AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19
AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19
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DOI：
10.1681/asn.2020060897
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发表时间：
2021-01-01
影响因子：
13.6
通讯作者：
Leaf, David E.
中科院分区：
文献类型：
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作者：
Gupta, Shruti;Coca, Steven G.;Leaf, David E.
阿基是2019冠状病毒病（COVID-19）的常见后遗症。然而，很少有研究集中在阿基与RRT治疗（阿基- RRT）。方法我们进行了一项多中心队列研究的3099名重症成人与COVID-19入住重症监护室（ICU）在美国67家医院。我们使用多变量logistic回归确定患者和医院水平的危险因素为AKI-RRT，并检查28天死亡率的危险因素，在这样的patients.Results共637 3099例患者（20.6%）开发AKI-RRT在14天的ICU入院，其中350人（54.9%）在28天内死亡的ICU入院。AKI-RRT的患者水平风险因素包括慢性肾脏病、男性、非白人、高血压、糖尿病、较高的体重指数、较高的D-二聚体以及入住ICU时较严重的低氧血症。AKIRRT患者28天死亡率的预测因素是年龄较大、严重少尿、入住ICU床位较少或COVID-19区域密度较大的医院。在中位随访17天（范围，1-123天）结束时，637例AKI-RRT患者中有403例（63.3%）死亡，216例（33.9%）出院，18例（2.8%）仍住院。在出院的216例患者中，73例（33.8%）在出院时仍然依赖RRT，39例（18.1%）在ICU入院后60天仍然依赖RRT。结论AKI-RRT在COVID-19危重患者中很常见，与住院死亡率0.60%相关。在存活出院的患者中，三分之一的患者在出院时仍依赖RRT，六分之一的患者在ICU入院后60天仍依赖RRT。
Background AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, fewstudies have focused on AKI treated with RRT (AKI- RRT).Methods We conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. We used multivariable logistic regression to identify patient-and hospital-level risk factors for AKI-RRT and to examine risk factors for 28-day mortality among such patients.Results A total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Patient-level risk factors for AKI-RRT included CKD, men, non-White race, hypertension, diabetes mellitus, higher body mass index, higher D-dimer, and greater severity of hypoxemia on ICU admission. Predictors of 28-day mortality in patients with AKIRRT were older age, severe oliguria, and admission to a hospital with fewer ICU beds or one with greater regional density of COVID-19. At the end of a median follow-up of 17 days (range, 1-123 days), 403 of the 637 patients (63.3%) with AKI-RRT had died, 216 (33.9%) were discharged, and 18 (2.8%) remained hospitalized. Of the 216 patients discharged, 73 (33.8%) remained RRT dependent at discharge, and 39 (18.1%) remained RRT dependent 60 days after ICU admission.Conclusions AKI-RRT is common among critically ill patients with COVID-19 and is associated with a hospital mortality rate of.60%. Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission.