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Objective:To investigate the characteristics and the risk factors of coronavirus disease 2019 (COVID-19) associated acute kidney injury (AKI).Methods:A retrospective cohort study was performed to examine the basic data, clinical characteristics and prognosis of patients with COVID-19 in Zhongnan Hospital of Wuhan University and Wuhan Fourth Hospital from January 1st to February 1st in 2020. According to the diagnostic criteria of Kidney Disease: Improving Global Outcomes (KDIGO), patients with AKI were included in AKI group and those without AKI were included in non-AKI group. The differences of each index between the two groups were compared. The prognostic value of AKI for COVID-19 was analyzed by Kaplan-Meier survival curve and Cox regression.Results:A total of 394 COVID-19 patients were included, with a total mortality of 5.6%; 37 (9.4%) of them developed AKI. The mortality of patients with COVID-19 associated AKI was 18.9%. There were significant differences in age, gender, smoking history, hypertension history, malignancy history, cardiovascular disease history and cerebrovascular disease history between the two groups. In addition to the difference of serum creatinine (SCr) and blood urea nitrogen (BUN), white blood cell count (WBC), neutrophil count (NEU), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), D-dimer, procalcitonin (PCT) and C-reaction protein (CRP) in AKI group were significantly higher than those in non-AKI group [WBC (×10 9/L): 5.75 (4.13, 7.83) vs. 4.52 (3.35, 5.90), NEU (×10 9/L): 4.55 (2.81, 6.11) vs. 3.06 (2.03, 4.50), AST (U/L): 40.0 (24.5, 69.5) vs. 30.0 (23.0, 42.5), LDH (μmol·s -1·L -1): 5.21 (3.68, 7.57) vs. 4.24 (3.05, 5.53), D-dimer (μg/L): 456 (266, 2 172) vs. 290 (152, 610), PCT (μg/L): 0.33 (0.03, 1.52) vs. 0.01 (0.01, 0.11), CRP (mg/L): 53.80 (26.00, 100.90) vs. 23.60 (9.25, 51.10), all P < 0.05], while lymphocyte count (LYM) and platelet count (PLT) were decreased [LYM (×10 9/L): 0.68 (0.47, 1.05) vs. 0.91 (0.63, 1.25), PLT (×10 9/L): 142.0 (118.0, 190.0) vs. 171.0 (130.0, 2 190.0), both P < 0.05]. The mortality of AKI group was significantly higher than that of non-AKI group [18.9% (7/37) vs. 4.2% (15/357), P < 0.01]. Kaplan-Meier survival curve showed that the 30-day cumulative survival of AKI group was lower than that of non-AKI group (log-rank: P = 0.003). Cox analysis also showed that AKI increased the odds of patients with COVID-19 mortality by 3.2-fold [hazard ratio ( HR) = 3.208, 95% confidence interval (95% CI) was 1.076-9.566, P = 0.037]. Conclusions:The risk of AKI is higher in patients with COVID-19. Early intervention to prevent AKI in patients with COVID-19 is of great significance to improve the prognosis of patients.
