合并新型冠状病毒肺炎的维持性血液透析患者死亡危险因素

doi:10.6040/j.issn.1671-7554.0.2023.0386

摘要/Abstract

摘要： 目的探讨合并新型冠状病毒肺炎(简称新冠肺炎)的维持性血液透析患者住院期间死亡的危险因素。方法纳入2022年12月1日至2023年2月28日期间于山东大学第二医院血液净化中心因罹患新冠肺炎而入院治疗的维持性血液透析患者进行病例对照研究,共纳入54例患者,平均(66.5±11.4)岁,男性比例74.1%,根据住院期间是否死亡分为死亡组(n=21)和存活组(n=33),对比两组基线资料、临床及实验室检查特征,进一步应用多因素二分类 Logistic 回归方法明确合并新冠肺炎的维持性血液透析患者住院期间死亡的独立危险因素。结果死亡组患者入院后平均生存期(8.8±6.7)d,其中因重症肺炎死亡15例(71.4%),因心血管事件死亡4例(19.0%),因脑血管事件死亡2例(9.5%)。与存活组相比,死亡组高龄(≥75岁)患者占比更高(P=0.024)、合并糖尿病的比例更高(P=0.030),罹患新冠肺炎前6个月平均白蛋白(ALB)水平偏低(P=0.046),入院后24 h内D-二聚体(D-dimer)、白细胞计数(WBC)、中性粒细胞计数(NEUT)及C反应蛋白(CRP)、白介素-6(IL-6)、降钙素原(PCT)水平明显升高(P均<0.05),淋巴细胞计数LYM、ALB、PA水平则明显降低(P均<0.05)。多因素二分类Logistic 回归分析显示,年龄≥75岁、IL-6升高是合并新冠肺炎的维持性血液透析患者死亡的独立危险因素。进一步分析结果显示,IL-6升高同时是患者住院期间出现严重低氧血症(氧分压≤60 mmHg)、胸部影像学病变进展大于50%的独立影响因素。结论合并新冠肺炎的维持性血液透析患者住院期间死亡率高,且大多死于重症肺炎。高龄、合并糖尿病、营养状态差、炎症水平高、易栓状态是患者死亡的危险因素,其中IL-6水平升高可能尤为关键。

关键词: 新型冠状病毒肺炎, 血液透析, 高龄, 细胞因子风暴, 危险因素

Abstract: Objective To explore the risk factors of in-hospital mortality of maintenance hemodialysis(MHD)patients with COVID-19 pneumonia. Methods A case-control study was conducted on MHD patients admitted due to COVID-19 pneumonia during Dec. 1, 2022 and Feb. 28, 2023. A total of 54 patients were included in the study. According to whether the patients died during the hospitalization, they were divided into two groups: the death group(n=21)and the survival group(n=33). The patients had a mean age of(66.5±11.4)years, with a male proportion of 74.1%. The clinical and laboratory characteristics of the two groups were compared, and the multivariable Logistic regression models were applied to identify the independent risk factors of in-hospital mortality. Results Mean survival time of patients in the death group was(8.8±6.7)days. The causes of death were severe pneumonia secondary to COVID-19(15 cases, 71.4%), cardiovascular disease(4 cases, 19.0%), and cerebrovascular disease(2 cases, 9.5%). Compared with the survival group, more patients in the death group were ≥75 years of age(P=0.024); had a positive history of diabetes mellitus(P=0.030); had lower albumin(ALB)level in the 6 months before COVID-19 pneumonia(P=0.046); had higher levels of D-dimer, white blood cell(WBC)count, neutrophil(NEUT)count, C-reactive protein(CRP), interleukin-6(IL-6)and procalcitonin(PCT)within 24 hours of admission(all P<0.05); had lower levels of lymphocyte(LYM)count, ALB and prealbumin(PA)(all P<0.05). Multivariable Logistic regression analysis showed that ≥75 years of age and elevated IL-6 level were independent risk factors of in-hospital mortality. Elevated IL-6 level was independent influencing factor of oxygen partial pressure ≤60 mmHg and progression of chest imaging lesions >50% during hospitalization. Conclusion MHD patients with COVID-19 pneumonia have a high mortality during hospitalization, most of whom die of severe pneumonia. Advanced age, history of diabetes mellitus, poor nutritional status, high inflammatory levels and hypercoagulability, especially IL-6 level, are risk factors of mortality in these patients.

Key words: COVID-19 pneumonia, Dialysis, Advanced age, Cytokine storm, Risk factor

中图分类号:

R692.5

王园园,孙云. 合并新型冠状病毒肺炎的维持性血液透析患者死亡危险因素[J]. 山东大学学报 (医学版), 2023, 61(11): 68-73.

WANG Yuanyuan, SUN Yun. Risk factors of mortality of maintenance hemodialysis patients with COVID-19 pneumonia[J]. Journal of Shandong University (Health Sciences), 2023, 61(11): 68-73.

