并发肾衰竭的新冠肺炎患者临床特征和死亡风险分析

Analysis of clinical features and risk of death in COVID-19 patients complicated with renal failure

目的本研究旨在分析肾衰竭新冠肺炎患者疾病临床特征和死亡风险。方法纳入2020年2月3日至2020年4月10日武汉市泰康同济新冠肺炎专科医院收治的1412例新冠肺炎患者进行研究。根据eGFR[ml/(min·1.73 m^(2))]将研究对象分为3组:正常肾功能组(eGFR≥90);肾功能不全组(60≤eGFR<90);肾衰竭组(eGFR<60)。分析其临床表现、实验室指标、并发症和预后。结果正常肾功能组1086例(76.9%),肾功能不全组258例(18.3%),肾衰竭组68例(4.8%)。患者平均年龄为62岁(50~70岁),男性为650例(46.0%)。与正常肾功能组相比,肾功能不全组和肾衰竭组患者年龄较大,肾衰竭组患者发生气短和胸闷症状更多,但是出现发热和咳痰症状的比例却更低(P<0.05)。肾衰竭组患者患有高血压、糖尿病、冠心病、脑血管疾病的比例最高。与正常肾功能组相比,肾衰竭组患者的炎症相关指标(C反应蛋白、白细胞介素-6)和凝血功能指标(纤维蛋白原、D-二聚体)显著升高,但淋巴细胞计数、血小板计数、血红蛋白、白蛋白明显降低(P<0.05)。肾衰竭组患者更多需要肾脏支持治疗(6.0%)、抗生素治疗(55.2%)和糖皮质激素治疗(18.2%),更容易出现各种严重并发症,包括呼吸衰竭、急性呼吸窘迫综合征、急性心力衰竭、急性心脏损伤、凝血障碍、脓毒症、休克、贫血、低蛋白血症、电解质紊乱和酸中毒(P<0.05)。随着基线肾功能的降低,患者的死亡比例逐渐升高(P<0.05),肾衰竭组患者死亡率高达18.5%。多因素Cox回归分析发现,与正常肾功能组相比,肾衰竭组死亡风险升高7.873倍(95%CI:2.110~29.376,P=0.002)。结论并发肾衰竭的新冠肺炎患者,心脑并发症发生率高,死亡率高,更加需要肾脏支持、抗生素和糖皮质激素治疗等。

Objective The purpose of this study was to analyze the clinical characteristics of disease and the risk of death in COVID-19 patients complicated with renal failure.MethodsA total of 1412 patients with COVID-19 in Taikang Tongji COVID-19 Hospital from February 3,2020 to April 10,2020 were included in the study.The patients were divided into three groups based on eGFR(mL/min/1.73 m^(2)):normal renal function group(eGFR≥90),renal insufficiency group(60≤eGFR<90),renal failure group(eGFR<60).The clinical manifestations,laboratory indicators,complications,and prognosis were analyzed.ResultsThere were 1086 cases(76.9%)in the normal renal function group,258 cases(18.3%)in the renal insufficiency group,and 68 cases(4.8%)in the renal failure group.The mean age of the patients was 62 years(50-70 years),and 650 cases(46.0%)were males.Compared with the normal renal function group,patients of the renal insufficiency group and the renal failure group were older,and patients of the renal failure group showed higher proportion of shortness of breath and chest tightness,but less fever and expectoration(P<0.05).The renal failure patients showed the highest proportion of hypertension,diabetes,coronary heart disease,and cerebrovascular disease.Compared with normal renal function group,the renal failure group displayed higher levels of inflammation-related indexes(C-reactive protein,interleukin-6)and coagulation function indexes(fibrinogen,D-dimer),while the lymphocyte count,platelet count,hemoglobin,and albumin were significantly decreased(P<0.05).Patients of the renal failure group were more likely to need renal support therapy(6.0%),antibiotic therapy(55.2%),and glucocorticoid therapy(18.2%),and were more prone to various serious complications,including respiratory failure,acute respiratory distress syndrome,acute heart failure,acute cardiac injury,coagulopathy,sepsis,shock,anemia,hypoproteinemia,electrolyte disorder,and acidosis(P<0.05).With the decrease of baseline renal function,the mortality rate of patients increased gradually(P<0.05),and the mortality rate of the renal failure group was up to 18.5%.Multivariate Cox regression analysis found that the risk of death in patients with renal failure was significantly increased by 7.873 times that of the normal renal function group(95%CI:2.110-29.376,P=0.002).ConclusionCOVID-19 patients complicated with renal failure had a higher incidence of cardiocerebral complications and higher mortality rate,requiring more renal support,antibiotics,and glucocorticoid therapy,etc.