Critical Illness and Systemic Inflammation Are Key Risk Factors of Severe Acute Kidney Injury in Patients With COVID-19.
Critical Illness and Systemic Inflammation Are Key Risk Factors of Severe Acute Kidney Injury in Patients With COVID-19.
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DOI：
10.1016/j.ekir.2021.01.011
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发表时间：
2021-04
影响因子：
6
通讯作者：
Schmidt-Ott KM
中科院分区：
文献类型：
--
作者：
Hardenberg JB;Stockmann H;Aigner A;Gotthardt I;Enghard P;Hinze C;Balzer F;Schmidt D;Zickler D;Kruse J;Körner R;Stegemann M;Schneider T;Schumann M;Müller-Redetzky H;Angermair S;Budde K;Weber-Carstens S;Witzenrath M;Treskatsch S;Siegmund B;Spies C;Suttorp N;Rauch G;Eckardt KU;Schmidt-Ott KM
急性肾损伤（阿基）是COVID-19的重要并发症，但其确切病因尚未完全阐明。可以通过分析反映疾病过程和阿基发展的临床参数的时间关联来提供对阿基机制的见解。我们对在三级医疗转诊中心的3个站点接受治疗的223名连续COVID-19患者进行了一项观察性队列研究，以描述重度阿基（肾脏疾病：改善全球结局3期）的演变，并确定促进其发展的条件。使用描述性统计量和解释性多变量考克斯回归模型（以临床参数作为随时间变化的协变量）来确定重度阿基的风险因素。223例COVID-19患者中有70例（31%）发生重度阿基，其中95.7%需要肾脏替代治疗。重度阿基患者年龄较大，主要为男性，合并症较多，死亡率较高。重度阿基仅发生在重症监护室患者中，97.3%的重度阿基患者发生呼吸衰竭。机械通气、血管加压药治疗和炎症标志物（血清降钙素原水平和白细胞计数）是重度阿基的独立时变风险因素。炎症标志物的增加与严重阿基的发生存在密切的时间相关性。对阿基2期和3期风险因素的敏感性分析证实了这些发现。COVID-19中的重度阿基与危重疾病和全身性炎症密切相关，在较轻的病程中未观察到。这些发现表明，传统的全身性阿基机制而不是肾脏特异性过程导致了COVID-19中的严重阿基。
Acute kidney injury (AKI) is an important complication in COVID-19, but its precise etiology has not fully been elucidated. Insights into AKI mechanisms may be provided by analyzing the temporal associations of clinical parameters reflecting disease processes and AKI development. We performed an observational cohort study of 223 consecutive COVID-19 patients treated at 3 sites of a tertiary care referral center to describe the evolvement of severe AKI (Kidney Disease: Improving Global Outcomes stage 3) and identify conditions promoting its development. Descriptive statistics and explanatory multivariable Cox regression modeling with clinical parameters as time-varying covariates were used to identify risk factors of severe AKI. Severe AKI developed in 70 of 223 patients (31%) with COVID-19, of which 95.7% required kidney replacement therapy. Patients with severe AKI were older, predominantly male, had more comorbidities, and displayed excess mortality. Severe AKI occurred exclusively in intensive care unit patients, and 97.3% of the patients developing severe AKI had respiratory failure. Mechanical ventilation, vasopressor therapy, and inflammatory markers (serum procalcitonin levels and leucocyte count) were independent time-varying risk factors of severe AKI. Increasing inflammatory markers displayed a close temporal association with the development of severe AKI. Sensitivity analysis on risk factors of AKI stage 2 and 3 combined confirmed these findings. Severe AKI in COVID-19 was tightly coupled with critical illness and systemic inflammation and was not observed in milder disease courses. These findings suggest that traditional systemic AKI mechanisms rather than kidney-specific processes contribute to severe AKI in COVID-19.
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影响因子：
28.2
作者：
Liu, Yuwei;Du, Xuebei;Zhao, Yan
通讯作者：
Zhao, Yan
影响因子：
82.9
作者：
Del Valle DM;Kim-Schulze S;Huang HH;Beckmann ND;Nirenberg S;Wang B;Lavin Y;Swartz TH;Madduri D;Stock A;Marron TU;Xie H;Patel M;Tuballes K;Van Oekelen O;Rahman A;Kovatch P;Aberg JA;Schadt E;Jagannath S;Mazumdar M;Charney AW;Firpo-Betancourt A;Mendu DR;Jhang J;Reich D;Sigel K;Cordon-Cardo C;Feldmann M;Parekh S;Merad M;Gnjatic S
通讯作者：
Gnjatic S
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：
13.6
作者：
Fisher, Molly;Neugarten, Joel;Golestaneh, Ladan
通讯作者：
Golestaneh, Ladan