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Dos Santos L, Silva LL, Pelloso FC, Maia V, Pujals C, Borghesan DH, Carvalho MD, Pedroso RB, Pelloso SM. Use of machine learning to identify protective factors for death from COVID-19 in the ICU: a retrospective study. PeerJ 2024; 12:e17428. [PMID: 38881861 PMCID: PMC11179634 DOI: 10.7717/peerj.17428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/29/2024] [Indexed: 06/18/2024] Open
Abstract
Background Patients in serious condition due to COVID-19 often require special care in intensive care units (ICUs). This disease has affected over 758 million people and resulted in 6.8 million deaths worldwide. Additionally, the progression of the disease may vary from individual to individual, that is, it is essential to identify the clinical parameters that indicate a good prognosis for the patient. Machine learning (ML) algorithms have been used for analyzing complex medical data and identifying prognostic indicators. However, there is still an urgent need for a model to elucidate the predictors related to patient outcomes. Therefore, this research aimed to verify, through ML, the variables involved in the discharge of patients admitted to the ICU due to COVID-19. Methods In this study, 126 variables were collected with information on demography, hospital length stay and outcome, chronic diseases and tumors, comorbidities and risk factors, complications and adverse events, health care, and vital indicators of patients admitted to an ICU in southern Brazil. These variables were filtered and then selected by a ML algorithm known as decision trees to identify the optimal set of variables for predicting patient discharge using logistic regression. Finally, a confusion matrix was performed to evaluate the model's performance for the selected variables. Results Of the 532 patients evaluated, 180 were discharged: female (16.92%), with a central venous catheter (23.68%), with a bladder catheter (26.13%), and with an average of 8.46- and 23.65-days using bladder catheter and submitted to mechanical ventilation, respectively. In addition, the chances of discharge increase by 14% for each additional day in the hospital, by 136% for female patients, 716% when there is no bladder catheter, and 737% when no central venous catheter is used. However, the chances of discharge decrease by 3% for each additional year of age and by 9% for each other day of mechanical ventilation. The performance of the training data presented a balanced accuracy of 0.81, sensitivity of 0.74, specificity of 0.88, and the kappa value was 0.64. The test performance had a balanced accuracy of 0.85, sensitivity 0.75, specificity 0.95, and kappa value of 0.73. The McNemar test found that there were no significant differences in the error rates in the training and test data, suggesting good classification. This work showed that female, the absence of a central venous catheter and bladder catheter, shorter mechanical ventilation, and bladder catheter duration were associated with a greater chance of hospital discharge. These results may help develop measures that lead to a good prognosis for the patient.
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Affiliation(s)
- Lander Dos Santos
- State University of Maringá, Graduate Program in Health Sciences, Maringá, Paraná, Brazil
| | - Lincoln Luis Silva
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | | | | | - Constanza Pujals
- State University of Maringá, Graduate Program in Health Sciences, Maringá, Paraná, Brazil
| | | | - Maria Dalva Carvalho
- State University of Maringá, Graduate Program in Health Sciences, Maringá, Paraná, Brazil
| | - Raíssa Bocchi Pedroso
- State University of Maringá, Graduate Program in Health Sciences, Maringá, Paraná, Brazil
| | - Sandra Marisa Pelloso
- State University of Maringá, Graduate Program in Health Sciences, Maringá, Paraná, Brazil
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Koşunalp N, Kavurmaci M. Determination of anxiety, depression, avoidance and obsessions experienced by hemodialysis patients during the COVID-19. Ther Apher Dial 2023; 27:1070-1078. [PMID: 37386825 DOI: 10.1111/1744-9987.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/11/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION The purpose of this study was to ascertain the levels of anxiety, despair, avoidance, and obsessions that hemodialysis patients dealt with during the pandemic. METHODS The study was conducted with 139 hemodialysis patients. Research data "Coronavirus Anxiety Scale (CAS)," "Hospital Anxiety and Depression Scale (HAD)," "COVID-19 Avoidance Scale" (AA-COVID-19) and "Coronavirus Obsession Scale (OCS)." The data obtained from the research were analyzed using the SPSS 21 package program. RESULTS The average score of the patients on the CAS scale was 0.73 ± 1.17, on the HAD-A scale was 5.94 ± 3.67, and on the HAD-D scale was 7.06 ± 3.89. The COVID-19 outbreak has consequently had a severe impact on hemodialysis patients' mental health. CONCLUSION Covid 19 epidemic, the health sector failed to protect the mental health of patients. However, new epidemics and disasters await the world in the future. In these results show that new strategies need to be developed.
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Affiliation(s)
- Nazlı Koşunalp
- Regional Training and Research Hospital, Palliative Care Unit, Erzurum, Turkey
| | - Mehtap Kavurmaci
- Department of Internal Medicine Nursing, Atatürk University, Erzurum, Turkey
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Arrestier R, Gendreau S, Mokrani D, Bastard JP, Fellahi S, Bagate F, Masi P, d’Humières T, Razazi K, Carteaux G, De Prost N, Audard V, Mekontso-Dessap A. Acute Kidney Injury in Critically-Ill COVID-19 Patients. J Clin Med 2022; 11:jcm11072029. [PMID: 35407639 PMCID: PMC8999255 DOI: 10.3390/jcm11072029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: Acute kidney injury (AKI) is common in patients with COVID-19, however, its mechanism is still controversial, particularly in ICU settings. Urinary proteinuria profile could be a non-invasive tool of interest to scrutinize the pathophysiological process underlying AKI in COVID-19 patients. Material and Methods: We conducted a retrospective study between March 2020 and April 2020. All patients with laboratory-confirmed COVID-19 and without end-stage kidney disease requiring renal replacement therapy before ICU admission were included. Our objectives were to assess the incidence and risk factors for AKI and to describe its clinical and biological characteristics, particularly its urinary protein profile. Results: Seventy patients were included; 87% needed mechanical ventilation and 61% needed vasopressor during their ICU stay; 64.3% of patients developed AKI and half of them needed dialysis. Total and tubular proteinuria on day 1 were higher in patients with AKI, whereas glomerular proteinuria was similar in both groups. The main risk factor for AKI was shock at admission (OR = 5.47 (1.74−17.2), p < 0.01). Mortality on day 28 was higher in AKI (23/45, 51.1%) than in no-AKI patients (1/25, 4%), p < 0.001. Risk factors for 28-days mortality were AKI with need for renal replacement therapy, non-renal SOFA score and history of congestive heart failure. Conclusions: AKI is common in COVID-19 patients hospitalized in ICU; it seems to be related to tubular lesions rather than glomerular injury and is related to shock at ICU admission.
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Affiliation(s)
- Romain Arrestier
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
- Correspondence: ; Tel.: +33-01-4981-2399; Fax: +33-01-4981-2542
| | - Ségolène Gendreau
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
| | - David Mokrani
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
| | - Jean-Philippe Bastard
- Département de Biochimie-Pharmacologie-Biologie Moléculaire-Génétique Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (J.-P.B.); (S.F.)
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, 94010 Creteil, France;
| | - Soraya Fellahi
- Département de Biochimie-Pharmacologie-Biologie Moléculaire-Génétique Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (J.-P.B.); (S.F.)
- Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire de Cardio-Métabolisme et Nutrition (ICAN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR S938, Sorbonne Université, 75006 Paris, France
| | - François Bagate
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
| | - Paul Masi
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
| | - Thomas d’Humières
- Service de Physiologie Explorations Fonctionnelles, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France
| | - Keyvan Razazi
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
| | - Guillaume Carteaux
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, 94010 Creteil, France;
| | - Nicolas De Prost
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
| | - Vincent Audard
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, 94010 Creteil, France;
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Assistance Publique-Hôpitaux de Paris (AP-HP), Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France
| | - Armand Mekontso-Dessap
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, 94010 Creteil, France;
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Chen Z, Gao C, Yu H, Lu L, Liu J, Chen W, Xiang X, Hussain HMJ, Lee BJ, Li C, Wei W, Huang Y, Li X, Fang Z, Yu S, Weng Q, Ouyang Y, Hu X, Tong J, Liu J, Lin L, Liu M, Xu X, Liu D, Song Y, Lv X, Zha Y, Ye Z, Jiang T, Jia J, Chen X, Bi Y, Xue J, Chen N, Hu W, He CJ, Wang H, Liu J, Xie J. Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection. Ren Fail 2021; 43:1329-1337. [PMID: 34541999 PMCID: PMC8462927 DOI: 10.1080/0886022x.2021.1979039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study sought to investigate incidence and risk factors for acute kidney injury (AKI) in hospitalized COVID-19. METHODS In this retrospective study, we enrolled 823 COVID-19 patients with at least two evaluations of renal function during hospitalization from four hospitals in Wuhan, China between February 2020 and April 2020. Clinical and laboratory parameters at the time of admission and follow-up data were recorded. Systemic renal tubular dysfunction was evaluated via 24-h urine collections in a subgroup of 55 patients. RESULTS In total, 823 patients were enrolled (50.5% male) with a mean age of 60.9 ± 14.9 years. AKI occurred in 38 (40.9%) ICU cases but only 6 (0.8%) non-ICU cases. Using forward stepwise Cox regression analysis, we found eight independent risk factors for AKI including decreased platelet level, lower albumin level, lower phosphorus level, higher level of lactate dehydrogenase (LDH), procalcitonin, C-reactive protein (CRP), urea, and prothrombin time (PT) on admission. For every 0.1 mmol/L decreases in serum phosphorus level, patients had a 1.34-fold (95% CI 1.14-1.58) increased risk of AKI. Patients with hypophosphatemia were likely to be older and with lower lymphocyte count, lower serum albumin level, lower uric acid, higher LDH, and higher CRP. Furthermore, serum phosphorus level was positively correlated with phosphate tubular maximum per volume of filtrate (TmP/GFR) (Pearson r = 0.66, p < .001) in subgroup analysis, indicating renal phosphate loss via proximal renal tubular dysfunction. CONCLUSION The AKI incidence was very low in non-ICU patients as compared to ICU patients. Hypophosphatemia is an independent risk factor for AKI in patients hospitalized for COVID-19 infection.
