背景:虽然越来越多的证据表明慢性肾病是2019年冠状病毒病(COVID-19)的危险因素,肾功能正常或轻度下降与COVID-19之间的关联尚未解决。这里,在肾功能正常至轻度下降的患者中,我们研究了肾小球滤过率估计值(eGFR)升高与严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染和严重COVID-19结局的相关性.
方法:参加I期(2017-2018年)至II期(2019-2020年)两项健康检查的患者被纳入我们的研究。根据eGFR阶段从I到II的变化,将所有参与者分为四组:1)持续G1阶段,2)从G2阶段到G1阶段,3)从G1阶段到G2阶段,4)持续G2阶段。此外,eGFR值的变化是通过从II期减去I期的值来定义的。从2021年1月1日起,对患者进行SARS-CoV-2感染的随访,以诊断为COVID-19或2021年12月31日,以先发生者为准。此外,SARS-CoV-2感染者在确诊后随访1个月,分析重症COVID-19.使用多变量调整逻辑回归计算调整比值比(aOR)。
结果:我们确定了159,427例SARS-CoV-2感染患者和1,804,798例患者。当eGFR阶段从G2变为G1时,SARS-CoV-2感染的风险降低(aOR,0.957;95%置信区间[CI],0.938-0.977)并持续维持在G1(aOR,0.966;95%CI,0.943-0.990),与持续阶段G2组相比。此外,风险与eGFR值的变化呈负相关,这是由有限的三次样条曲线描绘。对于严重COVID-19的总体风险,持续G1期显示出最低的风险(aOR,0.897;95%CI,0.827-0.972),其次是从G1到G2阶段(aOR,0.900;95%CI,0.828-0.978)和G2至G1期的CI(aOR,0.931;95%CI,0.871-0.995),与持续阶段G2组相比。
结论:在肾功能正常或轻度下降的情况下,eGFR的增加与SARS-CoV-2感染和严重COVID-19的风险呈负相关。对于严重的COVID-19,保持较高的基线eGFR可能是预防其风险的保护因素。
BACKGROUND: While accumulating evidence indicates chronic kidney disease as a risk factor for coronavirus disease 2019 (COVID-19), the association between normal or mildly decreased kidney function and COVID-19 is unaddressed. Here, we have examined the association of an increase in estimated glomerular filtration rate (eGFR) with the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe COVID-19 outcomes among patients within normal to mildly decreased kidney function.
METHODS: The patients who participated in both health screenings from period I (2017-2018) to II (2019-2020) were enrolled to our study. All participants were categorized into four groups according to the changes in eGFR stage from period I to II: 1) persistently stage G1, 2) from stage G2 to G1, 3) from stage G1 to G2, 4) persistently stage G2. In addition, the changes in eGFR value were defined by subtracting its value of period I from II. Patients were followed up for SARS-CoV-2 infection from January 1, 2021 to any diagnosis of COVID-19 or December 31, 2021, whichever happened first. In addition, those with SARS-CoV-2 infection were followed-up for one month after diagnosis to analyze severe COVID-19. Adjusted odds ratio (aOR) was calculated using multivariable-adjusted logistic regression.
RESULTS: We identified 159,427 patients with and 1,804,798 patients without SARS-CoV-2 infection. The risk of SARS-CoV-2 infection decreased when eGFR stage changed from G2 to G1 (aOR, 0.957; 95% confidence interval [CI], 0.938-0.977) and persistently maintained at G1 (aOR, 0.966; 95% CI, 0.943-0.990), compared with the persistently stage G2 group. In addition, the risk showed an inverse relationship with changes in eGFR value, which was depicted by restricted cubic spline curves. For the overall risk of severe COVID-19, the persistently stage G1 showed the lowest risk (aOR, 0.897; 95% CI, 0.827-0.972), followed by those from stage G1 to G2 (aOR, 0.900; 95% CI, 0.828-0.978) and those from stage G2 to G1 (aOR, 0.931; 95% CI, 0.871-0.995), compared with the persistently stage G2 group.
CONCLUSIONS: An increase in eGFR was negatively associated with the risk of SARS-CoV-2 infection and severe COVID-19 among normal or mildly decreased kidney function. For severe COVID-19, maintaining higher baseline eGFR may act as a protective factor against its risk.