和COVID-19 （OR 3.80, 95% CI 2.62 ~ 5.51）的死亡几率较高。本研究的局限性包括回顾性设计，缺乏尿液分析数据，以及该地区的种族多样性低。我们观察到，COVID-19患者的AKI发生率高，其死亡几率比无AKI的COVID-19高3倍，比其他原因导致的AKI高4倍。这些数据表明，应监测COVID-19患者是否发生AKI，并采取措施预防AKI的发生。最近的报告表明，一些2019冠状病毒病（COVID-19）患者会出现急性肾损伤（AKI）。有必要更好地了解COVID-19患者AKI的危险因素。目前还不清楚COVID-19患者的AKI是否与其他原因引起的AKI不同。在这项研究中，我们检查了COVID-19患者AKI的危险因素，并将COVID-19患者的AKI与其他原因引起的AKI进行了比较。我们发现，男性和非白人患者以及患有合并症的患者在COVID-19中发生AKI的风险增加。AKI与COVID-19患者死亡率增加3倍相关。与其他原因引起的AKI患者相比，COVID-19和AKI患者的死亡率更高（60.5%对27.6%），并且COVID-19是死亡率的独立预测因子，其死亡几率几乎是4倍。COVID-19经常引起AKI，当它发生时，它的死亡率高于没有AKI的COVID-19或由于其他原因引起的AKI。应监测COVID-19患者是否有AKI的早期证据，以便采取预防措施避免AKI。
Initial reports indicate a high incidence of acute kidney injury (AKI) in Coronavirus Disease 2019 (COVID-19), but more data are required to clarify if COVID-19 is an independent risk factor for AKI and how COVID-19–associated AKI may differ from AKI due to other causes. We therefore sought to study the relationship between COVID-19, AKI, and outcomes in a retrospective cohort of patients admitted to 2 acute hospitals in Derby, United Kingdom. We extracted electronic data from 4,759 hospitalised patients who were tested for COVID-19 between 5 March 2020 and 12 May 2020. The data were linked to electronic patient records and laboratory information management systems. The primary outcome was AKI, and secondary outcomes included in-hospital mortality, need for ventilatory support, intensive care unit (ICU) admission, and length of stay. As compared to the COVID-19–negative group (n = 3,374), COVID-19 patients (n = 1,161) were older (72.1 ± 16.1 versus 65.3 ± 20.4 years, p < 0.001), had a greater proportion of men (56.6% versus 44.9%, p < 0.001), greater proportion of Asian ethnicity (8.3% versus 4.0%, p < 0.001), and lower proportion of white ethnicity (75.5% versus 82.5%, p < 0.001). AKI developed in 304 (26.2%) COVID-19–positive patients (COVID-19 AKI) and 420 (12.4%) COVID-19–negative patients (AKI controls). COVID-19 patients aged 65 to 84 years (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.11 to 2.50), needing mechanical ventilation (OR 8.74, 95% CI 5.27 to 14.77), having congestive cardiac failure (OR 1.72, 95% CI 1.18 to 2.50), chronic liver disease (OR 3.43, 95% CI 1.17 to 10.00), and chronic kidney disease (CKD) (OR 2.81, 95% CI 1.97 to 4.01) had higher odds for developing AKI. Mortality was higher in COVID-19 AKI versus COVID-19 patients without AKI (60.5% versus 27.4%, p < 0.001), and AKI was an independent predictor of mortality (OR 3.27, 95% CI 2.39 to 4.48). Compared with AKI controls, COVID-19 AKI was observed in a higher proportion of men (58.9% versus 51%, p = 0.04) and lower proportion with white ethnicity (74.7% versus 86.9%, p = 0.003); was more frequently associated with cerebrovascular disease (11.8% versus 6.0%, p = 0.006), chronic lung disease (28.0% versus 19.3%, p = 0.007), diabetes (24.7% versus 17.9%, p = 0.03), and CKD (34.2% versus 20.0%, p < 0.001); and was more likely to be hospital acquired (61.2% versus 46.4%, p < 0.001). Mortality was higher in the COVID-19 AKI as compared to the control AKI group (60.5% versus 27.6%, p < 0.001). In multivariable analysis, AKI patients aged 65 to 84 years, (OR 3.08, 95% CI 1.77 to 5.35) and ≥85 years of age (OR 3.54, 95% CI 1.87 to 6.70), peak AKI stage 2 (OR 1.74, 95% CI 1.05 to 2.90), AKI stage 3 (OR 2.01, 95% CI 1.13 to 3.57), and COVID-19 (OR 3.80, 95% CI 2.62 to 5.51) had higher odds of death. Limitations of the study include retrospective design, lack of urinalysis data, and low ethnic diversity of the region. We observed a high incidence of AKI in patients with COVID-19 that was associated with a 3-fold higher odds of death than COVID-19 without AKI and a 4-fold higher odds of death than AKI due to other causes. These data indicate that patients with COVID-19 should be monitored for the development of AKI and measures taken to prevent this. ClinicalTrials.gov NCT04407156 Recent reports have suggested that some patients with Coronavirus Disease 2019 (COVID-19) develop acute kidney injury (AKI). There is a need to better understand risk factors for AKI in patients with COVID-19. It is also unclear if AKI in patients with COVID-19 differs from AKI due to other causes. In this study, we examined risk factors for AKI in patients with COVID-19 and also compared AKI in COVID-19 with AKI due to other causes. We found that males and patients of nonwhite ethnicity as well as those with comorbidities were at increased risk of developing AKI in COVID-19. AKI was associated with a 3-fold increase in mortality in COVID-19 patients. Patients with COVID-19 and AKI had higher mortality (60.5% versus 27.6%) than patients with AKI due to other causes, and COVID-19 was an independent predictor of mortality associated with an almost 4-fold odds of death. COVID-19 frequently causes AKI, and when it does, it is associated with a higher mortality than COVID-19 without AKI or AKI due to other causes. Patients with COVID-19 should be monitored for early evidence of AKI so that preventive measures can be taken to avoid AKI.
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