参考文献

[1] 芦鸿曦,曹点,杨晨,等. 新型冠状病毒肺炎与严重急性呼吸综合征和中东呼吸综合征的对比分析[J]. 中华临床感染病杂志, 2020, 13(6): 467-474. LU Hongxi, CAO Dian, YANG Chen, et al. A review on the identification of COVID-19, SARS and MERS[J]. Chinese Journal of Clinical Infectious Diseases, 2020, 13(6): 467-474.
[2] Nassar M, Nso N, Alfishawy M, et al. Current systematic reviews and meta-analyses of COVID-19[J]. World J Virol, 2021, 10(4): 182-208.
[3] Syed-Ahmed M, Narayanan M. Immune dysfunction and risk of infection in chronic kidney disease[J]. Adv Chronic Kidney Dis, 2019, 26(1): 8-15.
[4] Valeri AM, Robbins-Juarez SY, Stevens JS, et al. Presentation and outcomes of patients with ESKD and COVID-19[J]. J Am Soc Nephrol, 2020, 31(7): 1409-1415.
[5] Wang X, Fang X, Cai Z, et al. Comorbid chronic diseases and acute organ injuries are strongly correlated with disease severity and mortality among COVID-19 patients: a systemic review and meta-analysis[J]. Research(Wash D C), 2020, 2020: 2402961. doi: 10.34133/2020/2402961.
[6] Turgutalp K, Ozturk S, Arici M, et al. Determinants of mortality in a large group of hemodialysis patients hospitalized for COVID-19[J]. BMC Nephrology, 2021, 22(1): 29. doi: 10.1186/s12882-021-02233-0.
[7] Betjes MGH. Uremia-associated immunological aging and severity of COVID-19 infection[J]. Front Med(Lausanne), 2021, 8: 675573. doi: 10.3389/fmed.2021.675573.
[8] Liu Y, Yang Y, Zhang C, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury [J]. Sci China Life Sci, 2020, 63(3): 364-374.
[9] Moro E, Priori A, Beghi E, et al. The international european academy of neurology survey on neurological symptoms in patients with COVID-19 infection [J]. Eur J Neurol, 2020, 27(9): 1727-1737.
[10] Chimenti C, Magnocavallo M, Ballatore F, et al. Prevalence and clinical implications of COVID-19 myocarditis [J]. Card Electrophysiol Clin, 2022, 14(1): 53-62.
[11] Lin L, Jiang X, Zhang Z, et al. Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection[J]. Gut, 2020, 69(6): 997-1001.
[12] 中国医药教育协会感染疾病专业委员会. 感染相关生物标志物临床意义解读专家共识[J]. 中华结核和呼吸杂志, 2017, 40(4): 243-257.
[13] Aziz M, Fatima R, Assaly R. Elevated interleukin-6 and severe COVID-19: a meta-analysis [J]. J Med Virol, 2020, 92(11): 2283-2285.
[14] Melo AKG, Milby KM, Caparroz ALMA, et al. Biomarkers of cytokine storm as red flags for severe and fatal COVID-19 cases: a living systematic review and meta-analysis [J]. PLoS One, 2021, 16(6): e0253894. doi:10.1371/journal.pone.0253894.
[15] Moore JB, June CH. Cytokine release syndrome in severe COVID-19[J]. Science, 2020, 368(6490): 473-474.
[16] 胡珊博,杨婧,于超平,等. IL-6、IL-1β和IL-10在外周血的水平可作为早期鉴别革兰阳性与革兰阴性脓毒症的指标[J]. 细胞与分子免疫学杂志, 2021, 37(6): 532-537. HU Shanbo, YANG Jing, YU Chaoping, et al. IL-6, IL-1β, and IL-10 levels in peripheral blood as indicators for early identification of gram-positive and gram-negative sepsis[J]. Chinese Journal of Cellular and Molecular Immunology, 2021, 37(6): 532-537.
[17] Libby P, Hanson GK. Inflammation and immunity in diseases of the arterial tree players and layers [J]. Circ Res, 2015, 116(2): 307-311.
[18] Cobo G, Lindholm B, Stenvinkel P. Chronic inflammation in end-stage renal disease and dialysis[J]. Nephrol Dial Transplant, 2018, 33: iii35-iii40. doi:10.1093/ndt/gfy175.
[19] Hasuike Y, Nonoguchi H, Ito K, et al. Interleukin-6 is a predictor of mortality in stable hemodialysis patients[J]. Am J Nephrol, 2009, 30(4): 389-398.
[20] Bologa RM, Levine DM, Parker TS, et al. Interleukin-6 predicts hypoalbuminemia, hypocholesterolemia, and mortality in hemodialysis patients[J]. Am J Kidney Dis, 1998, 32(1): 107-114.
[21] Kim Y, Molnar MZ, Rattanasompattikul M, et al. Relative contributions of inflammation and inadequate protein intake to hypoalbuminemia in patients on maintenance hemodialysis[J]. Int Urol Nephrol, 2013, 45(1): 215-227.

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