背景:急性肾损伤(AKI)经常在严重急性呼吸道综合征冠状病毒2(SARS-CoV-2)感染的情况下报道。我们工作的目的是评估急性透析使用对2019年冠状病毒病(COVID-19)大流行期间AKI患者死亡率的影响。
方法:这是一项在非斯哈桑二世大学医院进行的回顾性研究,摩洛哥。从2020年7月到2021年12月,我们纳入了根据2012年肾脏疾病改善全球结果(KDIGO2012)标准定义的COVID-19急性肾损伤的所有患者。我们的病人超过18岁,SARS-CoV-2感染通过RT-PCR检测阳性或胸部CT扫描成像证实。终末期肾病(ESRD)患者和孕妇被排除在我们的研究之外。
结果:研究期间在COVID-19病房住院的患者总数为2560例,其中重症监护病房206例。我们纳入了61例AKI患者,重症监护病房(ICU)的发病率为15.5%。百分之八十的病人入院时出现呼吸窘迫,这是协商的主要原因。1.6%的患者发现1期AKI,25.8%患有II期AKI,72.6%患有KDIGO3期AKI。AKI的主要病因为急性肾小管坏死。18例患者继发于感染的肺部严重受累;21例中度受累。在我们的研究中,我们的21例患者(34.4%)在ICU住院.我们的13例患者进行了插管(21.1%)。21例(34.4%)患者血流动力学不稳定,并服用了血管活性药物。我们的23例(37.7%)患者至少接受了一次常规急性血液透析,平均持续时间为2.1小时±0.9(1-3.5)。指示为过载(27%),严重代谢性酸中毒(1.6%),威胁性高钾血症(1.6%),和症状性尿毒症(62%)。进展以两名患者恢复基线肾功能为标志,其中35个在放电时得到部分改善,24名患者没有改善。我们记录的死亡率为34.4%(n=21)。在单变量分析中,我们比较了人口统计,临床,临床旁,透析组和非透析组的透析特性。不稳定之间存在显着差异,透析组的插管患者和ICU住院患者,p值分别为p=0.0001、p=0.0001和p=0.01。我们注意到透析组的死亡人数多于非透析组;这种差异具有统计学意义,p值为0.005。在多变量分析中,在校正其他辅助因素的同时,采用逻辑回归模型检验透析与COVID-19死亡率之间的关系.最终模型未显示透析与死亡率之间的显著关联(p=0.150,OR:2.578[0.710-9.364])。唯一保持独立显著的因素是入住重症监护病房(p=0.004,OR:6.732[1.847-24.540])。
结论:AKI是COVID-19患者经常遇到的并发症,尤其是在ICU住院的患者。在SARS-CoV-2感染的背景下,使用至少1次透析似乎代表与AKI相关的额外死亡风险.
BACKGROUND: Acute kidney injury (AKI) is frequently reported in the setting of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection. The aim of our work is to evaluate the impact of acute dialysis use on mortality in patients with AKI during the coronavirus disease 2019 (COVID-19) pandemic.
METHODS: This is a retrospective study conducted in the Hassan II University Hospital of Fez, Morocco. From July 2020 to December 2021, we included all patients admitted to a COVID-19 unit with acute kidney injury defined according to Kidney Disease Improvement Global Outcomes 2012 (KDIGO 2012) criteria. Our patients were older than 18 years, and SARS-CoV-2 infection was confirmed by a positive RT-PCR test or thoracic CT scan imaging. Patients with end-stage renal disease (ESRD) and pregnant women were excluded from our study.
RESULTS: The total number of patients hospitalized in the COVID-19 unit during the study period was 2560, including 206 in an intensive care setting. We included 61 patients with AKI, with an incidence in the intensive care unit (ICU) setting of 15.5%. Eighty percent of patients had respiratory distress on admission, which was the main reason for consultation. Stage 1 AKI was found in 1.6% of patients, 25.8% had stage II AKI, and 72.6% had KDIGO stage 3 AKI. The main etiology of AKI was acute tubular necrosis. Lung involvement secondary to infection was severe in 18 patients; 21 had moderate involvement. In our study, twenty-one of our patients (34.4%) were hospitalized in an ICU. Thirteen of our patients were intubated (21.1%). Twenty-one (34.4%) patients were hemodynamically unstable and were put on vasoactive drugs. Twenty-three (37.7%) of our patients received at least one session of conventional acute hemodialysis with an average duration of 2.1 hours ± 0.9 (1-3.5). The indication was overload (27%), severe metabolic acidosis (1.6%), threatening hyperkalemia (1.6%), and symptomatic hyperuremia (62%). The evolution was marked by a return to baseline renal function in two patients, partial improvement in 35 of them at discharge, and no improvement in 24 patients. We recorded a death rate of 34.4% (n=21). In a univariate analysis, we compared the demographic, clinical, paraclinical, and dialytic characteristics of the dialysis and non-dialysis groups. There was a significant difference between unstable, intubated patients and those hospitalized in the ICU in the dialysis group, with respective p-values of p=0.0001, p=0.0001, and p=0.01. We noticed there were more deaths in the dialysis group than in the non-dialysis group; this difference was statistically significant with a p-value of 0.005. In multivariate analysis, a logistic regression model was performed to test the relationship between dialysis and COVID-19 mortality while adjusting for other co-factors. The final model did not show a significant association between dialysis and mortality (p = 0.150, OR: 2.578 [0.710-9.364]). The only factor that remained independently significant was admission to the intensive care unit (p = 0.004, OR: 6.732 [1.847-24.540]).
CONCLUSIONS: AKI is a frequently encountered complication in patients with COVID-19, especially those hospitalized in the ICU. In the context of the SARS-CoV-2 infection, the use of at least one dialysis session seems to represent an excess risk of mortality related to AKI.