Kidney Outcomes in Long COVID
Kidney Outcomes in Long COVID
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DOI：
10.1681/asn.2021060734
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发表时间：
2021-11-01
影响因子：
13.6
通讯作者：
Al-Aly, Ziyad
中科院分区：
文献类型：
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作者：
Bowe, Benjamin;Xie, Yan;Al-Aly, Ziyad
背景COVID-19与涉及肺和肺外器官系统的急性后后遗症风险增加有关？被称为长期COVID。方法我们建立了一个由1，726，683名美国退伍军人组成的队列，从2020年3月1日到2021年3月15日，其中包括89，216名COVID-19 30天幸存者和1，637，467名未感染的对照。我们检查了AKI、eGFR下降、ESKD和主要不良肾脏事件（MAKE）的风险。MAKE是否定义为eGFR下降？50%、ESKD或全因死亡率。我们使用逆概率加权生存回归，调整预定义的人口统计学和健康特征，并通过算法选择高维协变量，包括诊断，药物和实验室检查。线性混合模型表征个体内eGFR轨迹。结果除了急性疾病外，COVID-19 30天存活者显示出更高的AKI风险，（aHR，1.94; 95% CI，1.86 - 2.04），eGFR下降>= 30%（aHR，1.25; 95% CI，1.14至1.37），eGFR下降>= 40%（aHR，1.44; 95% CI，1.37至1.51），eGFR下降>= 50%（aHR，1.62; 95% CI，1.51至1.74）、ESKD（aHR，2.96; 95% CI，2.49至3.51）和MAKE（aHR，1.66; 95% CI，1.58至1.74）。根据急性感染的严重程度（无论患者是否未住院、住院或入住重症监护室）对急性后肾脏结局风险的增加进行分级。与未感染的对照组相比，COVID-19的30天存活者表现出过度的eGFR下降（95% CI），为-3.26（-3.58至-2.94），-5.20-（6.24至-4.16）和-7.69（-8.27~-7.12）ml/min/1.73 m2/年，非住院组、住院组、以及在COVID-19感染急性期入住重症监护室的患者。结论COVID-19幸存患者在疾病急性期后表现出肾脏结局的风险增加。急性COVID-19后护理应包括关注肾脏疾病。
Background COVID-19 is associated with increased risk of post-acute sequelae involving pulmonary and extrapulmonary organ systems?referred to as long COVID. However, a detailed assessment of kidney outcomes in long COVID is not yet available.Methods We built a cohort of 1,726,683 US Veterans identified from March 1, 2020 to March 15, 2021, including 89,216 patients who were 30-day survivors of COVID-19 and 1,637,467 non-infected controls. We examined risks of AKI, eGFR decline, ESKD, and major adverse kidney events (MAKE). MAKE was defined as eGFR decline ?50%, ESKD, or all-cause mortality. We used inverse probability-weighted survival regression, adjusting for predefined demographic and health characteristics, and algorithmically selected high-dimensional covariates, including diagnoses, medications, and laboratory tests. Linear mixed models characterized intra-individual eGFR trajectory.Results Beyond the acute illness, 30-day survivors of COVID-19 exhibited a higher risk of AKI (aHR, 1.94; 95% CI, 1.86 to 2.04), eGFR decline >= 30% (aHR, 1.25; 95% CI, 1.14 to 1.37), eGFR decline >= 40% (aHR, 1.44; 95% CI, 1.37 to 1.51), eGFR decline >= 50% (aHR, 1.62; 95% CI, 1.51 to 1.74), ESKD (aHR, 2.96; 95% CI, 2.49 to 3.51), and MAKE (aHR, 1.66; 95% CI, 1.58 to 1.74). Increase in risks of post-acute kidney outcomes was graded according to the severity of the acute infection (whether patients were non-hospitalized, hospitalized, or admitted to intensive care). Compared with non-infected controls, 30-day survivors of COVID-19 exhibited excess eGFR decline (95% CI) of -3.26 (-3.58 to -2.94), -5.20 -(6.24 to -4.16), and -7.69 (-8.27 to -7.12) ml/min per 1.73 m(2) per year, respectively, in non-hospitalized, hospitalized, and those admitted to intensive care during the acute phase of COVID-19 infection.Conclusions Patients who survived COVID-19 exhibited increased risk of kidney outcomes in the post-acute phase of the disease. Post-acute COVID-19 care should include attention to kidney disease.