背景:急性肾损伤(AKI)是SARS-CoV-2引起COVID-19的主要并发症之一。本研究旨在评估诊断为COVID-19的巴西住院患者中AKI的发生率,并确定与其发病相关的危险因素和与预后相关的危险因素。
方法:一项2020年3月至12月在圣保罗的公立和三级大学医院诊断为COVID-19的住院患者的前瞻性队列研究。
结果:有347例COVID-19患者住院,其中52.4%进入重症监护病房(ICU),47.6%进入病房。AKI的总发生率为46.4%,ICU中更常见(68.1%vs22.4,p<0.01),总死亡率为36.1%.46.6%的AKI患者需要接受急性肾脏替代治疗。在一般人群中,与AKI相关的因素是年龄较大(OR1.03,CI1-1.05,p<0.05),机械通气(OR1.23,CI1.06-1.83,p<0.05),存在蛋白尿(OR1.46,CI1.22-1.93,p<0.05),和使用血管活性药物(OR1.26,CI1.07-1.92,p<0.05)。老年人死亡率较高(OR1.08,CI1.04-1.11,p<0.05),在患有AKI的患者中(OR1.12,CI1.02-2.05,p<0.05),特别是KDIGO3期AKI(OR1.10,CI1.22-2.05,p<0.05)和需要机械通气(OR1.13,CI1.03-1.60,p<0.05)。
结论:在COVID-19的住院患者中,AKI是常见的,其发展的相关因素是年龄较大,机械通气,使用血管活性药物,和蛋白尿的存在,是死亡的危险因素。
BACKGROUND: Acute kidney injury (AKI) is one of the main complications of COVID-19 caused by SARS-CoV-2. This
study aimed to evaluate the incidence of AKI in Brazilian hospitalized patients diagnosed with COVID-19 and identify the risk factors associated with its onset and those associated with its prognosis.
METHODS: A prospective cohort
study of hospitalized patients diagnosed with COVID-19 at a public and tertiary university hospital in São Paulo from March to December 2020.
RESULTS: There were 347 patients hospitalized with COVID-19, 52.4% were admitted to the intensive care unit (ICU) and 47.6% were admitted to the wards. The overall incidence of AKI was 46.4%, more frequent in the ICU (68.1% vs 22.4, p < 0.01) and the overall mortality was 36.1%. Acute kidney replacement therapy was indicated in 46.6% of patients with AKI. In the general population, the factors associated with AKI were older age (OR 1.03, CI 1-1.05, p < 0.05), mechanical ventilation (OR 1.23, CI 1.06-1.83, p < 0.05), presence of proteinuria (OR 1.46, CI 1.22-1.93, p < 0.05), and use of vasoactive drugs (OR 1.26, CI 1.07-1.92, p < 0.05). Mortality was higher in the elderly (OR 1.08, CI 1.04-1.11, p < 0.05), in those with AKI (OR 1.12, CI 1.02-2.05, p < 0.05), particularly KDIGO stage 3 AKI (OR 1.10, CI 1.22-2.05, p < 0.05) and in need of mechanical ventilation (OR 1.13, CI 1.03-1.60, p < 0.05).
CONCLUSIONS: AKI was frequent in hospitalized patients with COVID-19 and the factors associated with its development were older age, mechanical ventilation, use of vasoactive drugs, and presence of proteinuria, being a risk factor for death.