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Affiliation(s)
- Zijin Chen
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Chenni Gao
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Haijin Yu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lin Lu
- Department of Nephrology, North Huashan Hospital, Fudan University, Shanghai, China
| | - Jialin Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University, School of medicine, Shanghai, China
| | - Wei Chen
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Respiratory Diseases, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiaogang Xiang
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Hafiz Muhammad Jafar Hussain
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Benjamin J Lee
- Houston Kidney Consultants, Houston, TX, USA.,Houston Methodist Institute for Academic Medicine, Houston, TX, USA
| | - Chuanlei Li
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjie Wei
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yuhan Huang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiang Li
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Zhengying Fang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Shuwen Yu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Qinjie Weng
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yan Ouyang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiaofan Hu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jun Tong
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jian Liu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Li Lin
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | | | - Xiaoman Xu
- Renal Department, Wuhan Ninth Hospital, Wuhan, Hubei, China
| | - Dan Liu
- Radiology Department of Renmin Hospital, Wuhan University, Wuhan, Hubei, China
| | - Yuan Song
- Renal Department of Renmin Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xifeng Lv
- Renal Department of Renmin Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yixin Zha
- Clinical Research Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyin Ye
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tingting Jiang
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jieshuang Jia
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaonong Chen
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yufang Bi
- Department of Endocrinology and Metabolism disease, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jun Xue
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Nan Chen
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Weiguo Hu
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cijiang John He
- Division of Nephrology, Mount Sinai School of Medicine, New York, NY, USA
| | - Huiming Wang
- Renal Department of Renmin Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jun Liu
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jingyuan Xie
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Costa RLD, Sória TC, Salles EF, Gerecht AV, Corvisier MF, Menezes MADM, Ávila CDS, Silva ECDF, Pereira SRN, Simvoulidis LFN. Acute kidney injury in patients with Covid-19 in a Brazilian ICU: incidence, predictors and in-hospital mortality. ACTA ACUST UNITED AC 2021; 43:349-358. [PMID: 33570081 PMCID: PMC8428632 DOI: 10.1590/2175-8239-jbn-2020-0144] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/12/2020] [Indexed: 02/27/2023]
Abstract
Introduction: There is little data in the literature on acute kidney injury (AKI) in
Covid-19 cases, although relevant in clinical practice in the ICU,
especially in Brazil. Our goal was to identify the incidence of AKI,
predictive factors and impact on hospital mortality. Method: Retrospective cohort of patients with Covid-19 admitted to the ICU. AKI was
defined according to KDIGO criteria. Data was collected from electronic
medical records between March 17 and April 26. Results: Of the 102 patients, 55.9% progressed with AKI, and the majority (66.7%) was
classified as stage 3. Multivariate logistic regression showed age (RC
1.101; 95% CI 1.026 - 1.181; p = 0.0070), estimated
glomerular filtration rate - eGFR (RC 1.127; 95% CI 1.022 - 1.243;
p = 0.0170) and hypertension (RC 3.212; 95% CI 1.065 -
9.690; p = 0.0380) as independent predictors of AKI.
Twenty-three patients died. In the group without kidney injury, there were
8.9% deaths, while in the group with AKI, 33.3% of patients died (RR 5.125;
95% CI 1.598 - 16.431; p = 0.0060). The average survival,
in days, was higher in the group without AKI. Cox multivariate analysis
showed age (RR 1.054; 95% CI 1.014 - 1.095; p = 0.0080) and
severe acute respiratory distress syndrome (RR 8.953; 95% CI 1.128 - 71.048;
p = 0.0380) as predictors of hospital mortality. Conclusion: We found a high incidence of AKI; and as predictive factors for its
occurrence: age, eGFR and hypertension. AKI was associated with higher
hospital mortality.
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Acute kidney injury in patients with pneumonia with A/H1N1 influenza. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Mejdani M, Haddadi K, Pham C, Mahadevan R. SARS-CoV-2 receptor-binding mutations and antibody contact sites. Antib Ther 2021; 4:149-158. [PMID: 34386694 PMCID: PMC8353666 DOI: 10.1093/abt/tbab015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/28/2021] [Accepted: 07/15/2021] [Indexed: 12/11/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mutations can impact infectivity, viral load, and overall morbidity/mortality during infection. In this analysis, we look at the mutational landscape of the SARS-CoV-2 receptor-binding domain, a structure that is antigenic and allows for viral binding to the host. We develop a bioinformatics platform and analyze 104 193 Global Initiative on Sharing All Influenza Data sequences acquired on 15 October 2020, with a majority of sequences (96%) containing point mutations. We report high frequency mutations with improved binding affinity to ACE2 including S477N, N439K, V367F, and N501Y and address the potential impact of RBD mutations on antibody binding. The high frequency S477N mutation is present in 6.7% of all SARS-CoV-2 sequences, co-occurs with D614G, and is currently present in 14 countries. To address RBD-antibody interactions, we take a subset of human-derived antibodies and define their interacting residues using PDBsum. Our analysis shows that RBD mutations were found in approximately 9% of our dataset, with some mutations improving RBD-ACE2 interactions. We also show that antibody-mediated immunity against SARS-CoV-2 enlists broad coverage of the RBD, with multiple antibodies targeting a variety of RBD regions. These data suggest that it is unlikely for neutralization/RBD antibody binding to be significantly impacted, as a whole, in the presence of RBD point mutations that conserve the RBD structure.
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Affiliation(s)
- Marios Mejdani
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON M5S 3E5, Canada
| | - Kiandokht Haddadi
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON M5S 3E5, Canada
| | - Chester Pham
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON M5S 3E5, Canada
| | - Radhakrishnan Mahadevan
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON M5S 3E5, Canada
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Scarpioni R, Valsania T, Albertazzi V, Blanco V, DeAmicis S, Manini A, Melfa L, Ricardi M, Rocca C, Gandolfi S. Acute kidney injury, a common and severe complication in hospitalized patients during the COVID-19 pandemic. J Nephrol 2021; 34:1019-1024. [PMID: 34146335 PMCID: PMC8214067 DOI: 10.1007/s40620-021-01087-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/01/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Acute respiratory failure (ARF) is the main clinical sign of coronavirus disease-2019 (COVID-19), but little is known about the outcome of acute kidney injury (AKI) associated with ARF. STUDY DESIGN Retrospective cohort study on clinical features of adult patients hospitalized with COVID-19 between March 1st and April 30th, 2020 in the district of Piacenza (Italy). RESULTS Among 1894 hospitalized patients, 1701 affected by COVID-19 underwent at least two serum creatinine evaluations. According to KDIGO definitions, 233 of 1,701 patients (13.7%) developed AKI: 159, 34, and 40 had stage 1, 2 and 3 AKI, respectively. Patients with AKI were older (mean age 73.5 ± 14 years, range 24-95) than those without AKI (72 ± 14 years, range 20-102). In-hospital mortality was high in COVID patients (567/1701 patients, 33%), which almost doubled among AKI patients (132/233 patients, 57%), compared with those without AKI (p < 0.01). Risk factors for AKI included older age, male gender, diabetes and need for ventilation. Fourteen patients with stage 3 AKI underwent renal replacement therapy (RRT). CONCLUSIONS Hospitalized COVID-19 patients with AKI associated with ARF have poor chances of survival. Diagnosing and preventing the progression of renal damage is fundamental in order to delay initiating RRT, especially when resources are limited.
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Affiliation(s)
- Roberto Scarpioni
- Department of Nephrology and Dialysis, ASL "Guglielmo da Saliceto" Hospital Piacenza, via Taverna 49, 29121, Piacenza, Italy.
| | - Teresa Valsania
- Department of Nephrology and Dialysis, ASL "Guglielmo da Saliceto" Hospital Piacenza, via Taverna 49, 29121, Piacenza, Italy
| | - Vittorio Albertazzi
- Department of Nephrology and Dialysis, ASL "Guglielmo da Saliceto" Hospital Piacenza, via Taverna 49, 29121, Piacenza, Italy
| | - Valentina Blanco
- Department of Nephrology and Dialysis, ASL "Guglielmo da Saliceto" Hospital Piacenza, via Taverna 49, 29121, Piacenza, Italy
| | - Sara DeAmicis
- Department of Nephrology and Dialysis, ASL "Guglielmo da Saliceto" Hospital Piacenza, via Taverna 49, 29121, Piacenza, Italy
| | - Alessandra Manini
- Department of Nephrology and Dialysis, ASL "Guglielmo da Saliceto" Hospital Piacenza, via Taverna 49, 29121, Piacenza, Italy
| | - Luigi Melfa
- Department of Nephrology and Dialysis, ASL "Guglielmo da Saliceto" Hospital Piacenza, via Taverna 49, 29121, Piacenza, Italy
| | - Marco Ricardi
- Department of Nephrology and Dialysis, ASL "Guglielmo da Saliceto" Hospital Piacenza, via Taverna 49, 29121, Piacenza, Italy
| | - Chiara Rocca
- Department of Nephrology and Dialysis, ASL "Guglielmo da Saliceto" Hospital Piacenza, via Taverna 49, 29121, Piacenza, Italy
| | - Stefano Gandolfi
- Department of Staff, ASL "Guglielmo da Saliceto" Hospital, Piacenza, Italy
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9
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Finn MT, Gogia S, Ingrassia JJ, Cohen M, Madhavan MV, Nabavi Nouri S, Brailovsky Y, Masoumi A, Fried JA, Uriel N, Agerstrand CI, Eisenberger A, Einstein AJ, Brodie D, B Rosenzweig E, Leon MB, Takeda K, Pucillo A, Green P, Kirtane AJ, Parikh SA, Sethi SS. Pulmonary Embolism Response Team utilization during the COVID-19 pandemic. Vasc Med 2021; 26:426-433. [PMID: 33818200 PMCID: PMC8047511 DOI: 10.1177/1358863x21995896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Coronavirus disease 2019 (COVID-19) may predispose patients to venous thromboembolism (VTE). Limited data are available on the utilization of the Pulmonary Embolism Response Team (PERT) in the setting of the COVID-19 global pandemic. We performed a single-center study to evaluate treatment, mortality, and bleeding outcomes in patients who received PERT consultations in March and April 2020, compared to historical controls from the same period in 2019. Clinical data were abstracted from the electronic medical record. The primary study endpoints were inpatient mortality and GUSTO moderate-to-severe bleeding. The frequency of PERT utilization was nearly threefold higher during March and April 2020 (n = 74) compared to the same period in 2019 (n = 26). During the COVID-19 pandemic, there was significantly less PERT-guided invasive treatment (5.5% vs 23.1%, p = 0.02) with a numerical but not statistically significant trend toward an increase in the use of systemic fibrinolytic therapy (13.5% vs 3.9%, p = 0.3). There were nonsignificant trends toward higher in-hospital mortality or moderate-to-severe bleeding in patients receiving PERT consultations during the COVID-19 period compared to historical controls (mortality 14.9% vs 3.9%, p = 0.18 and moderate-to-severe bleeding 35.1% vs 19.2%, p = 0.13). In conclusion, PERT utilization was nearly threefold higher during the COVID-19 pandemic than during the historical control period. Among patients evaluated by PERT, in-hospital mortality or moderate-to-severe bleeding were not significantly different, despite being numerically higher, while invasive therapy was utilized less frequently during the COVID-19 pandemic.
