AKI in Hospitalized Patients with and without COVID-19: A Comparison Study
AKI in Hospitalized Patients with and without COVID-19: A Comparison Study
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DOI：
10.1681/asn.2020040509
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发表时间：
2020-09-01
影响因子：
13.6
通讯作者：
Golestaneh, Ladan
中科院分区：
文献类型：
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作者：
Fisher, Molly;Neugarten, Joel;Golestaneh, Ladan
来自2019年冠状病毒病患者治疗中心(新冠肺炎)的背景报告指出，此类患者经常发生急性心肌梗死。然而，没有直接比较有无新冠肺炎的住院患者急性心肌梗死的风险、病程和结果。方法在一项回顾性观察研究中，我们评估了3,345例患有新冠肺炎的成人和1,265例无新冠肺炎的成人急性心肌梗死的发生率、危险因素和预后，并将他们与一年前在同一医疗系统住院的9859人进行比较。我们还开发了一个模型来确定COVID-19中2期或3期AKI的预测因素。结果我们发现，与既往队列患者相比，新冠肺炎患者的AKI发生率更高(分别为56.9%和25.1%)。有急性肾损伤和新冠肺炎的患者比没有新冠肺炎的患者更有可能需要进行RRT，而肾功能恢复的可能性更小。AKI的发生与男性、黑人种族和高龄(>；50岁)显著相关。无论新冠肺炎状态如何，男性、年龄和50岁与RRT或死亡率的综合结果相关。早期呼吸频率、白细胞计数、中性粒细胞/淋巴细胞比值、乳酸脱氢酶水平是预测2、3期急性脑损伤的危险因素。入院时的生命体征和实验室数据可能有助于风险分层以预测严重的AKI。虽然男性、黑人和高龄与急性心肌梗死的发生有关，但这些关联并不是新冠肺炎独有的。
Background Reports from centers treating patients with coronavirus disease 2019 (COVID-19) have noted that such patients frequently develop AKI. However, there have been no direct comparisons of AKI in hospitalized patients with and without COVID-19 that would reveal whether there are aspects of AKI risk, course, and outcomes unique to this infection.Methods In a retrospective observational study, we evaluated AKI incidence, risk factors, and outcomes for 3345 adults with COVID-19 and 1265 without COVID-19 who were hospitalized in a large New York City health system and compared them with a historical cohort of 9859 individuals hospitalized a year earlier in the same health system. We also developed a model to identify predictors of stage 2 or 3 AKI in our COVID-19.Results We found higher AKI incidence among patients with COVID-19 compared with the historical cohort (56.9% versus 25.1%, respectively). Patients with AKI and COVID-19 were more likely than those without COVID-19 to require RRT and were less likely to recover kidney function. Development of AKI was significantly associated with male sex, Black race, and older age (>50 years). Male sex and age >50 years associated with the composite outcome of RRT or mortality, regardless of COVID-19 status. Factors that were predictive of stage 2 or 3 AKI included initial respiratory rate, white blood cell count, neutrophil/lymphocyte ratio, and lactate dehydrogenase level.Conclusions Patients hospitalized with COVID-19 had a higher incidence of severe AKI compared with controls. Vital signs at admission and laboratory data may be useful for risk stratification to predict severe AKI. Although male sex, Black race, and older age associated with development of AKI, these associations were not unique to COVID-19.