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Objective:To analyze multiple factors that may affect renal function in septic shock patients with acute kidney injury (AKI) in the intensive care unit (ICU), in order to find factors of predictive value for renal function change in those patients.Methods:Septic patients with AKI admitted to department of critical care medicine of Wuhan University Zhongnan Hospital from January 2017 to June 2019 were enrolled, and the patients were divided into renal function improvement group and renal function non-improvement group according to their renal function change. Baseline, laboratory and clinical indicators of them were collected to conduct retrospective analysis. Comparing the difference of each index between the two groups, the statistically significant indexes in the univariate analysis were selected to perform ridge regression analysis. The receiver operating characteristic (ROC) curve and its 95% confidence interval (95% CI) were used to analyze the predictive value of each influencing factor on the recovery of renal function in patients. Results:A total of 323 patients met the inclusion criteria, and 195 of them were divided into renal function improvement group while the other 128 of them into the renal function non-improvement group. Univariate analysis showed that, there was significantly difference in acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), sequential organ failure assessment (SOFA), Glasgow coma score (GCS), heart rate (HR), serum creatinine (SCr), blood urea nitrogen (BUN), potassium (K +), white blood cell count (WBC), maximum central venous pressure (CVP max), maximum-minimum central venous pressure distance (ΔCVP), fluid balance, maximum lactic acid (LAC max), and maximum norepinephrine infusion speed (NE max) between the renal function improvement group and the renal function non-improvement group. Ridge regression analysis of those indexes found that APACHEⅡ, SOFA, SCr, BUN, HR, WBC, fluid balance, and NE max were influential factors of non-improvement renal function ( t values were 5.507, 3.690, 2.026, 4.815, 2.512, 2.114, 3.532, 3.735, all P < 0.05). ROC analysis found the predictive value combining the APACHEⅡ, SOFA, BUN, NE max was the highest [the area under ROC curve (AUC) and 95% CI: 0.863 (0.821-0.899)], which had a higher AUC than any of APACHEⅡ, SOFA, BUN, SCr and NE max [AUC and 95% CI: 0.863 (0.821-0.899) vs. 0.755 (0.705-0.801), 0.722 (0.670-0.770), 0.738 (0.686-0.785), 0.743 (0.692-0.790), 0.748 (0.697-0.794), all P < 0.01], and so did it when compared to APACHEⅡ, SOFA, SCr and NE max combination [AUC and 95% CI: 0.863 (0.821-0.899) vs. 0.825 (0.799-0.865), P < 0.01]. Conclusions:APACHEⅡ, SOFA, SCr, BUN, HR, WBC, fluid balance, and NE max are the positive influencing factors for patients without renal function improvement. The combination of APACHEⅡ, SOFA, BUN, and NE max had a relatively high predictive value for renal function recovery.
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Objective To analyze the risk factors of in-hospital mortality in patients with intracerebral hemorrhage (ICH) in the intensive care unit.Methods Patients with intracerebral hemorrhage were retrospectively collected from January 2013 to January 2018 in the Department of Intensive Care Unit,Zhongnan Hospital of Wuhan University.Patients were excluded aged less than 18 years,pregnant women,the onset time of more than 7 days,the length of hospital stay of less than 48 hours,lack of renal function outcomes within 24 hours after admission,the glomerular filtration rate (eGFR) of lower than 15 mL/(min.1.73 m2),the history of chronic kidney disease,regular dialysis and renal transplantation,and incomplete data.Clinical data were collected from baseline characteristics,past history,and laboratory examination.The included patients were divided into the in-hospital non-survival group and the survival group.SPSS 20.0 software as used for statistical analysis,the binary Logistic regression analysis was performed to evaluate risk factors of in-hospital mortality with intracerebral hemorrhage,the prognosis was assessed by receiver operating characteristic (ROC) curve and survival curve (Kaplan-Meier).A P＜0.05 was considered statistically significant.Results In this single-center retrospective study,a total of 300 patients were enrolled,including 96 patients in the hospital nonsurvival group and 204 patients in the survival group.The incidence of in-hospital death in patients with intracerebral hemorrhage in ICU was 32％.Multivariate analysis demonstrated that the risk factors of inhospital mortality were lower GCS score (OR=0.629,95％CI:0.523-0.757,P＜0.01),higher APACHE Ⅱ score (OR=1.590,95％CI:1.369-1.847,P＜0.01),elevated leukocytes (OR=1.082,95％CI:1.028-1.139,P=0.002) and the incidence of acute kidney injury (AKI) (OR=6.978,95％CI:3.381-14.405,P＜0.01).The ROC curve demonstrated that the area under curve (AUC) of APACHE Ⅱ score was the largest with a sensitivity and specificity of 73.96％ and 75.98％,respectively,which can better predict the mortality of patients with cerebral hemorrhage.Kaplan-Meier survival curve showed that in-hospital survival rate of non-AKI patients were higher than that of AKI patients (P＜0.01).Conclusions Lower GCS score,higher APACHE Ⅱ score,elevated white blood cells and AKI are risk factors for predicting in-hospital mortality in patients with intracerebral hemorrhage in the ICU.Therefore,early identification and treatment should be adopted in these high-risk populations.