tetano
Editor, Senior Moderator
Sci Rep
. 2021 Jul 26;11(1):15205.
doi: 10.1038/s41598-021-94570-1.
Clinical outcomes of hospitalized COVID-19 patients with renal injury: a multi-hospital observational study from Wuhan
Kehong Chen[SUP] #[/SUP][SUP] 1 2 [/SUP], Yu Lei[SUP] #[/SUP][SUP] 3 4 [/SUP], Yani He[SUP] 1 [/SUP], Fei Xiao[SUP] 1 [/SUP], Yan Yu[SUP] 1 2 [/SUP], Xiaodong Lai[SUP] 5 6 [/SUP], Yang Liu[SUP] 7 8 [/SUP], Jiang Wang[SUP] 9 10 [/SUP], Huanzi Dai[SUP] 11 12 [/SUP]
Affiliations
Abstract
Renal injury is common in patients with coronavirus disease 2019 (COVID-19). We aimed to determine the relationship of estimated glomerular filtration rate (eGFR) and acute kidney injury (AKI) with the characteristics, progression, and prognosis of COVID-19 in-patients. We retrospectively reviewed 1851 COVID-19 patients admitted to 3 hospitals in Wuhan, China. Clinical, laboratory, radiological, treatment, complication, and outcome data were analyzed. Patients were stratified according to levels of eGFR (≥ 90 vs. 60-89 vs. < 60 mL/min/1.73 m[SUP]2[/SUP]). The risk of reaching the composite endpoint-intensive care unit admission, invasive ventilation, or death-was compared. On admission, 25.5% patients had renal impairment (eGFR < 90 mL/min/1.73 m[SUP]2[/SUP]), but only 2.6% patients had chronic kidney disease (CKD). The overall in-hospital AKI incidence was 6.7%. Severe illness and comorbidities (hypertension, diabetes, CKD, and cardiovascular/cerebrovascular diseases) were more common among patients with low eGFR (< 90 mL/min/1.73 m[SUP]2[/SUP]). Despite the more frequent use of intensive oxygen therapy, continuous blood purification, and glucocorticoid treatment, the prognosis of these patients was unsatisfactory, with the incidence of the composite endpoint (15.4% vs. 19.6% vs. 54.5%; P = 0.000) and complications (AKI, respiratory failure, cardiac injury, coagulation disorders, sepsis, etc.) increasing with decreasing eGFR. Kaplan-Meier survival analysis revealed that patients with eGFR < 90 mL/min/1.73 m[SUP]2[/SUP] or AKI had significantly escalated risks of reaching the composite endpoint. Multivariate regression analysis showed that renal insufficiency (eGFR < 60 mL/min/1.73 m[SUP]2[/SUP]) on admission and in-hospital AKI independently predicted poor prognosis among COVID-19 in-patients. And renal impairment on admission was a greater predictor of poor prognosis in non-elderly patients than that in elderly patients. Early and continuous renal-function monitoring and early AKI diagnosis are necessary to predict and prevent the progression of COVID-19.
. 2021 Jul 26;11(1):15205.
doi: 10.1038/s41598-021-94570-1.
Clinical outcomes of hospitalized COVID-19 patients with renal injury: a multi-hospital observational study from Wuhan
Kehong Chen[SUP] #[/SUP][SUP] 1 2 [/SUP], Yu Lei[SUP] #[/SUP][SUP] 3 4 [/SUP], Yani He[SUP] 1 [/SUP], Fei Xiao[SUP] 1 [/SUP], Yan Yu[SUP] 1 2 [/SUP], Xiaodong Lai[SUP] 5 6 [/SUP], Yang Liu[SUP] 7 8 [/SUP], Jiang Wang[SUP] 9 10 [/SUP], Huanzi Dai[SUP] 11 12 [/SUP]
Affiliations
- PMID: 34312430
- DOI: 10.1038/s41598-021-94570-1
Abstract
Renal injury is common in patients with coronavirus disease 2019 (COVID-19). We aimed to determine the relationship of estimated glomerular filtration rate (eGFR) and acute kidney injury (AKI) with the characteristics, progression, and prognosis of COVID-19 in-patients. We retrospectively reviewed 1851 COVID-19 patients admitted to 3 hospitals in Wuhan, China. Clinical, laboratory, radiological, treatment, complication, and outcome data were analyzed. Patients were stratified according to levels of eGFR (≥ 90 vs. 60-89 vs. < 60 mL/min/1.73 m[SUP]2[/SUP]). The risk of reaching the composite endpoint-intensive care unit admission, invasive ventilation, or death-was compared. On admission, 25.5% patients had renal impairment (eGFR < 90 mL/min/1.73 m[SUP]2[/SUP]), but only 2.6% patients had chronic kidney disease (CKD). The overall in-hospital AKI incidence was 6.7%. Severe illness and comorbidities (hypertension, diabetes, CKD, and cardiovascular/cerebrovascular diseases) were more common among patients with low eGFR (< 90 mL/min/1.73 m[SUP]2[/SUP]). Despite the more frequent use of intensive oxygen therapy, continuous blood purification, and glucocorticoid treatment, the prognosis of these patients was unsatisfactory, with the incidence of the composite endpoint (15.4% vs. 19.6% vs. 54.5%; P = 0.000) and complications (AKI, respiratory failure, cardiac injury, coagulation disorders, sepsis, etc.) increasing with decreasing eGFR. Kaplan-Meier survival analysis revealed that patients with eGFR < 90 mL/min/1.73 m[SUP]2[/SUP] or AKI had significantly escalated risks of reaching the composite endpoint. Multivariate regression analysis showed that renal insufficiency (eGFR < 60 mL/min/1.73 m[SUP]2[/SUP]) on admission and in-hospital AKI independently predicted poor prognosis among COVID-19 in-patients. And renal impairment on admission was a greater predictor of poor prognosis in non-elderly patients than that in elderly patients. Early and continuous renal-function monitoring and early AKI diagnosis are necessary to predict and prevent the progression of COVID-19.