武汉市COVID-19住院患者急性肾损伤的发生:287例单中心回顾性分析  

Acute kidney injury in patients hospitalized with COVID-19 in Wuhan,China:a single-center retrospective observational study

作　　者：肖冠华[1] 胡鸿彬 吴凤 沙桐 曾振华[2] 黄巧冰[3] 李海军[4] 韩家发[4] 宋文鸿 陈仲清[2] 蔡淑敏[2] XIAO Guanhua;HU Hongbin;WU Feng;SHA Tong;ZENG Zhenhua;HUANG Qiaobing;LI Haijun;HAN Jiafa;SONGWenhong;CHEN Zhongqing;CAI Shumin(Department of Respiratory and Critical Care Medicine,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Critical Care Medicine,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Guangdong Provincial Key Laboratory of Shock and Microcirculation,School of Basic Medical Sciences,Southern Medical University,Guangzhou 510515,China;Department of Radiology,Hankou Hospital of Wuhan,Wuhan 430012,China)

机构地区：[1]南方医科大学南方医院呼吸与危重症医学科,广东广州510515 [2]南方医科大学南方医院重症医学科,广东广州510515 [3]南方医科大学基础医学院广东省休克与微循环重点实验室,广东广州510515 [4]湖北省武汉市汉口医院影像科,湖北武汉430012

出　　处：《南方医科大学学报》2021年第2期157-163,共7页Journal of Southern Medical University

基　　金：国家自然科学基金(81871604);广东省自然科学基金(2020A151501361,2017A030313590)。

摘　　要：目的COVID-19可能累及肾脏,本研究评估了COVID-19患者中急性肾损伤(AKI)的预测因素和预后。方法本研究为单中心回顾性观察性研究。纳入2020年1月5日~3月8日在武汉汉口医院住院的临床确诊COVID-19患者。采用单因素回归分析评估AKI和COVID-19疾病的发病率变化与临床结果之间的关系。结果共有287例患者进入分析,55例AKI患者和232例非AKI患者。与没有AKI的患者相比,AKI患者年龄更大,以男性为主,更有可能出现缺氧,合并高血压和脑血管疾病。此外,AKI患者的白细胞、D-二聚体、天冬氨酸氨基转移酶、总胆红素、肌酸激酶、乳酸脱氢酶、降钙素原、C反应蛋白水平较高,高钾血症患病率较高,淋巴细胞计数较低,胸部CT评分较高。1期AKI发生率为14.3%,2~3期AKI发生率为4.9%。AKI患者的死亡率明显较高。结论AKI是COVID-19的重要并发症。高龄、男性、合并多种疾病、淋巴细胞减少、感染指标增高、D-二聚体升高、心、肝功能受损可能是AKI的危险因素。进展到2期或3期AKI的COVID-19患者死亡率较高。Objective To assess the predictors and outcomes of acute kidney injury(AKI)among patients with coronavirus disease 2019(COVID-19).Methods This retrospective observational study was conducted among patients with a confirmed diagnosis of COVID-19 admitted to Hankou Hospital between January,5 and March 8,2020.We evaluated the association of AKI with the demographic and biochemical parameters and clinical outcomes of the patients using univariate regression analysis.ResultsAtotal of 287 COVID-19 patients,including 55 with AKI and 232 without AKI,were included in the analysis.Compared with the patients without AKI,the patients with AKI were older,predominantly male,and were more likely to have hypoxia and pre-existing hypertension and cerebrovascular diseases.The patients with AKI also had higher levels of white blood cells,D-dimer,aspartate aminotransferase,total bilirubin,creatine kinase,lactate dehydrogenase,procalcitonin,C-reactive protein,a higher prevalence of hyperkalemia,lower lymphocyte counts,and higher chest computed tomographic scores.The incidence of stage 1 AKI was 14.3%and that of stage 2 or 3 AKI was 4.9%.The patients with AKI had much higher mortality rate than those without AKI.Conclusions AKI is an important complication of COVID-19.An older age,a male gender,multiple pre-existing comorbidities,lymphopenia,increased infection indicators,elevated D-dimer,and impaired heart and liver functions are all potential risk factors of AKI.COVID-19 patients with AKI that progresses into stages 2 or 3 AKI have a high mortality rate.Prevention of AKI and monitoring kidney function is critical in the care of COVID-19 patients.

关 键 词：COVID-19 急性肾损伤 肾功能 

分 类 号：R563.1[医药卫生—呼吸系统] R692[医药卫生—内科学]