Outcomes of patients with end -stage kidney disease hospitalized with COVID-19
Outcomes of patients with end -stage kidney disease hospitalized with COVID-19
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DOI：
10.1016/j.kint.2020.07.030
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发表时间：
2020-12-01
影响因子：
19.6
通讯作者：
Fishbane, Steven
中科院分区：
文献类型：
--
作者：
Ng, Jia H.;Hirsch, Jamie S.;Fishbane, Steven
考虑到感染相关死亡的高风险，终末期肾病（ESKD）患者感染COVID-19的风险可能会增加。为了评估这一点，我们比较了因COVID-19住院的ESKD患者和非ESKD患者的结局。这是一项回顾性研究，研究对象为2020年3月1日至2020年4月27日期间从13家纽约医院收治的COVID-19患者，并随访至2020年5月27日。我们测量了主要结局（院内死亡）和次要结局（机械通气和住院时间）。在10，482名COVID-19患者中，419人患有ESKD。ESKD患者年龄较大，自我认定为黑人的比例更高，合并症更多。ESKD患者的院内死亡率高于非ESKD患者（31.7% vs 25.4%，比值比1.38，95%可信区间1.12 ± 1.70）。在调整人口统计学和共病条件后，该增加率保持不变（调整后比值比1.37，1.09-1.73）。在粗分析和校正分析中，与未ESKD组相比，ESKD组中7天或7天以上住院时间的比值更高（分别为1.62，1.27-2.06; vs 1.57，1.22 - 2.02）。两组之间机械通气的几率没有差异。ESKD患者院内死亡的独立危险因素是年龄增加、使用呼吸机、淋巴细胞减少、血尿素氮和血清铁蛋白。黑人种族与较低的死亡风险有关。因此，在因COVID-19住院的患者中，与未患ESKD的患者相比，ESKD患者的院内死亡率更高。
Given the high risk of infection-related mortality, patients with end-stage kidney disease (ESKD) may be at increased risk with COVID-19. To assess this, we compared outcomes of patients with and without ESKD, hospitalized with COVID-19. This was a retrospective study of patients admitted with COVID-19 from 13 New York hospitals from March 1, 2020, to April 27, 2020, and followed through May 27, 2020. We measured primary outcome (in-hospital death), and secondary outcomes (mechanical ventilation and length of stay). Of 10,482 patients with COVID-19, 419 had ESKD. Patients with ESKD were older, had a greater percentage self-identified as Black, and more comorbid conditions. Patients with ESKD had a higher rate of inhospital death than those without (31.7% vs 25.4%, odds ratio 1.38, 95% confidence interval 1.12 1.70). This increase rate remained after adjusting for demographic and comorbid conditions (adjusted odds ratio 1.37, 1.09-1.73). The odds of length of stay of seven or more days was higher in the group with compared to the group without ESKD in both the crude and adjusted analysis (1.62, 1.27-2.06; vs 1.57, 1.22 - 2.02, respectively). There was no difference in the odds of mechanical ventilation between the groups. Independent risk factors for in-hospital death for patients with ESKD were increased age, being on a ventilator, lymphopenia, blood urea nitrogen and serum ferritin. Black race was associated with a lower risk of death. Thus, among patients hospitalized with COVID-19, those with ESKD had a higher rate of in-hospital death compared to those without ESKD.