描述COVID-19危重患者的预后,特别是肾脏替代治疗与死亡率的关系。
进行了单中心前瞻性观察研究。
三级护理中心的ICU。
连续成年COVID-19患者进入ICU。
肾脏替代疗法。
人口统计数据,病史,疾病严重程度,氧疗类型,实验室数据和使用肾脏替代治疗来生成描述死亡的独立危险因素的逻辑回归模型.
在总共166名患者中,51%的人进行了机械通气,26%的人需要肾脏替代疗法。整体住院死亡率为36%,需要肾脏替代治疗的患者为56%,机械通气和肾脏替代疗法的患者为68%。逻辑回归模型确定了四个独立的死亡危险因素:年龄(每10年增加校正OR2.8[95%CI1.8-4.4]),机械通气(4.2[1.7-10.6]),需要连续静脉血液滤过(2.3[1.3-4.0])和C反应蛋白(每10mg/L增加1.1[1.0-1.2])。
在我们的队列中,需要肾脏替代治疗的急性肾损伤与高死亡率相关,类似于需要机械通气的死亡率。而需要两种技术的多器官衰竭意味着极高的死亡风险。
To describe outcomes of critically ill patients with COVID-19, particularly the association of renal replacement therapy to mortality.
A single-center prospective observational study was carried out.
ICU of a tertiary care center.
Consecutive adults with COVID-19 admitted to the ICU.
Renal replacement therapy.
Demographic data, medical history, illness severity, type of oxygen therapy, laboratory data and use of renal replacement therapy to generate a logistic regression model describing independent risk factors for mortality.
Of the total of 166 patients, 51% were mechanically ventilated and 26% required renal replacement therapy. The overall hospital mortality rate was 36%, versus 56% for those requiring renal replacement therapy, and 68% for those with both mechanical ventilation and renal replacement therapy. The logistic regression model identified four independent risk factors for mortality: age (adjusted OR 2.8 [95% CI 1.8-4.4] for every 10-year increase), mechanical ventilation (4.2 [1.7-10.6]), need for continuous venovenous hemofiltration (2.3 [1.3-4.0]) and C-reactive protein (1.1 [1.0-1.2] for every 10mg/L increase).
In our cohort, acute kidney injury requiring renal replacement therapy was associated to a high mortality rate similar to that associated to the need for mechanical ventilation, while multiorgan failure necessitating both techniques implied an extremely high mortality risk.