Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19
Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19
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DOI：
10.1159/000511946
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发表时间：
2020-11-10
影响因子：
2.8
通讯作者：
Koraishy, Farrukh M.
中科院分区：
文献类型：
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作者：
Chaudhri, Imran;Moffitt, Richard;Koraishy, Farrukh M.
急性肾损伤（AKI）与2019冠状病毒病（COVID-19）住院患者的不良预后密切相关，但蛋白尿和血尿相关性的数据仅限于非美国人群。此外，肾脏异常的入院和住院措施尚未单独研究。方法：本回顾性队列研究旨在分析2020年3月7日至2020年4月1日在纽约石溪大学医学中心连续入院的321例患者的这些关联。我们调查了蛋白尿、血尿和AKI与炎症、重症监护病房（ICU）入院、有创机械通气（IMV）和院内死亡的关系。双变量分析采用方差分析、t检验、chi(2)检验和Fisher精确检验，多变量分析采用logistic回归。结果：300例患者符合研究队列的纳入标准。多变量分析显示，入院时蛋白尿与院内AKI风险显著相关（OR 4.71, 95% CI 1.28-17.38），而入院时血尿与ICU入院（OR 4.56, 95% CI 1.12-18.64）、IMV （OR 8.79, 95% CI 2.08-37.00）和死亡（OR 18.03, 95% CI 2.84-114.57）相关。住院期间，新发蛋白尿与死亡风险增加显著相关（OR 8.94, 95% CI 1.19-114.4, p = 0.04）。院内AKI增加（OR 27.14, 95% CI 4.44-240.17），而院内AKI恢复降低死亡风险（OR 0.001, 95% CI 0.001-0.06）。结论：新冠肺炎住院患者入院时和住院期间的蛋白尿和血尿与不良临床结局相关。
Introduction: Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. Methods: This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, t test, chi(2) test, and Fisher's exact test for bivariate analyses and logistic regression for multivariable analysis. Results: Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28-17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12-18.64), IMV (OR 8.79, 95% CI 2.08-37.00), and death (OR 18.03, 95% CI 2.84-114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19-114.4, p = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44-240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001-0.06). Conclusion: Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.