Acute Kidney Injury Incidence, Recovery, and Long-term Kidney Outcomes Among Hospitalized Patients With COVID-19 and Influenza.
Acute Kidney Injury Incidence, Recovery, and Long-term Kidney Outcomes Among Hospitalized Patients With COVID-19 and Influenza.
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DOI：
10.1016/j.ekir.2021.07.008
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发表时间：
2021-10
影响因子：
6
通讯作者：
Sise ME
中科院分区：
文献类型：
--
作者：
Strohbehn IA;Zhao S;Seethapathy H;Lee M;Rusibamayila N;Allegretti AS;Parada XV;Sise ME
急性肾损伤（阿基）是严重COVID-19患者的常见并发症。我们试图比较因COVID-19和流感住院患者的阿基发生率和结局。这是一项回顾性队列研究，对象为2020年3月至5月期间住院的COVID-19患者以及2017年1月至2019年12月期间因甲型或B流感住院的历史对照。使用考克斯比例风险模型比较住院期间阿基的风险。次要结局包括阿基恢复、死亡率、新发慢性肾病（CKD）和估计肾小球滤过率（eGFR）下降≥25%。共纳入2425例患者; 1091例（45%）患有COVID-19，1334例（55%）患有流感。COVID-19和流感患者的总体阿基率分别为23%和13%。与流感相比，COVID-19住院患者发生阿基的风险增加（校正风险比[aHR] = 1.58; 95%置信区间[CI]，1.29-1.94）。与流感相比，感染COVID-19的阿基患者更有可能在医院死亡（aHR = 3.55; 95% CI，2.11-5.97）。在存活出院的患者中，COVID-19患者的阿基恢复率较低（aHR = 0.47; 95% CI，0.36-0.62）;然而，在随访≥90天的患者中，新发CKD（aHR = 1.24; 95% CI，0.86-1.78）和末次随访时eGFR下降≥25%（aHR = 1.36，95% CI，0.97-1.90）在队列间无显著差异。COVID-19患者的阿基和死亡率显著高于流感患者;然而，长期存活者的肾脏恢复似乎相似。
Acute kidney injury (AKI) is a common complication in patients with severe COVID-19. We sought to compare the AKI incidence and outcomes among patients hospitalized with COVID-19 and with influenza. This was a retrospective cohort study of patients with COVID-19 hospitalized between March and May 2020 and historical controls hospitalized with influenza A or B between January 2017 and December 2019 within a large health care system. Cox proportional hazards models were used to compare the risk of AKI during hospitalization. Secondary outcomes included AKI recovery, mortality, new-onset chronic kidney disease (CKD), and ≥25% estimated glomerular filtration rate (eGFR) decline. A total of 2425 patients were included; 1091 (45%) had COVID-19, and 1334 (55%) had influenza. The overall AKI rate was 23% and 13% in patients with COVID-19 and influenza, respectively. Compared with influenza, hospitalized patients with COVID-19 had an increased risk of developing AKI (adjusted hazard ratio [aHR] = 1.58; 95% confidence interval [CI], 1.29–1.94). Patients with AKI were more likely to die in the hospital when infected with COVID-19 versus influenza (aHR = 3.55; 95% CI, 2.11–5.97). Among patients surviving to hospital discharge, the rate of AKI recovery was lower in patients with COVID-19 (aHR = 0.47; 95% CI, 0.36–0.62); however, among patients followed for ≥90 days, new-onset CKD (aHR = 1.24; 95% CI, 0.86–1.78) and ≥25% eGFR decline at the last follow-up (aHR = 1.36, 95% CI, 0.97–1.90) were not significantly different between the cohorts. AKI and mortality rates are significantly higher in patients with COVID-19 than influenza; however, kidney recovery among long-term survivors appears to be similar.
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