维持性血液透析患者新型冠状病毒感染和死亡的危险因素分析

Infection and mortality of COVID⁃19 in maintenance hemodialysis patients

目的:观察维持性血液透析(MHD)患者新型冠状病毒感染(COVID-19)的临床特征,分析患者进展为重型/危重型和死亡的危险因素。方法:回顾性观察2022-12-01~2023-02-01期间COVID-19的MHD患者流行病学特征、基线血液检查结果及透析相关指标,比较重型/危重型与死亡患者临床特征,并进行危险因素分析。结果:共纳入303例MHD患者,279例(92.1%)COVID-19,重型/危重型占7.9%,死亡率4.7%。与轻型/普通型相比,重型/危重型COVID-19患者年龄更大,糖尿病肾脏疾病(DKD)比例和合并糖尿病、冠心病、慢性阻塞性肺疾病(COPD)的比例更高,中心静脉导管使用率更高,基线的血红蛋白、血清白蛋白更低。多因素Logistic分析显示,高龄、糖尿病、COPD、基线血红蛋白较低是MHD患者重型/危重型COVID-19的独立危险因素;死亡患者年龄更大,抗中性粒细胞胞质抗体相关血管炎(AAV)肾损害以及合并糖尿病、冠心病、COPD的比例更高,基线血红蛋白、血清白蛋白更低。多因素Logistic分析显示,高龄、合并糖尿病、COPD、原发病AAV肾损害、较低的基线血红蛋白和血清白蛋白是患者死亡的独立危险因素。结论:在COVID-19的MHD患者中,高龄、合并糖尿病、COPD、基线血红蛋白较低者进展为重型/危重型的风险更大;高龄、合并糖尿病、COPD、原发病AAV肾损害、基线血红蛋白和血清白蛋白较低者死亡的风险更大。

Objective:To identify risk factors of maintenance hemodialysis(MHD)for severe/critical disease and mortality in waves of coronavirus disease 2019(COVID⁃19)infections in our hemodialysis center.Methodology:Include all the MHD patients in our center between 1 December 2022 and 1 February 2023,compare demographic and clinical data,dialysis⁃specific parameters between severe/critical and mild/moderate,die and survival,identify the risk factors for severe/critical disease and mortality.Results:A total of 279 MHD patients developed COVID⁃19 infections of omicron wave among 303 patients,the severity/critical rate is 7.9%,the fatality rate is 4.7%.Compared with the mild and moderate disease,severe/critical disease were older,had higher incidence of diabetes,coronary heart disease,chronic obstructive pulmonary disease(COPD),and lower baseline hemoglobin.Multivariate regression analysis revealed that older age,higher incidence of diabetes,COPD,lower baseline hemoglobin were associated with severe/critical COVID⁃19 infection.Compared to the survivors,non⁃survivors were older,had higher incidence of diabetes,coronary heart disease and COPD,diagnosed as anti⁃neutrophil cytoplasmic antibody(ANCA)⁃associated vasculitis(AAV)with renal injury,had lower baseline hemoglobin and albumin.Older age,comorbidities of diabetes,COPD,diagnosed as AAV with renal injury,lower baseline hemoglobin,albumin were associated with mortality.Conclusion:Older age,higher incidence of diabetes,COPD,lower baseline hemoglobin were more vulnerable of severe/critical COVID⁃19 infections.Older age,comorbidities of diabetes,COPD,diagnosed as AAV with renal injury,lower baseline hemoglobin,albuminassociated with higher mortality.