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Affiliation(s)
- Matthew T Finn
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Shawn Gogia
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
| | | | - Matthew Cohen
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
| | - Mahesh V Madhavan
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - Amir Masoumi
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
| | - Justin A Fried
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
| | - Nir Uriel
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Cara I Agerstrand
- Department of Pulmonology, Columbia Irving Medical Center, New York, NY, USA
| | - Andrew Eisenberger
- Department of Hematology/Oncology, Columbia Irving Medical Center, New York, NY, USA
| | - Andrew J Einstein
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
| | - Daniel Brodie
- Department of Pulmonology, Columbia Irving Medical Center, New York, NY, USA
| | - Erika B Rosenzweig
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
- Department of Pediatric Cardiology, Columbia Irving Medical Center, New York, NY, USA
| | - Martin B Leon
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Koji Takeda
- Department of Cardiothoracic Surgery, Columbia Irving Medical Center, New York, NY, USA
| | - Anthony Pucillo
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
| | - Philip Green
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
| | - Ajay J Kirtane
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Sahil A Parikh
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Sanjum S Sethi
- Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
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10
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Khatri M, Charytan DM, Parnia S, Petrilli CM, Michael J, Liu D, Tatapudi V, Jones S, Benstein J, Horwitz LI. Outcomes among Hospitalized Chronic Kidney Disease Patients with COVID-19. KIDNEY360 2021; 2:1107-1114. [PMID: 35368350 PMCID: PMC8786103 DOI: 10.34067/kid.0006852020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/04/2021] [Indexed: 02/04/2023]
Abstract
Background Patients with CKD ha ve impaired immunity, increased risk of infection-related mortality, and worsened COVID-19 outcomes. However, data comparing nondialysis CKD and ESKD are sparse. Methods Patients with COVID-19 admitted to three hospitals in the New York area, between March 2 and August 27, 2020, were retrospectively studied using electronic health records. Patients were classified as those without CKD, those with nondialysis CKD, and those with ESKD, with outcomes including hospital mortality, ICU admission, and mortality rates. Results Of 3905 patients, 588 (15%) had nondialysis CKD and 128 (3%) had ESKD. The nondialysis CKD and ESKD groups had a greater prevalence of comorbidities and higher admission D-dimer levels, whereas patients with ESKD had lower C-reactive protein levels at admission. ICU admission rates were similar across all three groups (23%-25%). The overall, unadjusted hospital mortality was 25%, and the mortality was 24% for those without CKD, 34% for those with nondialysis CKD, and 27% for those with ESKD. Among patients in the ICU, mortality was 56%, 64%, and 56%, respectively. Although patients with nondialysis CKD had higher odds of overall mortality versus those without CKD in univariate analysis (OR, 1.58; 95% CI, 1.31 to 1.91), this was no longer significant in fully adjusted models (OR, 1.11; 95% CI, 0.88 to 1.40). Also, ESKD status did not associate with a higher risk of mortality compared with non-CKD in adjusted analyses, but did have reduced mortality when compared with nondialysis CKD (OR, 0.57; 95% CI, 0.33 to 0.95). Mortality rates declined precipitously after the first 2 months of the pandemic, from 26% to 14%, which was reflected in all three subgroups. Conclusions In a diverse cohort of patients with COVID-19, we observed higher crude mortality rates for patients with nondialysis CKD and, to a lesser extent, ESKD, which were not significant after risk adjustment. Moreover, patients with ESKD appear to have better outcom es than those with nondialysis CKD.
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Affiliation(s)
- Minesh Khatri
- New York University Long Island School of Medicine, Mineola, New York
| | - David M. Charytan
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Sam Parnia
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | | | - Jeffrey Michael
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - David Liu
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Vasishta Tatapudi
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Simon Jones
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Judith Benstein
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Leora I. Horwitz
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
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11
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Liu J, Wang T, Cai Q, Huang D, Sun L, He Q, Wang FS, Chen J. Acute Kidney Injury and Early Predictive Factors in COVID-19 Patients. Front Med (Lausanne) 2021; 8:604242. [PMID: 34322497 PMCID: PMC8311118 DOI: 10.3389/fmed.2021.604242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 06/11/2021] [Indexed: 01/14/2023] Open
Abstract
Objectives: Our objective was to explore the incidence and early predictive factors of acute kidney injury in coronavirus disease 2019 (COVID-19) patients. Method: We established a retrospective cohort of 408 patients who were admitted to Shenzhen Third People's Hospital in Shenzhen, China, between January 1 and March 31, 2020. Clinical outcomes and renal function were monitored until April 12, 2020, with a median follow-up duration of 21 days [interquartile range (IQR) = 14-33]. Results: When first admitted to hospital (baseline), 19.36% (79/408) presented renal dysfunction [estimated glomerular filtration rate (eGFR) <90 ml/min/1.73 m2]. During follow-up, 3.9% (16/408) developed acute kidney injury (AKI). Age ≥60 years [hazard ratio (HR) = 4.78, 95% CI = 1.10-20.69], PaO2/FiO2 ratio <300 (HR = 3.48, 95% CI = 1.04-11.62), and higher creatinine (HR = 1.04, 95% CI = 1.01-1.07) at baseline independently predicted the risk of AKI. Respectively, 25.0% (102/408), 3.9% (16/408), 0.5% (2/408), 1.0% (4/408), and 0.2% (1/408) experienced G2, G3a, G3b, G4, and G5 as their most severe category during hospitalization, while 69.4% (283/408) had normal eGFRs throughout the follow-up period. When finally discharged from hospital, there were 12.5% (51/408) of patients with abnormal eGFRs. Conclusions: COVID-19 patients can be at risk of AKI and continuous eGFR decline during hospitalization, which can be early predicted by baseline factors. Some individuals still had renal dysfunction when finally discharged from hospital.
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Affiliation(s)
- Jiaye Liu
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Tingyan Wang
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Qingxian Cai
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Deliang Huang
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Liqin Sun
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Qing He
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Fu-Sheng Wang
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
- Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jun Chen
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
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12
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Öztürk S, Turgutalp K, Arıcı M, Çetinkaya H, Altıparmak MR, Aydın Z, Soypaçacı Z, Bora F, Kara E, Cebeci E, Özler TE, Dölarslan ME, Sipahi S, Ayar Y, Şahin İ, Bakırdöğen S, İslam M, Görgülü N, Öğütmen MB, Şengül E, Güngör Ö, Seyahi N, Tokgöz BÜ, Odabaş AR, Tonbul HZ, Sezer S, Yıldız A, Ateş K. Impact of hospital-acquired acute kidney injury on Covid-19 outcomes in patients with and without chronic kidney disease: a multicenter retrospective cohort study. Turk J Med Sci 2021; 51:947-961. [PMID: 33611868 PMCID: PMC8283512 DOI: 10.3906/sag-2011-169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/21/2021] [Indexed: 01/08/2023] Open
Abstract
Background/aim Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data investigating the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19. Materials and methods HA-AKI development was assessed in a group of stage 3–5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared. Results Among 621 hospitalized patients (age 60 [IQR: 47–73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4%, and stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas it developed in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1% compared to 14.3% of patients with HA-AKI but no CKD (p < 0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate to patients with CKD without AKI. Adjusted mortality risks of the AKI+non-CKD group (HR: 9.0, 95% CI: 1.9–44.2) and AKI+CKD group (HR: 7.9, 95% CI: 1.9–33.3) were significantly higher than that of the non-AKI+non-CKD group. Conclusion AKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcomes whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients.
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Affiliation(s)
- Savaş Öztürk
- Department of Nephrology, University of Health Sciences, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Kenan Turgutalp
- Department of Internal Medicine, Division of Nephrology, Mersin University Faculty of Medicine, Training and Research Hospital, Mersin, Turkey
| | - Mustafa Arıcı
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hakkı Çetinkaya
- Department of Nephrology, Sultan 2. Abdulhamid Han Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Mehmet Rıza Altıparmak
- Department of Internal Medicine, Division of Nephrology, Cerrahpaşa Faculty of Medicine, İstanbul University–Cerrahpaşa, İstanbul, Turkey
| | - Zeki Aydın
- Department of Nephrology, Darıca Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Zeki Soypaçacı
- Department of Internal Medicine, Division of Nephrology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Feyza Bora
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ekrem Kara
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Egemen Cebeci
- Department of Nephrology, University of Health Sciences, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Tuba Elif Özler
- Department of Internal Medicine, Division of Nephrology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Mürşide Esra Dölarslan
- Department of Nephrology, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - Savaş Sipahi
- Department of Internal Medicine, Division of Nephrology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Yavuz Ayar
- Department of Nephrology, Bursa City Hospital, Bursa, Turkey
| | - İdris Şahin
- Department of Internal Medicine, Division of Nephrology, Turgut Özal Medical Center, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Serkan Bakırdöğen
- Department of Internal Medicine, Division of Nephrology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Mahmud İslam
- Department of Nephrology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey
| | - Numan Görgülü
- Department of Internal Medicine, Division of Nephrology, Bağcılar Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Melike Betül Öğütmen
- Department of Nephrology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Erkan Şengül
- Department of Nephrology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Özkan Güngör
- Department of Nephrology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Nurhan Seyahi
- Department of Internal Medicine, Division of Nephrology, Cerrahpaşa Faculty of Medicine, İstanbul University–Cerrahpaşa, İstanbul, Turkey
| | - BÜlent Tokgöz
- Department of Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ali Rıza Odabaş
- Department of Nephrology, Sultan 2. Abdulhamid Han Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Halil Zeki Tonbul
- Department of Nephrology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Siren Sezer
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Atılım University, Ankara, Turkey
| | - Alaattin Yıldız
- Department of Internal Medicine, Division of Nephrology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Kenan Ateş
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Ankara University, Ankara, Turkey
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13
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Komaru Y, Doi K. Does a slight change in serum creatinine matter in coronavirus disease 2019 (COVID-19) patients? Kidney Res Clin Pract 2021; 40:177-179. [PMID: 34162046 PMCID: PMC8237121 DOI: 10.23876/j.krcp.21.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yohei Komaru
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo Hospital, Tokyo, Japan
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14
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Pecly IMD, Azevedo RB, Muxfeldt ES, Botelho BG, Albuquerque GG, Diniz PHP, Silva R, Rodrigues CIS. A review of Covid-19 and acute kidney injury: from pathophysiology to clinical results. ACTA ACUST UNITED AC 2021; 43:551-571. [PMID: 34057983 PMCID: PMC8940122 DOI: 10.1590/2175-8239-jbn-2020-0204] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/16/2021] [Indexed: 01/08/2023]
Abstract
Acute kidney injury (AKI) in hospitalized patients with COVID-19 is associated with higher mortality and a worse prognosis. Nevertheless, most patients with COVID-19 have mild symptoms, and about 5% can develop more severe symptoms and involve hypovolemia and multiple organ dysfunction syndrome. In a pathophysiological perspective, severe SARS-CoV-2 infection is characterized by numerous dependent pathways triggered by hypercytokinemia, especially IL-6 and TNF-alpha, leading to systemic inflammation, hypercoagulability, and multiple organ dysfunction. Systemic endotheliitis and direct viral tropism to proximal renal tubular cells and podocytes are important pathophysiological mechanisms leading to kidney injury in patients with more critical infection, with a clinical presentation ranging from proteinuria and/or glomerular hematuria to fulminant AKI requiring renal replacement therapies. Glomerulonephritis, rhabdomyolysis, and nephrotoxic drugs are also associated with kidney damage in patients with COVID-19. Thus, AKI and proteinuria are independent risk factors for mortality in patients with SARS-CoV-2 infection. We provide a comprehensive review of the literature emphasizing the impact of acute kidney involvement in the evolutive prognosis and mortality of patients with COVID-19.
