Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy.
Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy.
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DOI：
10.1007/s40620-020-00875-1
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发表时间：
2021-03
影响因子：
3.4
通讯作者：
GECOVID working group
中科院分区：
文献类型：
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作者：
Russo E;Esposito P;Taramasso L;Magnasco L;Saio M;Briano F;Russo C;Dettori S;Vena A;Di Biagio A;Garibotto G;Bassetti M;Viazzi F;GECOVID working group
据报道，SARS-CoV-2感染期间肾脏受累的患病率很高。然而，缺乏关于COVID-19患者急性肾损伤（阿基）的决定因素以及慢性肾脏病（CKD）和阿基的综合影响的数据。我们收集了连续入住本机构的COVID-19患者的患者人口统计学、合并症、慢性药物、生命体征、基线实验室检查结果和住院治疗数据。慢性肾脏疾病定义为入院前180天内尿分析时eGFR < 60 mL/min/1.73 m2或蛋白尿。根据KDIGO标准定义阿基。主要和次要结局是发生阿基和死亡。在符合研究条件的777例患者中，176例（22.6%）发生急性肾损伤。其中，79例（45%）患者表现出既存CKD的急性恶化，21例（12%）患者需要肾脏替代治疗。阿基的独立相关因素为慢性肾脏疾病、C反应蛋白（CRP）和通气支持。在急性肾损伤患者中，111例死亡（63%），其发生使死亡风险增加60%（HR 1.60 [95% IC 1.21-2.49] p = 0.002），与潜在混杂因素（包括高血压、既存肾损伤和合并症）无关。与CKD和整个人群相比，阿基患者因出血导致的死亡率显著更高（分别为7.5% vs 1.5% vs 3.5%）。了解肾功能，包括既存的CKD和急性肾损伤的发展，可能有助于识别死亡风险增加的患者。本文的在线版本（10.1007/s40620-020-00875-1）包含补充材料，可供授权用户使用。
The prevalence of kidney involvement during SARS-CoV-2 infection has been reported to be high. Nevertheless, data are lacking about the determinants of acute kidney injury (AKI) and the combined effect of chronic kidney disease (CKD) and AKI in COVID-19 patients. We collected data on patient demographics, comorbidities, chronic medications, vital signs, baseline laboratory test results and in-hospital treatment in patients with COVID-19 consecutively admitted to our Institution. Chronic kidney disease was defined as eGFR < 60 mL/min per 1.73 m2 or proteinuria at urinalysis within 180 days prior to hospital admission. AKI was defined according to KDIGO criteria. The primary and secondary outcomes were the development of AKI and death. Of 777 patients eligible for the study, acute kidney injury developed in 176 (22.6%). Of these, 79 (45%) showed an acute worsening of a preexisting CKD, and 21 (12%) required kidney replacement therapy. Independent associates of AKI were chronic kidney disease, C-reactive protein (CRP) and ventilation support. Among patients with acute kidney injury, 111 died (63%) and its occurrence increased the risk of death by 60% (HR 1.60 [95% IC 1.21–2.49] p = 0.002) independently of potential confounding factors including hypertension, preexisting kidney damage, and comorbidities. Patients with AKI showed a significantly higher rate of deaths attributed to bleeding compared to CKD and the whole population (7.5 vs 1.5 vs 3.5%, respectively). Awareness of kidney function, both preexisting CKD and development of acute kidney injury, may help to identify those patients at increased risk of death. The online version of this article (10.1007/s40620-020-00875-1) contains supplementary material, which is available to authorized users.
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