Association of Inflammatory Biomarkers with Immunosuppression Management and Outcomes in Kidney Transplant Recipients with COVID-19.
Association of Inflammatory Biomarkers with Immunosuppression Management and Outcomes in Kidney Transplant Recipients with COVID-19.
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DOI：
10.1016/j.transproceed.2021.08.002
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发表时间：
2021-10
影响因子：
0.9
通讯作者：
Hedayati SS
中科院分区：
文献类型：
--
作者：
AbdulRahim N;McAdams M;Xu P;Wojciechowski D;La Hoz RM;Lu C;Vazquez MA;Hedayati SS
患有2019冠状病毒病（COVID-19）的肾移植受者发生不良结局的风险增加，如急性肾损伤（AKI），重症监护室（ICU）入院和死亡。炎症生物标志物与预后的相关性以及免疫抑制变化对生物标志物水平的影响尚不清楚。我们研究了与AKI、ICU入院或死亡复合因素相关的因素，以及免疫抑制变化是否与严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）聚合酶链反应阳性的肾移植受者的炎症生物标志物变化和结局相关。在59例患者中，50%的患者估计肾小球滤过率（eGFR）<60 mL/min/1.73 m2。停用钙调磷酸酶抑制剂（CNI）的患者的高敏C反应蛋白（hs-CRP）峰值高于维持相同剂量的患者（中位数，344;四分位距[IQR]，145 - 374 vs中位数，41; IQR，22 - 116 mg/L，P = 0.03）。在这些患者中，73%住院，22%进入ICU，20%死亡。在56%的AKI患者中，35%需要透析。所有无肺部表现的AKI患者均恢复至基线肌酐水平的10%。与复合结局相关的因素为eGFR <60 mL/min/1.73 m2（比值比[OR]，5.833; 95%置信区间[CI]，1.880 - 18.099; P =.002），hs-CRP（OR，1.011/单位增加; 95% CI，1.002 - 1.021; P =.019），白色血细胞计数（OR，1.173/单位增加; 95% CI，1.006 - 1.368; P =.041），减少或停用CNI（OR，4.286; 95% CI，1.353 - 13.572; P =.013）。eGFR <60 mL/min/1.73 m2（OR，11.176; 95% CI，1.581 - 79.001; P =.016）和hs-CRP峰值（OR，1.010/单位增加; 95% CI，1.000 - 1.020; P =.049）仍与多变量模型中的复合指标相关。患有COVID-19的肾移植受者的ICU入院率、AKI和死亡率很高。eGFR <60 mL/min/1.73 m2的患者风险最高。CNI减少与较高的炎症生物标志物相关，与较差的结局相关。需要更多的研究来确定这种关联是否应该推动临床管理。
Kidney transplant recipients with coronavirus disease 2019 (COVID-19) are at increased risk for adverse outcomes, such as acute kidney injury (AKI), intensive care unit (ICU) admission, and death. The association of inflammatory biomarkers with outcomes and the impact of changes in immunosuppression on biomarker levels are unknown. We investigated factors associated with a composite of AKI, ICU admission, or death, and whether immunosuppression changes correlated with changes in inflammatory biomarkers and outcomes in kidney transplant recipients with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction. Of 59 patients, 50% had estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Patients who discontinued calcineurin inhibitors (CNIs) had higher peak high-sensitivity C-reactive protein (hs-CRP) than those who maintained the same dose (median, 344; interquartile range [IQR], 145-374 vs median, 41; IQR, 22-116 mg/L, P = .03). Of the patients, 73% were hospitalized, 22% had admissions to the ICU, and 20% died. Of the 56% with AKI, 35% required dialysis. All patients with AKI but without pulmonary manifestations recovered to 10% of baseline creatinine levels. Factors associated with the composite outcome were eGFR <60 mL/min/1.73 m2 (odds ratio [OR], 5.833; 95% confidence interval [CI], 1.880-18.099; P = .002), hs-CRP (OR, 1.011/unit increase; 95% CI, 1.002-1.021; P = .019), white blood cell count (OR, 1.173/unit increase; 95% CI, 1.006-1.368; P = .041), and decreased or discontinued CNI (OR, 4.286; 95% CI, 1.353-13.572; P = .013). eGFR<60 mL/min/1.73 m2 (OR, 11.176; 95% CI, 1.581-79.001; P = .016), and peak hs-CRP (OR, 1.010/unit increase; 95% CI, 1.000-1.020; P = .049) remained associated with the composite in the multivariable model. Kidney transplant recipients with COVID-19 have high rates of ICU admissions, AKI, and death. Those with eGFR<60 mL/min/1.73 m2 are at highest risk. CNI reduction is associated with higher inflammatory biomarkers, correlating with worse outcomes. More studies are needed to determine if this association should drive clinical management.
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