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Affiliation(s)
- Inah Maria D Pecly
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Rafael B Azevedo
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Elizabeth S Muxfeldt
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil.,Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, Brasil
| | - Bruna G Botelho
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | | | | | - Rodrigo Silva
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Cibele I S Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, São Paulo, SP, Brasil
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15
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Morell-Garcia D, Ramos-Chavarino D, Bauça JM, Argente Del Castillo P, Ballesteros-Vizoso MA, García de Guadiana-Romualdo L, Gómez-Cobo C, Pou JA, Amezaga-Menéndez R, Alonso-Fernández A, Llompart I, García-Raja A. Urine biomarkers for the prediction of mortality in COVID-19 hospitalized patients. Sci Rep 2021; 11:11134. [PMID: 34045530 PMCID: PMC8159957 DOI: 10.1038/s41598-021-90610-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/10/2021] [Indexed: 01/08/2023] Open
Abstract
Risk factors associated with severity and mortality attributable to COVID-19 have been reported in different cohorts, highlighting the occurrence of acute kidney injury (AKI) in 25% of them. Among other, SARS-CoV-2 targets renal tubular cells and can cause acute renal damage. The aim of the present study was to evaluate the usefulness of urinary parameters in predicting intensive care unit (ICU) admission, mortality and development of AKI in hospitalized patients with COVID-19. Retrospective observational study, in a tertiary care hospital, between March 1st and April 19th, 2020. We recruited adult patients admitted consecutively and positive for SARS-CoV-2. Urinary and serum biomarkers were correlated with clinical outcomes (AKI, ICU admission, hospital discharge and in-hospital mortality) and evaluated using a logistic regression model and ROC curves. A total of 199 COVID-19 hospitalized patients were included. In AKI, the logistic regression model with a highest area under the curve (AUC) was reached by the combination of urine blood and previous chronic kidney disease, with an AUC of 0.676 (95%CI 0.512-0.840; p = 0.023); urine specific weight, sodium and albumin in serum, with an AUC of 0.837 (95% CI 0.766-0.909; p < 0.001) for ICU admission; and age, urine blood and lactate dehydrogenase levels in serum, with an AUC of 0.923 (95%CI 0.866-0.979; p < 0.001) for mortality prediction. For hospitalized patients with COVID-19, renal involvement and early alterations of urinary and serum parameters are useful as prognostic factors of AKI, the need for ICU admission and death.
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Affiliation(s)
- Daniel Morell-Garcia
- Laboratory Medicine Department, Hospital Universitari Son Espases, Ctra. Valldemossa 79, mòdul 0-J., 07120, Palma de Mallorca, Spain.
- Institut d'Investigació Sanitària de Les Illes Balears (IdISBa), Palma de Mallorca, Spain.
| | - David Ramos-Chavarino
- Laboratory Medicine Department, Hospital Universitari Son Espases, Ctra. Valldemossa 79, mòdul 0-J., 07120, Palma de Mallorca, Spain
| | - Josep M Bauça
- Laboratory Medicine Department, Hospital Universitari Son Espases, Ctra. Valldemossa 79, mòdul 0-J., 07120, Palma de Mallorca, Spain
- Institut d'Investigació Sanitària de Les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Paula Argente Del Castillo
- Laboratory Medicine Department, Hospital Universitari Son Espases, Ctra. Valldemossa 79, mòdul 0-J., 07120, Palma de Mallorca, Spain
| | | | | | - Cristina Gómez-Cobo
- Laboratory Medicine Department, Hospital Universitari Son Espases, Ctra. Valldemossa 79, mòdul 0-J., 07120, Palma de Mallorca, Spain
- Institut d'Investigació Sanitària de Les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - J Albert Pou
- Institut d'Investigació Sanitària de Les Illes Balears (IdISBa), Palma de Mallorca, Spain
- Internal Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Rocío Amezaga-Menéndez
- Institut d'Investigació Sanitària de Les Illes Balears (IdISBa), Palma de Mallorca, Spain
- Intensive Care Unit, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Alberto Alonso-Fernández
- Institut d'Investigació Sanitària de Les Illes Balears (IdISBa), Palma de Mallorca, Spain
- Respiratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Isabel Llompart
- Laboratory Medicine Department, Hospital Universitari Son Espases, Ctra. Valldemossa 79, mòdul 0-J., 07120, Palma de Mallorca, Spain
- Institut d'Investigació Sanitària de Les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Ana García-Raja
- Laboratory Medicine Department, Hospital Universitari Son Espases, Ctra. Valldemossa 79, mòdul 0-J., 07120, Palma de Mallorca, Spain
- Institut d'Investigació Sanitària de Les Illes Balears (IdISBa), Palma de Mallorca, Spain
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16
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Molina Barragan AM, Pardo E, Galichon P, Hantala N, Gianinazzi AC, Darrivere L, Tsai ES, Garnier M, Bonnet F, Fieux F, Verdonk F. SARS-CoV-2 Renal Impairment in Critical Care: An Observational Study of 42 Cases (Kidney COVID). J Clin Med 2021; 10:jcm10081571. [PMID: 33917886 PMCID: PMC8068224 DOI: 10.3390/jcm10081571] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 01/08/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to 5% to 16% hospitalization in intensive care units (ICU) and is associated with 23% to 75% of kidney impairments, including acute kidney injury (AKI). The current work aims to precisely characterize the renal impairment associated to SARS-CoV-2 in ICU patients. Forty-two patients consecutively admitted to the ICU of a French university hospital who tested positive for SARS-CoV-2 between 25 March 2020, and 29 April 2020, were included and classified in categories according to their renal function. Complete renal profiles and evolution during ICU stay were fully characterized in 34 patients. Univariate analyses were performed to determine risk factors associated with AKI. In a second step, we conducted a logistic regression model with inverse probability of treatment weighting (IPTW) analyses to assess major comorbidities as predictors of AKI. Thirty-two patients (94.1%) met diagnostic criteria for intrinsic renal injury with a mixed pattern of tubular and glomerular injuries within the first week of ICU admission, which lasted upon discharge. During their ICU stay, 24 patients (57.1%) presented AKI which was associated with increased mortality (p = 0.007), hemodynamic failure (p = 0.022), and more altered clearance at hospital discharge (p = 0.001). AKI occurrence was associated with lower pH (p = 0.024), higher PaCO2 (CO2 partial pressure in the arterial blood) (p = 0.027), PEEP (positive end-expiratory pressure) (p = 0.027), procalcitonin (p = 0.015), and CRP (C-reactive protein) (p = 0.045) on ICU admission. AKI was found to be independently associated with chronic kidney disease (adjusted OR (odd ratio) 5.97 (2.1-19.69), p = 0.00149). Critical SARS-CoV-2 infection is associated with persistent intrinsic renal injury and AKI, which is a risk factor of mortality. Mechanical ventilation settings seem to be a critical factor of kidney impairment.
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Affiliation(s)
- Antoine-Marie Molina Barragan
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France; (A.-M.M.B.); (E.P.); (N.H.); (A.-C.G.); (L.D.); (M.G.); (F.B.); (F.F.)
| | - Emmanuel Pardo
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France; (A.-M.M.B.); (E.P.); (N.H.); (A.-C.G.); (L.D.); (M.G.); (F.B.); (F.F.)
- Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
| | - Pierre Galichon
- Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
- Transplantation and Nephrology Department, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France
| | - Nicolas Hantala
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France; (A.-M.M.B.); (E.P.); (N.H.); (A.-C.G.); (L.D.); (M.G.); (F.B.); (F.F.)
- Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
| | - Anne-Charlotte Gianinazzi
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France; (A.-M.M.B.); (E.P.); (N.H.); (A.-C.G.); (L.D.); (M.G.); (F.B.); (F.F.)
- Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
| | - Lucie Darrivere
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France; (A.-M.M.B.); (E.P.); (N.H.); (A.-C.G.); (L.D.); (M.G.); (F.B.); (F.F.)
- Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
| | - Eileen S. Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Marc Garnier
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France; (A.-M.M.B.); (E.P.); (N.H.); (A.-C.G.); (L.D.); (M.G.); (F.B.); (F.F.)
- Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
| | - Francis Bonnet
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France; (A.-M.M.B.); (E.P.); (N.H.); (A.-C.G.); (L.D.); (M.G.); (F.B.); (F.F.)
- Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
| | - Fabienne Fieux
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France; (A.-M.M.B.); (E.P.); (N.H.); (A.-C.G.); (L.D.); (M.G.); (F.B.); (F.F.)
| | - Franck Verdonk
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France; (A.-M.M.B.); (E.P.); (N.H.); (A.-C.G.); (L.D.); (M.G.); (F.B.); (F.F.)
- Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Correspondence:
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17
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Pérez A, Torregrosa I, D’Marco L, Juan I, Terradez L, Solís MÁ, Moncho F, Carda-Batalla C, Forner MJ, Gorriz JL. IgA-Dominant Infection-Associated Glomerulonephritis Following SARS-CoV-2 Infection. Viruses 2021; 13:587. [PMID: 33807151 PMCID: PMC8066364 DOI: 10.3390/v13040587] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/13/2022] Open
Abstract
The renal involvement of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported. The etiology of kidney injury appears to be tubular, mainly due to the expression of angiotensin-converting enzyme 2, the key joint receptor for SARS-CoV-2; however, cases with glomerular implication have also been documented. The multifactorial origin of this renal involvement could include virus-mediated injury, cytokine storm, angiotensin II pathway activation, complement dysregulation, hyper-coagulation, and microangiopathy. We present the renal histological findings from a patient who developed acute kidney injury and de novo nephrotic syndrome, highly suggestive of acute IgA-dominant infection-associated glomerulonephritis (IgA-DIAGN) after SARS-CoV-2 infection, as evidenced by the presence of this virus detected in the renal tissue of the patient via immunohistochemistry assay. In summary, we document the first case of IgA-DIAGN associated to SARS-CoV-2. Thus, SARS-CoV-2 S may act as a super antigen driving the development of multisystem inflammatory syndrome as well as cytokine storm in patients affected by COVID-19, reaching the glomerulus and leading to the development of this novel IgA-DIAGN.
