Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia
Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia
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COVID-19 肺炎患者的肾脏受累和早期预后
DOI：
10.1681/asn.2020030276
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发表时间：
2020-06-01
影响因子：
13.6
通讯作者：
Xu, Gang
中科院分区：
文献类型：
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作者：
Pei, Guangchang;Zhang, Zhiguo;Xu, Gang
重要性声明部分COVID-19肺炎病例出现肾损伤，COVID-19患者的尸检结果显示肾脏受累。在这项针对中国COVID-19肺炎患者的回顾性单中心研究中，333例患者中有251例（75.4%）出现肾脏并发症，包括蛋白尿、血尿和阿基。在12天的中位随访时间后，近一半的阿基患者在感染发生后3周内从阿基中恢复。然而，肾脏受累患者的总体死亡率（11.2%）高于无肾脏受累患者（1.2%）。肾脏受累的不良短期结局与COVID-19肺炎的严重程度相关。这些发现表明，虽然这些患者的早期肾脏异常通常会消退，但对于伴有肾脏并发症的COVID-19肺炎，加强支持和对重症或危重疾病的仔细监测是合适的。背景一些COVID-19肺炎患者也会出现肾损伤，死于该病的患者的尸检结果有时会显示肾损伤。然而，对肾脏相关并发症的临床特征知之甚少，包括血尿、蛋白尿和阿基。方法在这项中国回顾性单中心研究中，我们分析了333例COVID-19肺炎住院患者的电子病历数据，包括临床、实验室、放射学和其他特征的信息，结果我们发现333例患者中有251例（75.4%）有尿试纸试验或阿基异常。在198例中位持续时间为12天的肾脏受累患者中，118例（59.6%）在此期间出现肺炎缓解，162例患者中有111例（68.5%）出现蛋白尿缓解。在35例发生阿基的患者中（阿基的标准在某种程度上超出了2012年肾脏疾病：改善全球结局定义），16例（45.7%）肾功能完全恢复。我们怀疑大多数阿基病例为内源性阿基。肾脏受累患者的总体死亡率高于无肾脏受累患者（分别为28/251 [11.2%] vs 1/82 [1.2%]）。逐步多变量二元Logistic回归分析显示，肺炎严重程度是阿基蛋白尿或血尿缓解和恢复几率较低的最常见危险因素。结论大多数COVID-19肺炎患者发生肾脏异常。尽管蛋白尿、血尿和阿基通常在症状出现后3周内消退，但COVID-19的肾脏并发症与较高的死亡率相关。
Significance Statement Some cases of COVID-19 pneumonia have presented with kidney injury, and autopsy findings for patients with COVID-19 have revealed renal involvement. In this retrospective, single-center study of Chinese patients with COVID-19 pneumonia, 251 of 333 patients (75.4%) presented with renal complications, including proteinuria, hematuria, and AKI. After the median duration of 12 days of follow-up, nearly half of patients with AKI recovered from AKI within 3 weeks of onset of infection. However, patients with renal involvement had higher overall mortality (11.2%) compared with patients without renal involvement (1.2%). Adverse short-term outcomes of renal involvement were associated with severity of COVID-19 pneumonia. These findings indicate that although early renal abnormalities often resolve in such patients, intensive support and careful monitoring of severe or critical illness is appropriate for COVID-19 pneumonia with renal complications.Background Some patients with COVID-19 pneumonia also present with kidney injury, and autopsy findings of patients who died from the illness sometimes show renal damage. However, little is known about the clinical characteristics of kidney-related complications, including hematuria, proteinuria, and AKI.Methods In this retrospective, single-center study in China, we analyzed data from electronic medical records of 333 hospitalized patients with COVID-19 pneumonia, including information about clinical, laboratory, radiologic, and other characteristics, as well as information about renal outcomes.Results We found that 251 of the 333 patients (75.4%) had abnormal urine dipstick tests or AKI. Of 198 patients with renal involvement for the median duration of 12 days, 118 (59.6%) experienced remission of pneumonia during this period, and 111 of 162 (68.5%) patients experienced remission of proteinuria. Among 35 patients who developed AKI (with AKI identified by criteria expanded somewhat beyond the 2012 Kidney Disease: Improving Global Outcomes definition), 16 (45.7%) experienced complete recovery of kidney function. We suspect that most AKI cases were intrinsic AKI. Patients with renal involvement had higher overall mortality compared with those without renal involvement (28 of 251 [11.2%] versus one of 82 [1.2%], respectively). Stepwise multivariate binary logistic regression analyses showed that severity of pneumonia was the risk factor most commonly associated with lower odds of proteinuric or hematuric remission and recovery from AKI.Conclusions Renal abnormalities occurred in the majority of patients with COVID-19 pneumonia. Although proteinuria, hematuria, and AKI often resolved in such patients within 3 weeks after the onset of symptoms, renal complications in COVID-19 were associated with higher mortality.