COVID-19危重症患者肾功能变化与预后的相关性分析  

Correlation of the renal function changes to prognosis in critical patients with COVID-19

作　　者：王超臣 李一莎 何威 杨宇 魏磊 程庆砾 Wang Chao-Chen;Li Yi-Sha;He Wei;Yang Yu;Wei Lei;Cheng Qing-Li(Department of Cadre Ward 3,General Hospital of Central Theater Command,Wuhan 430070,China;Graduate School of Chinese PLA General Hospital,Beijing 100853,China;Department of Health Care,General Hospital of Central Theater Command,Wuhan 430070,China;Department of Nephrology,the Second Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中部战区总医院干部三科,武汉430070 [2]解放军总医院研究生院,北京100853 [3]中部战区总医院保健科,武汉430070 [4]解放军总医院第二医学中心肾脏病科,北京100853

出　　处：《解放军医学杂志》2020年第11期1156-1160,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的了解新型冠状病毒肺炎(COVID-19)患者的肾损伤情况及其原因,分析肾损伤与COVID-19分型及预后的相关性,为患者的治疗及预后评估提供参考。方法按照回顾性队列研究方案,收集2020年1月1日-3月14日在解放军中部战区总医院(武汉)住院的319例COVID-19确诊患者的临床资料和预后情况,采用单因素及多因素logistic回归模型分析COVID-19患者肾功能变化与疾病分型及预后的相关性。结果患者年龄(55.2±17.0)岁,非危重症(轻型+普通型)患者、危重症(重型+危重型)患者的比例分别为62.1%(198/319)、37.9%(121/319)。本研究队列患者的病死率为5.6%(18/319)。入院时血尿素氮(BUN)、血清肌酐(SCr)均较正常参考值升高的患者占3.8%(12/319);入院时仅有BUN升高的患者占5.6%(18/319)。单因素logistic回归分析显示:年龄,入院时SCr、BUN,入院后1周SCr、BUN,合并糖尿病、慢性肾脏病是COVID-19危重症患者死亡的危险因素(P<0.05)。多因素logistic回归分析显示:患者入院时及入院1周后BUN升高是COVID-19危重症患者死亡的独立危险因素。结论COVID-19患者入院时及入院1周后BUN升高是COVID-19危重症患者的重要临床特征及死亡的独立危险因素,在诊治过程中应关注可能导致BUN升高的各种临床因素。Objective To get the message of kidney injury and its causes in patients with COVID-19,and analyze the correlation of kidney injury to COVID-19 typing and prognosis,so provide a reference for the treatment and prognosis evaluation of COVID-19.Methods According to the retrospective cohort study protocol,the clinical data and prognosis of 319 confirmed patients with COVID-19,admitted in the General Hospital of Central Theater Command(Wuhan)from Jan.1st to Mar.14th,2020,were collected.The correlation of COVID-19 patients'renal function changes to the classification and prognosis of diseases were analyzed using univariate and multivariate logistic regression analysis.Results The mean age of the 319 confirmed patients with COVID-19 was(55.2±17.0)years.The proportion of non-critical group(mild+moderate type)and critical group(severe+critical type)were 62.1%(198/319)and 37.9%(121/319),respectively.The fatality rate of present study cohort was 5.6%(18/319).About 3.8%cases(12/319)were with elevated blood urea nitrogen(BUN)and serum creatinine(SCr)at admission,and about 5.6%cases(18/319)were with elevated BUN only at admission.Univariate logistic regression analysis revealed that the age,the levels of SCr and BUN at admission and one week after admission,the combination of diabetes mellitus,and chronic kidney disease were the risk factors associated with the death in critical group patients(P<0.05).Multivariate logistic regression analysis revealed that the elevated levels of BUN at admission and one week after admission were the independent risk factors of death in the critical group patients.Conclusions The elevated levels of BUN at admission and one week after admission were the important clinical features and independent risk factors associated with the death of critical COVID-19 patients.More attention should be paid to all kinds of clinical factors that may lead to increase the level of BUN.

关 键 词：新型冠状病毒肺炎 危险因素 预后 血尿素氮 肾脏 

分 类 号：R512.99[医药卫生—内科学]