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Affiliation(s)
- Aurora Pérez
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
| | - Isidro Torregrosa
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
| | - Luis D’Marco
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
| | - Isabel Juan
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
| | - Liria Terradez
- Pathology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (L.T.); (C.C.-B.)
| | - Miguel Ángel Solís
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
| | - Francesc Moncho
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
| | - Carmen Carda-Batalla
- Pathology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (L.T.); (C.C.-B.)
| | - María J. Forner
- Internal Medicine Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain;
| | - Jose Luis Gorriz
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
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18
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Menon T, Sharma R, Kataria S, Sardar S, Adhikari R, Tousif S, Khan H, Rathore SS, Singh R, Ahmed Z. The Association of Acute Kidney Injury With Disease Severity and Mortality in COVID-19: A Systematic Review and Meta-Analysis. Cureus 2021; 13:e13894. [PMID: 33880250 PMCID: PMC8045562 DOI: 10.7759/cureus.13894] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and objective The coronavirus disease 2019 (COVID-19) pandemic has become a global healthcare emergency. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, has a wide range of clinical manifestations ranging from subclinical infection to multi-organ failure. In addition to the respiratory system, COVID-19 also adversely affects the kidneys. In this study, we aimed to measure the prevalence of acute kidney injury (AKI) in COVID-19 and its association with the disease severity and mortality in COVID-19 patients. Materials and methods We conducted our study by following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. A comprehensive literature search using four databases (PubMed, EMBASE, Google Scholar, and clinicaltrial.gov) was performed. Our initial search returned 2,771 articles. After excluding review articles, duplicates, and non-relevant studies, we included 20 articles that reported an association between COVID-19 and AKI. We subsequently performed a random effect analysis to find the pooled prevalence, pooled odds ratio (OR) estimates, and 95% confidence intervals for severe COVID-19 and mortality outcomes in AKI using Cochrane RevMan (version 5.4) and R programming language (version 4.16-2). Results A total of 14,415 patients from various countries were included. Among the 20 cohorts, the median age was 55.8 ±8.39 years (range: 43-72 years), and 43.78% of the subjects were female. Out of a total of 14,415 patients, 3,820 developed AKI with a pooled prevalence of 11% (95% CI: 0.07-0.15; p<0.01; I2=98%). AKI was found to have a significant association with severe COVID-19 disease, with a pooled OR of 8.45 (95% CI: 5.56-12.56; p<0.00001; I2=0%). AKI was associated with significantly higher mortality in patients with COVID-19 with an OR of 13.52 (95% CI: 5.43-33.67; p<0.00001; I2=88%). Conclusion AKI manifests as a common COVID-19 complication, and COVID-19 patients with AKI generally have poor outcomes in terms of disease severity and mortality.
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Affiliation(s)
| | - Rohit Sharma
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Saurabh Kataria
- Neurology and Neurocritical Care, University of Missouri Health Care, Columbia, USA.,Neurology, West Virginia University, Morgantown, USA
| | - Sundus Sardar
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Ramesh Adhikari
- Hospital Medicine, Franciscan Health, Lafayette, USA.,Geriatrics, Brown University, Providence, USA
| | | | - Hira Khan
- Internal Medicine, Islamic International Medical College, Rawalpindi, PAK
| | | | | | - Zahoor Ahmed
- Internal Medicine, King Edward Medical University, Mayo Hospital, Lahore, PAK
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19
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Perez M, Masse M, Deldicque A, Beuscart JB, De Groote P, Desbordes J, Fry S, Musy E, Odou P, Puisieux F, Lambert M, Scherpereel A, Décaudin B. Analysis of clinical pharmacist interventions in the COVID-19 units of a French university hospital. Eur J Hosp Pharm 2021; 29:e30-e35. [PMID: 33707185 PMCID: PMC7956730 DOI: 10.1136/ejhpharm-2020-002542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/11/2021] [Accepted: 02/23/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The objectives were to compare clinical pharmacist interventions between two care groups: COVID-19-positive and COVID-19-negative patients, and to identify drugs that require particular attention, especially those involved in COVID-19 management. METHODS A prospective cohort study was conducted on patients with positive and negative COVID-19 statuses admitted to Lille University Hospital over 1 month. Pharmaceutical analysis instigated interventions to rectify drug-related errors. For each pharmaceutical intervention (PI), the anatomical therapeutic chemical classification of the drug and the outcome of such an intervention were specified. RESULTS The study included 438 patients. Prescription analysis led to 188 PIs performed on 118 patients (64 COVID-19-positive patients and 54 COVID-19-negative patients). Most drug-related problems were incorrect dosage representing 36.7% (69/188) of all interventions: 27.9% (29/104) for the COVID-19-positive group and 47.6% (40/84) for the COVID-19-negative group. The most frequent PI in 34% (64/188) of cases was terminating a drug: 27.9% (29/104) for the COVID-19-positive group and 47.6% (40/84) for the COVID-19-negative group. The main drug classes involved were antithrombotic agents (20.7%, 39/188), antibacterials for systemic use (13.8%, 26/188) and drugs for gastric acid-related disorders (6.4%, 12/188). Study population was limited to a single centre over 1 month. CONCLUSION No difference in PI was noted between the two groups. The presence of pharmacists led to a reduction in drug-related prescription problems, especially for antithrombotic and antibacterial drugs for both groups. Clinical pharmacy commitment in such a pandemic is therefore important.
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Affiliation(s)
| | - Morgane Masse
- Univ. Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | | | - Jean Baptiste Beuscart
- ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, Lille, France
| | - Pascal De Groote
- Service de Cardiologie, Hôpital Cardiologique, Institut Pasteur de Lille, University of Lille, Lille, France
| | - Jacques Desbordes
- Department of Anaesthesiology, CHU Lille, University of Lille, Lille, France
| | - Stéphanie Fry
- Center for Infection and Immunity of Lille, Service de Pneumologie et Immuno-Allergologie, Centre de compétence pour les Maladies Pulmonaires Rares, University of Lille, Lille, France
| | - Elodie Musy
- CHU Lille, Institut de Pharmacie, Lille, France
| | - Pascal Odou
- Univ. Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Francois Puisieux
- ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, Lille, France
| | - Marc Lambert
- Univ. Lille, INSERM U995, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, F-59000 Lille, France, Lille, France
| | - Arnaud Scherpereel
- Pulmonary and Thoracic Oncology, CHU Lille, Hôpital Calmette, French National Network of Clinical Expert Centres for Malignant Pleural Mesothelioma Management, University of Lille, Lille, France
| | - Bertrand Décaudin
- Univ. Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
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20
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Zamani N, Aloosh O, Ahsant S, Khodabandeloo N, Ahimahalle TZ, Abkhoo A, Riahi T. Renal failure and lung hemorrhage as a presentation of COVID-19 infection, a case report. Clin Case Rep 2021; 9:1123-1129. [PMID: 33768795 PMCID: PMC7981756 DOI: 10.1002/ccr3.3685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022] Open
Abstract
The concurrent involvement of the lung and kidneys happens in COVID-19 infection. The patient's respiratory symptoms resolved after hemodialysis. This finding raises the question that if hemodialysis can have a role in the treatment of COVID-19.
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Affiliation(s)
- Nazanin Zamani
- Department of Internal MedicineSchool of MedicineHazrat‐ e Rasool General HospitalIran University of Medical Sciences(IUMS)TehranIran
| | - Oldooz Aloosh
- Department of RadiologySchool of MedicineImam Khomeini General HospitalTehran University of Medical Sciences(TUMS)TehranIran
| | - Samane Ahsant
- Department of Internal MedicineSchool of MedicineHazrat‐ e Rasool General HospitalIran University of Medical Sciences(IUMS)TehranIran
| | - Niloofar Khodabandeloo
- Department of Internal MedicineSchool of MedicineHazrat‐ e Rasool General HospitalIran University of Medical Sciences(IUMS)TehranIran
| | - Tahere Zarook Ahimahalle
- Department of Internal MedicineSchool of MedicineHazrat‐ e Rasool General HospitalIran University of Medical Sciences(IUMS)TehranIran
| | - Aminreza Abkhoo
- Department of RadiologySchool of MedicineImam Khomeini General HospitalTehran University of Medical Sciences(TUMS)TehranIran
| | - Taghi Riahi
- Department of Internal MedicineSchool of MedicineHazrat‐ e Rasool General HospitalIran University of Medical Sciences(IUMS)TehranIran
- Antimicrobial Resistance Research CenterIran University of Medical SciencesTehranIran
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21
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Weidmann MD, Ofori K, Rai AJ. Laboratory Biomarkers in the Management of Patients With COVID-19. Am J Clin Pathol 2021; 155:333-342. [PMID: 33107558 PMCID: PMC7665296 DOI: 10.1093/ajcp/aqaa205] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Laboratory testing and the measurement of appropriate biomarkers play a critical role in managing patients with coronavirus disease 2019 (COVID-19), allowing for disease diagnosis, monitoring progression, prognostication, prediction of treatment response, and risk stratification. We sought to characterize these effects on a more detailed, mechanistic level. METHODS We reviewed the literature and identified a multitude of reports that describe the unique effects of this virus and its devastating consequences to multiple organ systems in COVID-19 patients. RESULTS There are specific alterations in biomarkers related to coagulation, depopulation of T-cell subtypes, the cytokine storm and inflammation, and kidney and cardiac dysfunction. CONCLUSIONS Laboratory measurement of specific parameters and the use of appropriate prognostic, predictive, and monitoring biomarkers afford clinicians the ability to make informed medical decisions and guide therapy for patients afflicted with this dreaded disease.
