Kidney disease is associated with in -hospital death of patients with COVID-19
Kidney disease is associated with in -hospital death of patients with COVID-19
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DOI：
10.1016/j.kint.2020.03.005
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发表时间：
2020-05-01
影响因子：
19.6
通讯作者：
Xu, Gang
中科院分区：
文献类型：
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作者：
Cheng, Yichun;Luo, Ran;Xu, Gang
2019年12月，一起冠状病毒2019(新冠肺炎)疫情在湖北武汉、中国等地暴发，并迅速蔓延至全球其他地区。虽然弥漫性肺泡损伤和急性呼吸衰竭是主要特征，但其他器官的累及仍需探讨。由于有关新冠肺炎患者肾脏疾病的信息有限，我们确定了新冠肺炎患者急性肾损伤的患病率。进一步，我们评估了肾功能异常的标记物与新冠肺炎患者死亡的相关性。这是一项前瞻性队列研究，研究对象为一家三级教学医院收治的701名新冠肺炎患者，该医院还包括三家附属医院，其中113人(16.1%)在医院死亡。患者的平均年龄为63岁(四分位数范围为50-71岁)，包括367名男性和334名女性。入院时，43.9%的患者有蛋白尿，26.7%的患者有血尿。血肌酐升高、血尿素氮升高和估计肾小球滤过率低于60ml/min/1.73m2者分别为14.4%、13.1%和13.1%。在研究期间，AKI的发生率为5.1%。Kaplan-Meier分析表明，患有肾脏疾病的患者住院死亡的风险明显更高。COX比例风险回归分析证实，基线血肌酐升高(危险比：2.10，95%可信区间：1.36-3.26)，基础血尿素氮升高(3.97，2.57-6.14)，急性心肌梗死1期(1.90，0.76-4.76)，2期(3.51，1.49-8.26)，3期(4.38，2.31-8.31)，蛋白尿1+(1.8，0.81-4.00)，2+∼3+(4.84，在调整了年龄、性别、疾病严重程度、合并症和白细胞计数后，血尿1+(2.99，1.39~6.42)、2+∼3+(5.56，2.58~12.01)是住院死亡的独立危险因素。因此，我们的研究结果表明，新冠肺炎患者入院时肾脏疾病的患病率和住院期间急性肾损伤的发生率很高，并与住院死亡率有关。因此，临床医生应提高对重症新冠肺炎患者肾脏疾病的认识。
In December 2019, a coronavirus 2019 (COVID-19) disease outbreak occurred in Wuhan, Hubei Province, China, and rapidly spread to other areas worldwide. Although diffuse alveolar damage and acute respiratory failure were the main features, the involvement of other organs needs to be explored. Since information on kidney disease in patients with COVID-19 is limited, we determined the prevalence of acute kidney injury (AKI) in patients with COVID-19. Further, we evaluated the association between markers of abnormal kidney function and death in patients with COVID-19. This was a prospective cohort study of 701 patients with COVID-19 admitted in a tertiary teaching hospital that also encompassed three affiliates following this major outbreak in Wuhan in 2020 of whom 113 (16.1%) died in hospital. Median age of the patients was 63 years (interquartile range, 50-71), including 367 men and 334 women. On admission, 43.9% of patients had proteinuria and 26.7% had hematuria. The prevalence of elevated serum creatinine, elevated blood urea nitrogen and estimated glomerular filtration under 60 ml/min/1.73m2were 14.4, 13.1 and 13.1%, respectively. During the study period, AKI occurred in 5.1% patients. Kaplan-Meier analysis demonstrated that patients with kidney disease had a significantly higher risk for in-hospital death. Cox proportional hazard regression confirmed that elevated baseline serum creatinine (hazard ratio: 2.10, 95% confidence interval: 1.36-3.26), elevated baseline blood urea nitrogen (3.97, 2.57-6.14), AKI stage 1 (1.90, 0.76-4.76), stage 2 (3.51, 1.49-8.26), stage 3 (4.38, 2.31-8.31), proteinuria 1+ (1.80, 0.81-4.00), 2+∼3+ (4.84, 2.00-11.70), and hematuria 1+ (2.99, 1.39-6.42), 2+∼3+ (5.56,2.58- 12.01) were independent risk factors for in-hospital death after adjusting for age, sex, disease severity, comorbidity and leukocyte count. Thus, our findings show the prevalence of kidney disease on admission and the development of AKI during hospitalization in patients with COVID-19 is high and is associated with in-hospital mortality. Hence, clinicians should increase their awareness of kidney disease in patients with severe COVID-19.