Impact of renal function on admission in COVID-19 patients: an analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID 19) Registry
Impact of renal function on admission in COVID-19 patients: an analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID 19) Registry
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DOI：
10.1007/s40620-020-00790-5
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发表时间：
2020-06-29
影响因子：
3.4
通讯作者：
Estrada, Vicente
中科院分区：
文献类型：
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作者：
Uribarri, Aitor;Nunez-Gil, Ivan J.;Estrada, Vicente
背景：新冠肺炎是由严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)引起的一种疾病。尽管它在国际上具有侵袭性的扩展，具有显著的发病率和死亡率，但肾功能对其预后的影响尚不确定。方法应用国际HOPE-注册表(NCT04334291)进行分析。目的是评估入院时肾功能衰竭的严重程度与SARS-CoV-2感染患者死亡率的关系。根据入院时估计的肾小球滤过率将患者分为3组(EGFR和GT；60mL/min/1.73m(2)，EGFR 30~60mL/min/1.73m(2)和EGFR和lt；30mL/min/1.73m(2))。结果758例患者平均年龄为66+/-18岁，男性占58.6%。只有8.5%的患者有慢性肾脏疾病(CKD)病史；然而，30%的患者入院时有肾功能障碍(EGFR<；60mL/min/1.73m(2))。这些患者较少接受羟氯喹或抗病毒药物的药物治疗，有较多的并发症，如脓毒症(11.9%vs 26.4%vs 40.8%，p<；0.001)和呼吸衰竭(35.4%vs 72.2%vs 62.0%，p<；0.001)以及较高的住院死亡率(EGFR>；60 vs EGFR 30-60 vs EGFR<；30，18.4%vs 56.5%vs 65.5%，p<；0.001)。在多变量分析中：年龄、高血压、肾功能、入院时0(2)饱和度及92%和乳酸脱氢酶升高独立预测全因死亡率。结论SARS-CoV-2感染患者入院时肾功能衰竭较多，并发症和住院病死率较高。我们的数据来自多中心登记，因此不允许进行准确的死亡风险评估。需要更多的研究来证实这些发现。
Background Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite its international aggressive extension, with a significant morbidity and mortality, the impact of renal function on its prognosis is uncertain. Methods Analysis from the international HOPE-Registry (NCT04334291). The objective was to evaluate the association between kidney failure severity on admission with the mortality of patients with SARS-CoV-2 infection. Patients were categorized in 3 groups according to the estimated glomerular filtration rate on admission (eGFR > 60 mL/min/1.73 m(2), eGFR 30-60 mL/min/1.73 m(2)and eGFR < 30 mL/min/1.73 m(2)). Results 758 patients were included: mean age was 66 +/- 18 years, and 58.6% of patient were male. Only 8.5% of patients had a history of chronic kidney disease (CKD); however, 30% of patients had kidney dysfunction upon admission (eGFR < 60 mL/min/1.73 m(2)). These patients received less frequently pharmacological treatment with hydroxychloroquine or antivirals and had a greater number of complications such as sepsis (11.9% vs 26.4% vs 40.8%, p < 0.001) and respiratory failure (35.4% vs 72.2% vs 62.0%, p < 0.001) as well as a higher in-hospital mortality rate (eGFR > 60 vs eGFR 30-60 vs and eGFR < 30, 18.4% vs 56.5% vs 65.5%, p < 0.001). In multivariate analysis: age, hypertension, renal function, 0(2)saturation < 92% and lactate dehydrogenase elevation on admission independently predicted all-cause mortality. Conclusions Renal failure on admission in patients with SARS-CoV-2 infection is frequent and is associated with a greater number of complications and in-hospital mortality. Our data comes from a multicenter registry and therefore does not allow to have a precise mortality risk assessment. More studies are needed to confirm these findings.