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Affiliation(s)
- Maxwell D Weidmann
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Kenneth Ofori
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Alex J Rai
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
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22
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Tung ML, Tan B, Cherian R, Chandra B. Anti-phospholipid syndrome and COVID-19 thrombosis: connecting the dots. Rheumatol Adv Pract 2021; 5:rkaa081. [PMID: 33615129 PMCID: PMC7882149 DOI: 10.1093/rap/rkaa081] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
As the coronavirus disease 2019 (COVID-19) pandemic, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spreading rapidly worldwide, it has emerged as a leading cause of mortality, resulting in >1 million deaths over the past 10 months. The pathophysiology of COVID-19 remains unclear, posing a great challenge to the medical management of patients. Recent studies have reported an unusually high prevalence of thromboembolic events in COVID-19 patients, although the mechanism remains elusive. Several studies have reported the presence of aPLs in COVID-19 patients. We have noticed similarities between COVID-19 and APS, which is an autoimmune prothrombotic disease that is often associated with an infective aetiology. Molecular mimicry and endothelial dysfunction could plausibly explain the mechanism of thrombogenesis in acquired APS. In this review, we discuss the clinicopathological similarities between COVID-19 and APS, and the potential role of therapeutic targets based on the anti-phospholipid model for COVID-19 disease.
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Affiliation(s)
- Moon Ley Tung
- Department of Hematology and Oncology, National University Cancer Institute
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Bryce Tan
- Department of Medicine, National University Hospital
| | - Robin Cherian
- Yong Loo Lin School of Medicine, National University of Singapore
- Department of Cardiology, National University Heart Centre Singapore
| | - Bharatendu Chandra
- Yong Loo Lin School of Medicine, National University of Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
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23
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Ng JH, Hirsch JS, Hazzan A, Wanchoo R, Shah HH, Malieckal DA, Ross DW, Sharma P, Sakhiya V, Fishbane S, Jhaveri KD. Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury. Am J Kidney Dis 2021; 77:204-215.e1. [PMID: 32961245 PMCID: PMC7833189 DOI: 10.1053/j.ajkd.2020.09.002] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/16/2020] [Indexed: 12/29/2022]
Abstract
RATIONALE & OBJECTIVE Outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI) are not well understood. The goal of this study was to investigate the survival and kidney outcomes of these patients. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Patients (aged≥18 years) hospitalized with COVID-19 at 13 hospitals in metropolitan New York between March 1, 2020, and April 27, 2020, followed up until hospital discharge. EXPOSURE AKI. OUTCOMES Primary outcome: in-hospital death. SECONDARY OUTCOMES requiring dialysis at discharge, recovery of kidney function. ANALYTICAL APPROACH Univariable and multivariable time-to-event analysis and logistic regression. RESULTS Among 9,657 patients admitted with COVID-19, the AKI incidence rate was 38.4/1,000 patient-days. Incidence rates of in-hospital death among patients without AKI, with AKI not requiring dialysis (AKI stages 1-3), and with AKI receiving dialysis (AKI 3D) were 10.8, 31.1, and 37.5/1,000 patient-days, respectively. Taking those without AKI as the reference group, we observed greater risks for in-hospital death for patients with AKI 1-3 and AKI 3D (HRs of 5.6 [95% CI, 5.0-6.3] and 11.3 [95% CI, 9.6-13.1], respectively). After adjusting for demographics, comorbid conditions, and illness severity, the risk for death remained higher among those with AKI 1-3 (adjusted HR, 3.4 [95% CI, 3.0-3.9]) and AKI 3D (adjusted HR, 6.4 [95% CI, 5.5-7.6]) compared with those without AKI. Among patients with AKI 1-3 who survived, 74.1% achieved kidney recovery by the time of discharge. Among those with AKI 3D who survived, 30.6% remained on dialysis at discharge, and prehospitalization chronic kidney disease was the only independent risk factor associated with needing dialysis at discharge (adjusted OR, 9.3 [95% CI, 2.3-37.8]). LIMITATIONS Observational retrospective study, limited to the NY metropolitan area during the peak of the COVID-19 pandemic. CONCLUSIONS AKI in hospitalized patients with COVID-19 was associated with significant risk for death.
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Affiliation(s)
- Jia H Ng
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Jamie S Hirsch
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY; Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY; Department of Information Services, Northwell Health, New Hyde Park, NY
| | - Azzour Hazzan
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Rimda Wanchoo
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Hitesh H Shah
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Deepa A Malieckal
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Daniel W Ross
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Purva Sharma
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Vipulbhai Sakhiya
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Steven Fishbane
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY.
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Añazco PH, Balta FM, Córdova-Cueva L. Bilateral renal infarction in a patient with severe COVID-19 infection. ACTA ACUST UNITED AC 2021; 43:127-131. [PMID: 33460428 PMCID: PMC8061971 DOI: 10.1590/2175-8239-jbn-2020-0156] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/28/2020] [Indexed: 02/08/2023]
Abstract
Thromboembolic events are frequent in patients with COVID-19 infection, and no cases of bilateral renal infarctions have been reported. We present the case of a 41-year-old female patient with diabetes mellitus and obesity who attended the emergency department for low back pain, respiratory failure associated with COVID-19 pneumonia, diabetic ketoacidosis, and shock. The patient had acute kidney injury and required hemodialysis. Contrast abdominal tomography showed bilateral renal infarction and anticoagulation was started. Kidney infarction cases require high diagnostic suspicion and possibility of starting anticoagulation.
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Affiliation(s)
- Percy Herrera Añazco
- Hospital Nacional 2 de mayo, Departament of Nephrology, Lima, Perú.,Universidad Señor de Sipán, Chiclayo, Peru
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Nasiri N, Rahmati S, Etminan A, Sharifi H, Bazrafshan A, Karamouzian M, Sharifi A. Kidney Complications of COVID-19: A Systematic Review and Meta-Analysis. J Res Health Sci 2021; 21:e00503. [PMID: 34024761 PMCID: PMC8957695 DOI: 10.34172/jrhs.2021.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/13/2020] [Accepted: 12/20/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Some patients with coronavirus disease 2019 (COVID-19) have been reported to have developed mild to severe kidney injuries. The current systematic review and meta-analysis was carried out to estimate the prevalence and incidence of acute kidney injury (AKI) among COVID-19 patients.
Study design: A systematic review and meta-analysis
Methods: PubMed, Embase, Scopus, Web of Science, and MedRxiv databases were searched from December 1, 2019, up to July 27, 2020. Two independent co-authors completed the screening process, data extraction, and quality assessment of the retrieved records. Random-effects meta-analyses were used to determine the pooled prevalence and 95% confidence interval (CI) of AKI among COVID-19 patients.
Results: Out of 2,332 unique identified records, 51 studies were included in the review. Overall, the studies were carried out on 25,600 patients. A total of 6,505 patients (in 18 cross-sectional studies) were included to estimate the pooled prevalence of AKI, and 18,934 patients (in 27 cohort studies) were included to determine the pooled incidence of AKI. The pooled prevalence of AKI was estimated as 10.08% (95% CI: 4.59, 17.32; I 2=98.56%; P<0.001). Furthermore, the pooled incidence of AKI was 12.78% (95% CI: 7.38, 19.36; I 2=99.27%; P<0.001). The mean (95% CI) values of serum creatinine (SCr), blood urea nitrogen (BUN), potassium, and sodium were 76.10 (69.36, 82.84), 4.60 (4.04, 5.30), 3.94 (3.78, 4.11), and 139.30 (138.26, 140.36) mmol/L, respectively.
Conclusions: The AKI is a considerable complication among COVID-19 patients and should be screened for on clinical examinations. The BUN, SCr, potassium, and sodium levels were within the normal ranges.
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Affiliation(s)
- Naser Nasiri
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Shoboo Rahmati
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Etminan
- Department of Internal Medicine, School of Medicine, Endocrinology and Metabolism Research Center, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Azam Bazrafshan
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ali Sharifi
- Department of Ophthalmology, Shafa Hospital, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
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Khalili S, Sabaghian T, Sedaghat M, Soroureddin Z, Askari E, Khalili N. Prevalence, Risk Factors and Outcomes Associated with Acute Kidney Injury in Patients Hospitalized for COVID-19: A Comparative Study between Diabetic and Nondiabetic Patients. J Diabetes Res 2021; 2021:6666086. [PMID: 33506050 PMCID: PMC7808817 DOI: 10.1155/2021/6666086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/06/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The risk factors for acute kidney injury (AKI) development in patients with diabetes hospitalized for COVID-19 have not been fully studied yet. In this study, we aimed to estimate the rate of AKI among the hospitalized population with COVID-19 and to identify the risk factors associated with AKI among patients with diabetes. Material and Methods. This retrospective cohort study included 254 patients (127 with diabetes and 127 without diabetes) who were admitted for COVID-19 to a tertiary hospital in Tehran, Iran, between February and May 2020. Clinical characteristics and outcomes, radiological findings, and laboratory data, including data on AKI, hematuria, and proteinuria were recorded and analyzed. RESULTS Of 254 patients, 142 (55.9%) were male and the mean (± SD) age was 65.7 years (±12.5). In total, 58 patients (22.8%) developed AKI during hospitalization, of whom 36 patients had diabetes (p = 0.04); most patients (74.1%) had stage 1 or 2 AKI. Also, 8 patients (13.8%) required renal replacement therapy (RRT) after developing AKI. Regardless of diabetes status, patients who developed AKI had significantly higher mortality rates compared with patients who did not develop AKI (p = 0.02). Hematuria and proteinuria were observed in 38.1% and 55% of patients, respectively. Multivariate analysis showed that invasive mechanical ventilation, proteinuria, HBA1c level, history of cardiovascular disease, and use of statins were independent risk factors for AKI development in patients with diabetes. CONCLUSION Results of this study showed that AKI develops in a considerable percentage of patients with COVID-19, especially in those with diabetes, and is significantly associated with mortality.
