SARS-CoV-2肺炎危重患者急性肾损伤的危险因素和结局：一项多中心研究

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva Pub Date : 2025-01-01 DOI:10.1016/j.medin.2024.06.002

Iban Oliva , Cristina Ferré , Xavier Daniel , Marc Cartanyà , Christian Villavicencio , Melina Salgado , Loreto Vidaur , Elisabeth Papiol , FJ González de Molina , María Bodí , Manuel Herrera , Alejandro Rodríguez , on behalf of the COVID-19 SEMICYUC Working Group

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引用次数: 0

摘要

目的探讨SARS-CoV-2肺炎患者重症监护病房（ICU）入院48 h内急性肾损伤（AKI）的发生率、危险因素及对ICU死亡率的影响。评估AKI I型和II型患者持续肾替代治疗（CRRT）的ICU死亡率和危险因素。设计回顾性观察性研究。67个ICU来自西班牙，安道尔，爱尔兰。2020年3月至2022年4月，患者s5399例。主要感兴趣的变量在ICU入院前两天的人口统计变量、合并症、实验室数据（最差值），生成描述AKI和ICU死亡率独立危险因素的逻辑回归模型。AKI是根据现行国际指南（肾病改善全球预后，KDIGO）定义的。结果5399例患者中，1879例（34.8%）发生AKI。这些患者有较高的ICU死亡率，AKI与较高的ICU死亡率独立相关(HR 1.32 CI 1.17-1.48；p & lt;0.001)。男性、高血压、糖尿病、肥胖、慢性心力衰竭、心肌功能障碍、较高的严重程度评分和降钙素原与AKI的发生独立相关。在AKI I和II患者中，CRRT的需求为12.6%（217/1710）。在这些患者中，APACHE II、入住ICU后24小时内需要机械通气和心肌功能障碍与需要CRRT的风险相关。AKI I和AKI II患者的ICU死亡率较高（38.5%），特别是如果需要CRRT (64.1% vs. 34.8%；p & lt;0.001)。结论重症SARS-CoV-2肺炎合并AKI患者ICU病死率较高。即使是AKI I期和II期也与需要CRRT和ICU死亡率的高风险相关。

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Risk factors and outcome of acute kidney injury in critically ill patients with SARS-CoV-2 pneumonia: a multicenter study

Objective

To assess incidence, risk factors and impact of acute kidney injury(AKI) within 48 h of intensive care unit(ICU) admission on ICU mortality in patients with SARS-CoV-2 pneumonia. To assess ICU mortality and risk factors for continuous renal replacement therapy (CRRT) in AKI I and II patients.

Design

Retrospective observational study.

Setting

Sixty-seven ICU from Spain, Andorra, Ireland.

Patients

5399 patients March 2020 to April 2022.

Main variables of interest

Demographic variables, comorbidities, laboratory data (worst values) during the first two days of ICU admission to generate a logistic regression model describing independent risk factors for AKI and ICU mortality. AKI was defined according to current international guidelines (kidney disease improving global outcomes, KDIGO).

Results

Of 5399 patients included 1879 (34.8%) developed AKI. These patients had higher ICU mortality and AKI was independently associated with a higher ICU mortality (HR 1.32 CI 1.17–1.48; p < 0.001).

Male gender, hypertension, diabetes, obesity, chronic heart failure, myocardial dysfunction, higher severity scores, and procalcitonine were independently associated with the development of AKI.

In AKI I and II patients the need for CRRT was 12.6% (217/1710). In these patients, APACHE II, need for mechanical ventilation in the first 24 h after ICU admission and myocardial dysfunction were associated with risk of needing CRRT. AKI I and II patients had a high ICU mortality (38.5%), especially if CRRT were required (64.1% vs. 34,8%; p < 0.001).

Conclusions

Critically ill patients with SARS-CoV-2 pneumonia and AKI have a high ICU mortality. Even AKI I and II stages are associated with high risk of needing CRRT and ICU mortality.

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来源期刊

Medicina Intensiva CRITICAL CARE MEDICINE-

CiteScore

2.70

自引率

20.00%

发文量

146

审稿时长

33 days

期刊介绍： Medicina Intensiva is the journal of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) and of Pan American and Iberian Federation of Societies of Intensive and Critical Care Medicine. Medicina Intensiva has become the reference publication in Spanish in its field. The journal mainly publishes Original Articles, Reviews, Clinical Notes, Consensus Documents, Images, and other information relevant to the specialty. All works go through a rigorous selection process. The journal accepts submissions of articles in English and in Spanish languages. The journal follows the publication requirements of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE).