功能早期变化作为COVID-19患者住院死亡率的预测因素
Nicu Olariu1,2,3, Nilima Rajpal Kundnani4,5, Simona Ruxanda Dragan4,5
1Department of Internal Medicine II, Division of Nephrology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Life (Basel, Switzerland)
|February 27, 2026
概括
对于COVID-19患者来说,功能早期变化提供了重要的预后见解. 在48小时内追踪功能轨迹可以改善风险分层,超越静态措施.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 传染性疾病 传染性疾病
- 临界护理医学 临界护理医学
背景情况:
- 急性损伤 (AKI) 是COVID-19的一个常见并发症,具有显著的预后影响.
- 静态肌水平和二进制AKI定义可能无法捕捉早期,临床相关的功能变化.
- 评估早期功能轨迹可以提供额外的预后信息.
研究的目的:
- 评估在住院24-48小时内早期功能轨迹是否在COVID-19患者中提供增量预后价值.
- 为了确定血清肌素的动态变化是否提供比静态措施更好的风险分层.
- 确定与住院死亡相关的特定早期功能模式.
主要方法:
- 在2020年12月至2021年12月期间住院的721名成年COVID-19患者的回顾性队列研究.
- 根据KDIGO标准分类的早期功能模式 (稳定,早期改善,早期恶化) 在24-48小时内血清肌素的变化.
- 使用多变量逻辑回归来分析住院死亡率,调整多个临床和人口因素.
主要成果:
- 在早期功能模式中,住院死亡率显著不同 (p=0.007).
- 早期肌素改善 (48.1%) 和早期恶化 (44.9%) 的患者的死亡率高于功能稳定的患者 (35.1%).
- 早期改善独立预测了更高的死亡率 (aOR 1.53) 并与增加的AKI负担和血液透析的需求有关.
结论:
- 住院后24-48小时内早期功能变化模式提供了超出静态肌水平的预后信息.
- 显而易见的早期肌素改善可能表明系统不稳定,而不是真正的恢复,识别高风险患者.
- 根据早期功能动态对患者进行分类可以提高住院COVID-19患者的风险分层.
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