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Affiliation(s)
- Shayesteh Khalili
- Department of Internal Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Sabaghian
- Department of Nephrology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meghdad Sedaghat
- Department of Internal Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Soroureddin
- Department of Nephrology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Askari
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Khalili
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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27
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Bowe B, Cai M, Xie Y, Gibson AK, Maddukuri G, Al-Aly Z. Acute Kidney Injury in a National Cohort of Hospitalized US Veterans with COVID-19. Clin J Am Soc Nephrol 2020; 16:14-25. [PMID: 33199414 PMCID: PMC7792643 DOI: 10.2215/cjn.09610620] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/15/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Coronavirus disease 2019 (COVID-19) is associated with higher risk of AKI. We aimed to describe rates and characterize predictors and health outcomes associated with AKI in a national cohort of US veterans hospitalized with COVID-19. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In a cohort of 5216 US veterans hospitalized with COVID-19 identified through July 23, 2020, we described changes in serum creatinine and examined predictors of AKI and the associations between AKI, health resource utilization, and death, utilizing logistic regressions. We characterized geographic and temporal variations in AKI rates and estimated variance explained by key variables utilizing Poisson regressions. RESULTS In total, 1655 (32%) participants had AKI; 961 (58%), 223 (13%), and 270 (16%) met Kidney Disease Improving Global Outcomes definitions of stage 1, 2, and 3 AKI, respectively, and 201 (12%) received KRT. Eight percent of participants had AKI within 1 day of hospitalization, and 47% did not recover to baseline serum creatinine by discharge. Older age, Black race, male gender, obesity, diabetes, hypertension, and lower eGFR were significant predictors of AKI during hospitalization with COVID-19. AKI was associated with higher mechanical ventilation use (odds ratio, 6.46; 95% confidence interval, 5.52 to 7.57) and longer hospital stay (5.56 additional days; 95% confidence interval, 4.78 to 6.34). AKI was also associated with higher risk of death (odds ratio, 6.71; 95% confidence interval, 5.62 to 8.04); this association was stronger in Blacks (P value of interaction <0.001). Hospital-level rates of AKI exhibited substantial geographic variability, ranging from 10% to 56%. Between March and July 2020, AKI rates declined from 40% to 27%; proportions of AKI stage 3 and AKI requiring KRT decreased from 44% to 17%. Both geographic and temporal variabilities were predominately explained by percentages of Blacks (31% and 49%, respectively). CONCLUSIONS AKI is common during hospitalization with COVID-19 and associated with higher risk of health care resource utilization and death. Nearly half of patients with AKI did not recover to baseline by discharge. Substantial geographic variation and temporal decline in rates and severity of AKI were observed. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_11_16_CJN09610620_final.mp3.
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Affiliation(s)
- Benjamin Bowe
- Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St. Louis Health Care System, St. Louis, Missouri
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri
- Veterans Research and Education Foundation of St. Louis, St. Louis, Missouri
| | - Miao Cai
- Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St. Louis Health Care System, St. Louis, Missouri
- Veterans Research and Education Foundation of St. Louis, St. Louis, Missouri
| | - Yan Xie
- Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St. Louis Health Care System, St. Louis, Missouri
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri
- Veterans Research and Education Foundation of St. Louis, St. Louis, Missouri
| | - Andrew K. Gibson
- Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St. Louis Health Care System, St. Louis, Missouri
- Veterans Research and Education Foundation of St. Louis, St. Louis, Missouri
| | - Geetha Maddukuri
- Nephrology Section, Medicine Service, Veterans Affairs St. Louis Health Care System, St. Louis, Missouri
| | - Ziyad Al-Aly
- Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St. Louis Health Care System, St. Louis, Missouri
- Veterans Research and Education Foundation of St. Louis, St. Louis, Missouri
- Nephrology Section, Medicine Service, Veterans Affairs St. Louis Health Care System, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri
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28
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Wang B, Luo Q, Zhang W, Yu S, Cheng X, Wang L, Chen X, Chen Y. The Involvement of Chronic Kidney Disease and Acute Kidney Injury in Disease Severity and Mortality in Patients with COVID-19: A Meta-Analysis. Kidney Blood Press Res 2020; 46:17-30. [PMID: 33352576 PMCID: PMC7900473 DOI: 10.1159/000512211] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/11/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A meta-analysis was performed to evaluate the association of chronic kidney disease (CKD) and acute kidney injury (AKI) with the clinical prognosis of patients with coronavirus disease 2019 (COVID-19). METHODS The PubMed, EMBASE, Cochrane Library, medRxiv, Social Science Research Network, and Research Square databases (from December 1, 2019 to May 15, 2020) were searched to identify studies that reported the associations of CKD/AKI and disease severity/mortality. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and meta-regression was performed. RESULTS In total, 42 studies enrolling 8,932 participants were included in this meta-analysis. The quality of most included studies was moderate to high. Compared with patients without previously diagnosed CKD, those with CKD had a significantly increased risk of progressing to a severe condition (OR 2.31, 95% CI 1.64-3.24) or death (OR 5.11, 95% CI 3.36-7.77). Similarly, compared with patients without AKI, those with AKI had a significantly increased risk of progressing to a severe condition (OR 11.88, 95% CI 9.29-15.19) or death (OR 30.46, 95% CI 18.33-50.59). Compared with patients with previously diagnosed CKD, those with AKI were more likely to progress to a severe condition (pgroup < 0.001, I2 = 98.3%) and even to death (pgroup < 0.001, I2 = 96.5%). Age had a significant impact on the association between CKD and disease severity (p = 0.001) but had no impact on the associations between AKI and disease severity (p = 0.80), between CKD and mortality (p = 0.51), or between AKI and mortality (p = 0.86). Four important complications (cardiac injury, shock, acute respiratory distress syndrome, and liver injury) did not significantly affect the associations between CKD/AKI and disease severity/mortality, indicating that CKD/AKI may be independent clinical prognostic indicators for patients with COVID-19. CONCLUSIONS In COVID-19 patients, CKD/AKI was associated with worse outcomes compared with those without CKD/AKI. AKI was associated with higher risks of severity and mortality than CKD.
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Affiliation(s)
- Bin Wang
- Department of Nephrology, Hainan Hospital of Chinese PLA General Hospital, Hainan Academician Team Innovation Center, Sanya, China
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Qing Luo
- Department of Nephrology, Hainan Hospital of Chinese PLA General Hospital, Hainan Academician Team Innovation Center, Sanya, China
| | - Weiguang Zhang
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Shuai Yu
- Department of Tropical Medicine and Infectious Diseases, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Xiaowei Cheng
- Department of Nephrology, Hainan Hospital of Chinese PLA General Hospital, Hainan Academician Team Innovation Center, Sanya, China
| | - Lanlan Wang
- Department of Nephrology, Hainan Hospital of Chinese PLA General Hospital, Hainan Academician Team Innovation Center, Sanya, China
| | - Xiangmei Chen
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Yizhi Chen
- Department of Nephrology, Hainan Hospital of Chinese PLA General Hospital, Hainan Academician Team Innovation Center, Sanya, China
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
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Gómez-Belda AB, Fernández-Garcés M, Mateo-Sanchis E, Madrazo M, Carmona M, Piles-Roger L, Artero A. COVID-19 in older adults: What are the differences with younger patients? Geriatr Gerontol Int 2020; 21:60-65. [PMID: 33264816 PMCID: PMC7753273 DOI: 10.1111/ggi.14102] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 01/08/2023]
Abstract
AIM The present study aimed both to gain knowledge on the distinctive clinical characteristics of older adults with coronavirus disease 2019 (COVID-19), in comparison with those of younger patients, and to identify risk factors for mortality. METHODS A retrospective observational study was carried out of patients consecutively admitted to Doctor Peset University Hospital, Valencia (Spain) for COVID-19 from 11 March to 28 April 2020. Every case was diagnosed by reverse transcription polymerase chain reaction or by serology test to detect antibodies. Demographic details, clinical characteristics, laboratory findings on admission and complications of each case were collected from electronic medical records. RESULTS The dataset comprised 340 patients. Of them, 152 (44.6%) were aged >70 years. Comorbidities were more common in the older groups. Confusion was more common in older adults, whereas typical symptoms of COVID-19, such as fever, cough and myalgia, were less common. Oxygen saturation ≤93% on room air, neutrophilia, D-dimer >0.5 μg/mL, creatinine >1.5 mg/dL, lactate dehydrogenase ≥250 U/L and elevation of creatine kinase were higher in the older adult groups. Complications during hospitalization, such as acute respiratory distress syndrome (53.3% vs 33.2%, P < 0.001), acute kidney injury (11.8% vs 5.3%; P = 0.030) and mortality (28.9% vs 6.5%; P < 0.001) were more common in patients aged >70 years. Oxygen saturation ≤93% on room air on admission was a predictor of mortality (odds ratio 11.65, 95% confidence interval 3.26-41.66, P < 0.001) in patients aged >70 years. CONCLUSIONS Older adults with COVID-19 have more atypical presentation, more complications and higher mortality. Oxygen saturation ≤93% on room air on admission is a predictive factor of death. Geriatr Gerontol Int 2021; 21: 60-65.
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Affiliation(s)
- Ana B Gómez-Belda
- Department of Internal Medicine, Dr. Peset University Hospital, Valencia, Spain
| | | | | | - Manuel Madrazo
- Department of Internal Medicine, Dr. Peset University Hospital, Valencia, Spain
| | - Mar Carmona
- Department of Internal Medicine, Dr. Peset University Hospital, Valencia, Spain
| | - Laura Piles-Roger
- Department of Internal Medicine, Dr. Peset University Hospital, Valencia, Spain
| | - Arturo Artero
- Department of Internal Medicine, Dr. Peset University Hospital, Valencia, Spain.,University of Valencia, Valencia, Spain
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Zhou S, Xu J, Xue C, Yang B, Mao Z, Ong ACM. Coronavirus-associated kidney outcomes in COVID-19, SARS, and MERS: a meta-analysis and systematic review. Ren Fail 2020; 43:1-15. [PMID: 33256491 PMCID: PMC7717867 DOI: 10.1080/0886022x.2020.1847724] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES A meta-analysis and systematic review was conducted on kidney-related outcomes of three recent pandemics: SARS, MERS, and COVID-19, which were associated with potentially fatal acute respiratory distress syndrome (ARDS). METHODS A search of all published studies until 16 June 2020 was performed. The incidence/prevalence and mortality risk of acute and chronic renal events were evaluated, virus prevalence, and mortality in preexisting hemodialysis patients was investigated. RESULTS A total of 58 eligible studies involving 13452 hospitalized patients with three types of coronavirus infection were included. The reported incidence of new-onset acute kidney injury (AKI) was 12.5% (95% CI: 7.6%-18.3%). AKI significantly increased the mortality risk (OR = 5.75, 95% CI 3.75-8.77, p < 0.00001) in patients with coronavirus infection. The overall rate of urgent-start kidney replacement therapy (urgent-start KRT) use was 8.9% (95% CI: 5.0%-13.8%) and those who received urgent-start KRT had a higher risk of mortality (OR = 3.43, 95% CI 2.02-5.85, p < 0.00001). Patients with known chronic kidney disease (CKD) had a higher mortality than those without CKD (OR = 1.97, 95% CI 1.56-2.49, p < 0.00001). The incidence of coronavirus infection was 7.7% (95% CI: 4.9%-11.1%) in prevalent hemodialysis patients with an overall mortality rate of 26.2% (95% CI: 20.6%-32.6%). CONCLUSIONS Primary kidney involvement is common with coronavirus infection and is associated with significantly increased mortality. The recognition of AKI, CKD, and urgent-start KRT as major risk factors for mortality in coronavirus-infected patients are important steps in reducing future mortality and long-term morbidity in hospitalized patients with coronavirus infection.
