Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States.
Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States.
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DOI：
10.1053/j.ajkd.2020.09.003
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
STOP-COVID Investigators
中科院分区：
文献类型：
--
作者：
Flythe JE;Assimon MM;Tugman MJ;Chang EH;Gupta S;Shah J;Sosa MA;Renaghan AD;Melamed ML;Wilson FP;Neyra JA;Rashidi A;Boyle SM;Anand S;Christov M;Thomas LF;Edmonston D;Leaf DE;STOP-COVID Investigators
潜在肾脏疾病是2019年更严重的冠状病毒疾病（COVID-19）的新危险因素。我们研究了伴有和不伴有慢性肾脏疾病（CKD）的COVID-19危重患者的临床病程，并调查了潜在肾脏疾病程度与住院预后之间的关系。回顾性队列研究。美国68家医院的重症监护病房（icu）收治了4,264名COVID-19危重患者（143名既往存在肾衰竭接受维护性透析的患者；521名既往存在非透析依赖性CKD的患者；3,600名未存在CKD的患者）。存在（vs不存在）先前存在的肾脏疾病。住院死亡率（初级）；呼吸衰竭、休克、室性心律失常/心脏骤停、血栓栓塞事件、大出血和急性肝损伤（继发性）。我们使用标准化差异来比较患者特征（值> 0.10表示组间有意义的差异），并使用多变量调整的Fine和Gray生存模型来检查结果的相关性。与其他组相比，透析患者从症状出现到入住ICU的时间更短（维持性透析患者的中位数为4 [IQR， 2-9]天，非透析依赖性CKD患者的中位数为7 [IQR， 3-10]天，无CKD患者的中位数为7 [IQR， 4-10]天）。报告精神状态改变的透析患者（25%）多于非透析依赖性CKD患者（20%，标准化差值= 0.12）和未存在CKD患者（12%，标准化差值= 0.36）。一半的透析和非透析依赖性CKD患者在ICU入院28天内死亡，而没有预先存在CKD的患者为35%。与没有预先存在CKD的患者相比，透析患者28天住院死亡的风险更高（校正风险比1.41 [95% CI, 1.09-1.81]），而非透析依赖性CKD患者有中等风险（校正风险比1.25 [95% CI, 1.08-1.44]）。潜在的残留混淆。研究结果强调了患有潜在肾脏疾病和严重COVID-19的个体的高死亡率，强调了在这一弱势群体中确定安全有效的COVID-19治疗方法的重要性。
Underlying kidney disease is an emerging risk factor for more severe coronavirus disease 2019 (COVID-19) illness. We examined the clinical courses of critically ill COVID-19 patients with and without pre-existing chronic kidney disease (CKD) and investigated the association between the degree of underlying kidney disease and in-hospital outcomes. Retrospective cohort study. 4,264 critically ill patients with COVID-19 (143 patients with pre-existing kidney failure receiving maintenance dialysis; 521 patients with pre-existing non-dialysis-dependent CKD; and 3,600 patients without pre-existing CKD) admitted to intensive care units (ICUs) at 68 hospitals across the United States. Presence (vs absence) of pre-existing kidney disease. In-hospital mortality (primary); respiratory failure, shock, ventricular arrhythmia/cardiac arrest, thromboembolic events, major bleeds, and acute liver injury (secondary). We used standardized differences to compare patient characteristics (values > 0.10 indicate a meaningful difference between groups) and multivariable-adjusted Fine and Gray survival models to examine outcome associations. Dialysis patients had a shorter time from symptom onset to ICU admission compared to other groups (median of 4 [IQR, 2-9] days for maintenance dialysis patients; 7 [IQR, 3-10] days for non-dialysis-dependent CKD patients; and 7 [IQR, 4-10] days for patients without pre-existing CKD). More dialysis patients (25%) reported altered mental status than those with non-dialysis-dependent CKD (20%; standardized difference = 0.12) and those without pre-existing CKD (12%; standardized difference = 0.36). Half of dialysis and non-dialysis-dependent CKD patients died within 28 days of ICU admission versus 35% of patients without pre-existing CKD. Compared to patients without pre-existing CKD, dialysis patients had higher risk for 28-day in-hospital death (adjusted HR, 1.41 [95% CI, 1.09-1.81]), while patients with non-dialysis-dependent CKD had an intermediate risk (adjusted HR, 1.25 [95% CI, 1.08-1.44]). Potential residual confounding. Findings highlight the high mortality of individuals with underlying kidney disease and severe COVID-19, underscoring the importance of identifying safe and effective COVID-19 therapies in this vulnerable population.
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DOI：
10.15585/mmwr.mm6915e3
发表时间：
2020-04-17
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Garg S;Kim L;Whitaker M;O'Halloran A;Cummings C;Holstein R;Prill M;Chai SJ;Kirley PD;Alden NB;Kawasaki B;Yousey-Hindes K;Niccolai L;Anderson EJ;Openo KP;Weigel A;Monroe ML;Ryan P;Henderson J;Kim S;Como-Sabetti K;Lynfield R;Sosin D;Torres S;Muse A;Bennett NM;Billing L;Sutton M;West N;Schaffner W;Talbot HK;Aquino C;George A;Budd A;Brammer L;Langley G;Hall AJ;Fry A
通讯作者：
Fry A
影响因子：
15.1
作者：
Hutchison, Colin A.;Crowe, Alex V.;Lipkin, Graham W.
通讯作者：
Lipkin, Graham W.
影响因子：
24.3
作者：
Guan, Wei-jie;Liang, Wen-hua;He, Jian-xing
通讯作者：
He, Jian-xing
影响因子：
33.9
作者：
Killerby, Marie E.;Link-Gelles, Ruth;Tate, Jacqueline E.
通讯作者：
Tate, Jacqueline E.
影响因子：
39
作者：
Gupta, Shruti;Hayek, Salim S.;Leaf, David E.
通讯作者：
Leaf, David E.