A carregar...
Publicação
Long-term outcomes after AKI in hospitalized patients with COVID-19
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 509.19 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Introdução: A lesão renal aguda (LRA) é frequente em doentes hospitalizados e contribui para eventos adversos a curto e longo prazo. Este estudo teve como objetivo avaliar a associação entre LRA e eventos adversos renais a longo prazo e mortalidade numa coorte de doentes internados por COVID-19.
Métodos: Realizou-se um estudo unicêntrico e retrospetivo de doentes internados por COVID-19 na Unidade de Internamento de Contingência de Infeção Viral Emergente do Centro Hospitalar Universitário Lisboa Norte, Portugal, entre março e outubro de 2020. A LRA foi definida e classificada de acordo com a classificação KDIGO (Kidney Disease: Improving Global Outcomes), através da creatinina sérica. Os resultados analisados foram o desenvolvimento de eventos adversos renais major (MAKE) e de eventos adversos renais e cardiovasculares major (MARCE) e a mortalidade durante um período de seguimento de dois anos.
Resultados: Dos 409 doentes incluídos, 60.4% (n=247) teve LRA. Nos dois anos após a alta, 31.8% (n=130) dos doentes apresentou TFGe<60mL/min/1.73m2 e/ou uma diminuição de 25% da TFGe; 1.7% (n=7) dos doentes necessitou de TSR, 5.6% (n=23) teve eventos CV e 27.9% (n=114) morreu. A incidência de MAKE foi de 60.9% (n=249) e a de MARCE foi de 62.6% (n=256). Numa análise multivariada, mais idade (HR ajustado 1.02 (95% CI: 1.01-1.04), p=0.008), doença cardiovascular (HR ajustado 2.22 (95% CI: 1.24-3.95), p=0.007), doença renal crónica (HR ajustado 5.15 (95% CI: 2.22-11.93), p<0.001) e LRA (HR ajustado 1.76 (95% CI: 1.12-2.78), p=0.015) constituíram fatores preditores independentes de MAKE. Mais idade (HR ajustado 1.06 (95% CI: 1.04-1.08) e neoplasia (HR ajustado 4.88 (95% CI: 2.37-10.04), p<0.001) constituíram fatores preditores independentes de mortalidade.
Conclusão: Nesta coorte de doentes internados com COVID-19, LRA durante o internamento esteve independentemente associada com o risco de necessidade de diálise a longo prazo e/ou diminuição da função renal e/ou mortalidade após a alta.
Introduction: Acute kidney injury (AKI) is frequent in hospitalized patients and contributes to adverse short- and long-term outcomes. We aimed to evaluate the association of AKI and long-term adverse renal events and mortality in a cohort of patients hospitalized with COVID-19. Methods: Single-center and retrospective study of hospitalized patients admitted to a Dedicated Unit for COVID-19 at Centro Hospitalar Universitário Lisboa Norte, Portugal, between March 2020 and October 2020. AKI was defined and classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification, using SCr criteria. The analyzed outcomes were development of major adverse kidney events (MAKE) and major adverse renal cardiovascular events (MARCE), and mortality over a two-year follow-up period. Results: From the included 409 patients, AKI occurred in 60.4% (n=247). Within two years after discharge, 31.8% (n=130) of patients had an eGFR<60mL/min/1.73m2 and/or a 25% decrease on eGFR and 1.7% (n=7) of patients required RRT, 6.1% (n=25) of patients had CV events and 27.9% (n=114) of patients died. The incidence of MAKE was 60.9% (n=249), and MARCE was 62.6% (n=256). On a multivariate analysis, older age (adjusted HR 1.02 (95% CI: 1.01-1.04), p=0.008), cardiovascular disease (adjusted HR 2.22 (95% CI: 1.24-3.95), p=0.007), chronic kidney disease (adjusted HR 5.15 (95% CI: 2.22-11.93), p<0.001), and AKI (adjusted HR 1.76 (95% CI: 1.12-2.78), p=0.015) were independent predictors of MAKE. Older age (adjusted HR 1.06 (95% CI: 1.04-1.08), p<0.001) and neoplasia (adjusted HR 4.88 (95% CI: 2.37-10.04), p<0.001) were independent predictors of mortality. Conclusion: In this cohort of hospitalized patients with COVID-19, AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and/or mortality after hospital discharge.
Introduction: Acute kidney injury (AKI) is frequent in hospitalized patients and contributes to adverse short- and long-term outcomes. We aimed to evaluate the association of AKI and long-term adverse renal events and mortality in a cohort of patients hospitalized with COVID-19. Methods: Single-center and retrospective study of hospitalized patients admitted to a Dedicated Unit for COVID-19 at Centro Hospitalar Universitário Lisboa Norte, Portugal, between March 2020 and October 2020. AKI was defined and classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification, using SCr criteria. The analyzed outcomes were development of major adverse kidney events (MAKE) and major adverse renal cardiovascular events (MARCE), and mortality over a two-year follow-up period. Results: From the included 409 patients, AKI occurred in 60.4% (n=247). Within two years after discharge, 31.8% (n=130) of patients had an eGFR<60mL/min/1.73m2 and/or a 25% decrease on eGFR and 1.7% (n=7) of patients required RRT, 6.1% (n=25) of patients had CV events and 27.9% (n=114) of patients died. The incidence of MAKE was 60.9% (n=249), and MARCE was 62.6% (n=256). On a multivariate analysis, older age (adjusted HR 1.02 (95% CI: 1.01-1.04), p=0.008), cardiovascular disease (adjusted HR 2.22 (95% CI: 1.24-3.95), p=0.007), chronic kidney disease (adjusted HR 5.15 (95% CI: 2.22-11.93), p<0.001), and AKI (adjusted HR 1.76 (95% CI: 1.12-2.78), p=0.015) were independent predictors of MAKE. Older age (adjusted HR 1.06 (95% CI: 1.04-1.08), p<0.001) and neoplasia (adjusted HR 4.88 (95% CI: 2.37-10.04), p<0.001) were independent predictors of mortality. Conclusion: In this cohort of hospitalized patients with COVID-19, AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and/or mortality after hospital discharge.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
COVID-19 Lesão renal aguda Outcomes a longo prazo Eventos adversos renais major Mortalidade Nefrologia