Effect of therapeutic-dose heparin on severe acute kidney injury and death in noncritically ill patients hospitalized for COVID-19: a prespecified secondary analysis of the ACTIV4a and ATTACC randomized trial.
Effect of therapeutic-dose heparin on severe acute kidney injury and death in noncritically ill patients hospitalized for COVID-19: a prespecified secondary analysis of the ACTIV4a and ATTACC randomized trial.
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DOI：
10.1016/j.rpth.2023.102167
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发表时间：
2023-08
影响因子：
4.6
通讯作者：
Berger, Jeffrey S.
中科院分区：
文献类型：
--
作者：
Smilowitz, Nathaniel R.;Hade, Erinn M.;Kornblith, Lucy Z.;Castellucci, Lana A.;Cushman, Mary;Farkouh, Michael;Gong, Michelle N.;Heath, Anna;Hunt, Beverly J.;Kim, Keri S.;Kindzelski, Andrei;Lawler, Patrick;Leaf, David E.;Goligher, Ewan;Leifer, Eric S.;McVerry, Bryan J.;Reynolds, Harmony R.;Zarychanski, Ryan;Hochman, Judith S.;Neal, Matthew D.;Berger, Jeffrey S.
COVID-19患者的急性肾损伤（AKI）部分由血栓炎症介导。在COVID-19非危重患者中，治疗剂量肝素抗凝增加了存活至出院的可能性，同时减少了心血管或呼吸器官支持的使用。我们研究了治疗剂量肝素是否能降低因COVID-19住院的非危重患者AKI或死亡的发生率。我们报告了一项预先指定的二级分析，该分析是ACTIV4a和ATTACC开放标签、多平台随机试验，研究治疗剂量肝素与常规护理药理学血栓预防对COVID-19住院的非危重患者严重AKI发生率(血清肌酐升高≥2倍或开始肾脏替代治疗（KDIGO 2期或3期）或全因死亡率的影响。根据年龄、性别、d -二聚体、入组时间、国家、地点和平台对贝叶斯统计模型进行调整。在1922年纳入的研究中，23人因先前存在终末期肾病而被排除，205人缺乏基线或随访肌酐测量。治疗剂量肝素组和血栓预防组分别有4.4%和5.5%的受试者发生严重AKI或死亡（校正相对危险度[aRR]: 0.72； 95%可信区间（CrI）： 0.47, 1.10）；治疗剂量肝素的后验优势概率（相对危险度< 1.0）为93.6%。与血栓预防相比，治疗剂量肝素在减少3期AKI或死亡的综合发生率方面有97.7%的优势（3.1% vs 4.6%; aRR: 0.64; 95% CrI: 0.40, 0.99）。治疗剂量肝素与降低COVID-19住院患者院内严重AKI发生率或死亡的高概率优势相关。急性肾损伤（AKI）发生与COVID-19和可能是由于血栓炎症。我们评估了COVID-19住院患者血液稀释剂剂量与肾损伤的关系。4.9%的参与者发生了严重的肾损伤或死亡。治疗剂量肝素在降低COVID-19患者AKI/死亡方面具有很高的优势概率。
Acute kidney injury (AKI) in patients with COVID-19 is partly mediated by thromboinflammation. In noncritically ill patients with COVID-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge with reduced use of cardiovascular or respiratory organ support. We investigated whether therapeutic-dose heparin reduces the incidence of AKI or death in noncritically ill patients hospitalized for COVID-19. We report a prespecified secondary analysis of the ACTIV4a and ATTACC open-label, multiplatform randomized trial of therapeutic-dose heparin vs usual-care pharmacologic thromboprophylaxis on the incidence of severe AKI (≥2-fold increase in serum creatinine or initiation of kidney replacement therapy (KDIGO stage 2 or 3) or all-cause mortality in noncritically ill patients hospitalized for COVID-19. Bayesian statistical models were adjusted for age, sex, D-dimer, enrollment period, country, site, and platform. Among 1922 enrolled, 23 were excluded due to pre-existing end stage kidney disease and 205 were missing baseline or follow-up creatinine measurements. Severe AKI or death occurred in 4.4% participants assigned to therapeutic-dose heparin and 5.5% assigned to thromboprophylaxis (adjusted relative risk [aRR]: 0.72; 95% credible interval (CrI): 0.47, 1.10); the posterior probability of superiority for therapeutic-dose heparin (relative risk < 1.0) was 93.6%. Therapeutic-dose heparin was associated with a 97.7% probability of superiority to reduce the composite of stage 3 AKI or death (3.1% vs 4.6%; aRR: 0.64; 95% CrI: 0.40, 0.99) compared to thromboprophylaxis. Therapeutic-dose heparin was associated with a high probability of superiority to reduce the incidence of in-hospital severe AKI or death in patients hospitalized for COVID-19. Acute kidney injury (AKI) occurs with COVID-19 and may be due to thromboinflammation. We evaluated blood thinner dose and kidney injury in hospitalized patients with COVID-19. Severe kidney injury or death occurred in 4.9% of participants with COVID-19. Therapeutic-dose heparin had a high probability of superiority of reducing AKI/death in COVID-19.
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DOI：
10.1056/nejmoa2118542
发表时间：
2022-04-14
期刊：
The New England journal of medicine
影响因子：
--
作者：
Hammond J;Leister-Tebbe H;Gardner A;Abreu P;Bao W;Wisemandle W;Baniecki M;Hendrick VM;Damle B;Simón-Campos A;Pypstra R;Rusnak JM;EPIC-HR Investigators
通讯作者：
EPIC-HR Investigators
影响因子：
13.6
作者：
Gupta, Shruti;Coca, Steven G.;Leaf, David E.
通讯作者：
Leaf, David E.
DOI：
10.1053/j.ajkd.2020.09.002
发表时间：
2021-03
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Ng JH;Hirsch JS;Hazzan A;Wanchoo R;Shah HH;Malieckal DA;Ross DW;Sharma P;Sakhiya V;Fishbane S;Jhaveri KD;Northwell Nephrology COVID-19 Research Consortium
通讯作者：
Northwell Nephrology COVID-19 Research Consortium
影响因子：
19.6
作者：
Cheng, Yichun;Luo, Ran;Xu, Gang
通讯作者：
Xu, Gang
COVID-19与19号相关的急性肾脏损伤：第25次急性疾病质量倡议（ADQI）工作组的共识报告。
DOI：
10.1038/s41581-020-00356-5
发表时间：
2020-12
期刊：
Nature reviews. Nephrology
影响因子：
--
作者：
Nadim MK;Forni LG;Mehta RL;Connor MJ Jr;Liu KD;Ostermann M;Rimmelé T;Zarbock A;Bell S;Bihorac A;Cantaluppi V;Hoste E;Husain-Syed F;Germain MJ;Goldstein SL;Gupta S;Joannidis M;Kashani K;Koyner JL;Legrand M;Lumlertgul N;Mohan S;Pannu N;Peng Z;Perez-Fernandez XL;Pickkers P;Prowle J;Reis T;Srisawat N;Tolwani A;Vijayan A;Villa G;Yang L;Ronco C;Kellum JA
通讯作者：
Kellum JA