<br>地塞米松对严重 COVID-19 引起的急性肾损伤的影响：一项多中心队列研究,Annals of Intensive Care

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地塞米松对严重 COVID-19 引起的急性肾损伤的影响：一项多中心队列研究
Annals of Intensive Care ( IF 5.7 ) Pub Date : 2024-02-13 , DOI: 10.1186/s13613-024-01258-6
Sébastien Rubin _{1,

2} , Arthur Orieux ₃ , Mathilde Prezelin-Reydit _{4,

5} , Antoine Garric ₁ , Yoann Picard ₆ , Nouchan Mellati ₆ , Lisa Le Gall ₅ , Antoine Dewitte ₇ , Renaud Prevel _{3,

8} , Didier Gruson _{3,

8} , Guillaume Louis ₆ , Alexandre Boyer _{3,

8} ,

Affiliation

背景

重症监护病房 (ICU) 重症 COVID-19 患者中急性肾损伤 (AKI) 很常见 (> 50%)。 AKI 的发病机制中存在特定的炎症过程，地塞米松 (DXM) 可以改善这一过程。在一项小型单中心研究（ n = 100 名患者）中，我们报告了 DXM 对 AKI 风险的潜在保护作用。本研究旨在通过针对重症 COVID-19 患者的多中心研究，探讨 DXM 对 AKI 的预防作用。

方法

我们于 2020 年 3 月至 2021 年 8 月在法国三个 ICU 进行了一项多中心研究。所有因重症 COVID-19 入住 ICU 的患者均纳入其中。入住 ICU 之前已患有 AKI 或 DXM 的个体被排除在外。虽然在第一波期间从未使用过 DXM，但随后在进入 ICU 时使用了 DXM，提供了两个治疗组。多变量特定原因 Cox 模型考虑了 ICU 实践随时间的变化，用于确定 DXM 与 AKI 发生之间的关联。

结果

其中包括七百九十八名患者。平均年龄为 62.6 ± 12.1 岁，402/798 (50%) 患者患有高血压，46/798 (6%) 患者既往患有慢性肾病。 SOFA 中位数为 4 [3-6]，420/798 (53%) 需要有创机械通气。 ICU 死亡率为 208/798 (26%)。 598/798 (75%) 例患者存在 AKI：分别有 266/598 (38%)、163/598 (27%) 和 210/598 (35%) 患者患有 AKI KDIGO 1、2、3 和61/598 (10%) 患者需要肾脏替代治疗。与未接受 DXM 的患者相比，接受 DXM 的患者发生 AKI 的风险显着降低（HR 0.67；95CI 0.55-0.81）。这些结果与以下分析一致：(1) 排除服用 DXM 后 AKI 发病延迟少于 12 小时的患者，(2) 纳入了 COVID-19 大流行的不同“浪潮”。

结论

DXM 与入住 ICU 的重症 COVID-19 患者 AKI 风险降低相关。这支持了 AKI 的炎症损伤可能是可以预防的假设。

"点击查看英文标题和摘要"

Impact of dexamethasone in severe COVID-19-induced acute kidney injury: a multicenter cohort study

Background

Acute kidney injury (AKI) in intensive care unit (ICU) patients with severe COVID-19 is common (> 50%). A specific inflammatory process has been suggested in the pathogenesis of AKI, which could be improved by dexamethasone (DXM). In a small monocenter study (n = 100 patients), we reported a potential protective effect of DXM on the risk of AKI. This study aimed to investigate the preventive impact of DXM on AKI in a multicenter study of patients with severe COVID-19.

Methods

We conducted a multicenter study in three French ICUs from March 2020 to August 2021. All patients admitted to ICU for severe COVID-19 were included. Individuals with preexistent AKI or DXM administration before admission to ICU were excluded. While never used during the first wave, DXM was used subsequently at ICU entry, providing two treatment groups. Multivariate Cause-specific Cox models taking into account changes in ICU practices over time, were utilized to determine the association between DXM and occurrence of AKI.

Results

Seven hundred and ninety-eight patients were included. Mean age was 62.6 ± 12.1 years, 402/798 (50%) patients had hypertension, and 46/798 (6%) had previous chronic kidney disease. Median SOFA was 4 [3–6] and 420/798 (53%) required invasive mechanical ventilation. ICU mortality was 208/798 (26%). AKI was present in 598/798 (75%) patients: 266/598 (38%), 163/598 (27%), and 210/598 (35%) had, respectively, AKI KDIGO 1, 2, 3, and 61/598 (10%) patients required renal replacement therapy. Patients receiving DXM had a significantly decreased hazard of AKI occurrence compared to patients without DXM (HR 0.67; 95CI 0.55–0.81). These results were consistent in analyses that (1) excluded patients with DXM administration to AKI onset delay of less than 12 h, (2) incorporating the different ‘waves’ of the COVID-19 pandemic.

Conclusions

DXM was associated with a decrease in the risk of AKI in severe COVID-19 patients admitted to ICU. This supports the hypothesis that the inflammatory injury of AKI may be preventable.

更新日期：2024-02-13

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