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Affiliation(s)
- Shoulian Zhou
- Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China
| | - Jing Xu
- Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China
| | - Cheng Xue
- Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China
| | - Bo Yang
- Internal Medicine III (Nephrology & Endocrinology), Naval Medical Center of PLA, Second Military Medical University, Shanghai, People’s Republic of China
| | - Zhiguo Mao
- Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China
| | - Albert C. M. Ong
- Academic Nephrology Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Trust, Sheffield Kidney Institute, Sheffield, UK
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31
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COVID-19 and Microvascular Disease: Pathophysiology of SARS-CoV-2 Infection With Focus on the Renin-Angiotensin System. Heart Lung Circ 2020; 29:1596-1602. [PMID: 32972810 PMCID: PMC7467122 DOI: 10.1016/j.hlc.2020.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/26/2020] [Accepted: 08/14/2020] [Indexed: 02/08/2023]
Abstract
The recently described severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people, with thousands of fatalities. It has prompted global efforts in research, with focus on the pathophysiology of coronavirus disease-19 (COVID-19), and a rapid surge of publications. COVID-19 has been associated with a myriad of clinical manifestations, including the lungs, heart, kidneys, central nervous system, gastrointestinal system, skin, and blood coagulation abnormalities. The endothelium plays a key role in organ dysfunction associated with severe infection, and current data suggest that it is also involved in SARS-CoV-2-induced sepsis. This critical review aimed to address a possible unifying mechanism underlying the diverse complications of COVID-19: microvascular dysfunction, with emphasis on the renin-angiotensin system. In addition, research perspectives are suggested in order to expand understanding of the pathophysiology of the infection.
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Shao M, Li X, Liu F, Tian T, Luo J, Yang Y. Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: A systematic review and meta-analysis of 40 studies and 24,527 patients. Pharmacol Res 2020; 161:105107. [PMID: 32739424 PMCID: PMC7393179 DOI: 10.1016/j.phrs.2020.105107] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023]
Abstract
Currently, coronavirus disease 2019 (COVID-19) is spreading rapidly around the world. This study aimed to investigate whether the presence of acute kidney injury (AKI) might increase the risk of severe infection and fatality in COVID-19 patients. We searched the PubMed, Web of Science, ScienceDirect, MedRxiv and COVID-19 academic research communication platforms for studies reporting severe infection rates and case-fatality rates in COVID-19 patients with and without AKI up to June 20, 2020. The main outcomes were the comparisons of the severe infection rates and fatality rates in COVID-19 patients with and without AKI and the estimation of the odds ratio (OR) and its 95 % confidence interval (CI) for severe infection and mortality. Statistical analyses were performed with R statistical software. A total of 40 studies involving 24,527 patients with COVID-19 were included in our meta-analysis. The incidence of AKI was 10 % (95 % CI 8%-13 %) in COVID-19 patients. The patients had higher severe infection and fatality rates (55.6 % vs. 17.7 % and 63.1 % vs. 12.9 %, respectively, all P < 0.01) with COVID-19. AKI was a predictor of fatality (OR = 14.63, 95 % CI: 9.94-21.51, P < 0.00001) and severe infection (OR = 8.11, 95 % CI: 5.01-13.13, P < 0.00001) in patients with COVID-19. Higher levels of serum creatinine (Scr) and blood urea nitrogen (BUN) were associated with a significant increase in fatality [Scr: mean difference (MD): 20.19 μmol/L, 95 % CI: 14.96-25.42, P < 0.001; BUN: MD: 4.07 mmol/L, 95 % CI: 3.33-4.81, P < 0.001] and severe infection (Scr: MD: 7.78 μmol/L, 95 % CI: 4.43-11.14, P < 0.00001, BUN: MD: 2.12 mmol/L, 95 % CI: 1.74-2.50, P < 0.00001) in COVID-19 patients. In conclusion, AKI is associated with severe infection and higher fatality rates in patients with COVID-19. Clinicians should pay more attention to the monitoring and treatment of COVID-19 patients with AKI.
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Affiliation(s)
- Mengjiao Shao
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - XiaoMei Li
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ting Tian
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Junyi Luo
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Yining Yang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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Belani S, Pravoverov L, Goes NB, Zheng S, Asovskaya AV, Kroupa P, Poyan Mehr A. Moving beyond COVID-19 Surge-Caring for Patients with Kidney Disease throughout the Pandemic. KIDNEY360 2020; 1:1124-1127. [PMID: 35368790 PMCID: PMC8815484 DOI: 10.34067/kid.0005452020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Sharina Belani
- Department of Nephrology, Kaiser Permanente San Rafael Medical Center, San Rafael, California
| | - Leonid Pravoverov
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Nelson B. Goes
- Department of Nephrology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Sijie Zheng
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Anna V. Asovskaya
- Department of Nephrology, Kaiser Permanente Northern California Regional Offices, Oakland, California
| | - Paul Kroupa
- Department of Nephrology, Kaiser Permanente Northern California Regional Offices, Oakland, California
| | - Ali Poyan Mehr
- Department of Nephrology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
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Arantes MF, Rodrigues CE, Seabra VF, Lins PR, Reichert BV, Sales GT, Smolentzov I, Cabrera CP, Andrade L. Renal involvement in patients with COVID-19. Clinics (Sao Paulo) 2020; 75:e2194. [PMID: 33146361 PMCID: PMC7561068 DOI: 10.6061/clinics/2020/e2194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Márcia F. Arantes
- Divisao de Nefrologia, Hospital das Cl?nicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Camila E. Rodrigues
- Divisao de Nefrologia, Hospital das Cl?nicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Victor F. Seabra
- Divisao de Nefrologia, Hospital das Cl?nicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Paulo R.G. Lins
- Divisao de Nefrologia, Hospital das Cl?nicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Bernardo V. Reichert
- Divisao de Nefrologia, Hospital das Cl?nicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Gabriel T.M. Sales
- Divisao de Nefrologia, Hospital das Cl?nicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Igor Smolentzov
- Divisao de Nefrologia, Hospital das Cl?nicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Carla P.S. Cabrera
- Divisao de Nefrologia, Hospital das Cl?nicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Lúcia Andrade
- Divisao de Nefrologia, Hospital das Cl?nicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
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Oliveira CB, Lima CAD, Vajgel G, Campos Coelho AV, Sandrin-Garcia P. High burden of acute kidney injury in COVID-19 pandemic: systematic review and meta-analysis. J Clin Pathol 2020; 74:796-803. [PMID: 33023941 DOI: 10.1136/jclinpath-2020-207023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/07/2020] [Accepted: 09/20/2020] [Indexed: 01/08/2023]
Abstract
AIMS Hospitalised patients with COVID-19 have a variable incidence of acute kidney injury (AKI) according to studies from different nationalities. The present systematic review and meta-analysis describes the incidence of AKI, need for renal replacement therapy (RRT) and mortality among patients with COVID-19-associated AKI. METHODS We systematically searched electronic database PubMed, SCOPUS and Web of Science to identify English articles published until 25 May 2020. In case of significant heterogeneity, the meta-analyses were conducted assuming a random-effects model. RESULTS From 746 screened publications, we selected 21 observational studies with 15 536 patients with COVID-19 for random-effects model meta-analyses. The overall incidence of AKI was 12.3% (95% CI 7.3% to 20.0%) and 77% of patients with AKI were critically ill (95% CI 58.9% to 89.0%). The mortality among patients with AKI was 67% (95% CI 39.8% to 86.2%) and the risk of death was 13 times higher compared with patients without AKI (OR=13.3; 95% CI 6.1 to 29.2). Patients with COVID-19-associated AKI needed for RRT in 23.4% of cases (95% CI 12.6% to 39.4%) and those cases had high mortality (89%-100%). CONCLUSION The present study evidenced an incidence of COVID-19-associated AKI higher than previous meta-analysis. The majority of patients affected by AKI were critically ill and mortality rate among AKI cases was high. Thus, it is extremely important for health systems to be aware about the impact of AKI on patients' outcomes in order to establish proper screening, prevention of additional damage to the kidneys and adequate renal support when needed.
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Affiliation(s)
- Camila Barbosa Oliveira
- Keizo Azami Immunopathology Laboratory, Universidade Federal de Pernambuco, Recife, Brazil .,Department of Nephrology, Universidade Federal de Pernambuco, Recife, Brazil
| | - Camilla Albertina Dantas Lima
- Keizo Azami Immunopathology Laboratory, Universidade Federal de Pernambuco, Recife, Brazil.,Department of Oceanography, Universidade Federal de Pernambuco, Recife, Brazil
| | - Gisele Vajgel
- Keizo Azami Immunopathology Laboratory, Universidade Federal de Pernambuco, Recife, Brazil.,Department of Nephrology, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Paula Sandrin-Garcia
- Keizo Azami Immunopathology Laboratory, Universidade Federal de Pernambuco, Recife, Brazil.,Department of Genetics, Universidade Federal de Pernambuco, Recife, Brazil
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Yonter SJ, Alter K, Bartels MN, Bean JF, Brodsky MB, González-Fernández M, Henderson DK, Hoenig H, Russell H, Needham DM, Kumble S, Chan L. What Now for Rehabilitation Specialists? Coronavirus Disease 2019 Questions and Answers. Arch Phys Med Rehabil 2020; 101:2233-2242. [PMID: 32966809 PMCID: PMC7502167 DOI: 10.1016/j.apmr.2020.09.368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022]
Abstract
Recognizing a need for more guidance on the coronavirus disease 2019 (COVID-19) pandemic, members of the Archives of Physical Medicine and Rehabilitation Editorial Board invited several clinicians with early experience managing the disease to collaborate on a document to help guide rehabilitation clinicians in the community. This consensus document is written in a “question and answer” format and contains information on the following items: common manifestations of the disease; rehabilitation recommendations in the acute hospital setting, recommendations for inpatient rehabilitation and special considerations. These suggestions are intended for use by rehabilitation clinicians in the inpatient setting caring for patients with confirmed or suspected COVID-19. The text represents the authors’ best judgment at the time it was written. However, our knowledge of COVID-19 is growing rapidly. The reader should take advantage of the most up-to-date information when making clinical decisions.
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Affiliation(s)
- Simge J Yonter
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland.
| | - Katherine Alter
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Matthew N Bartels
- Department of Rehabilitation Medicine, Montefiore Medical Center, Bronx, New York; Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Jonathan F Bean
- Department of Physical Medicine & Rehabilitation Harvard Medical School, Boston, Massachusetts; New England Geriatric Research Education and Clinical Center, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Martin B Brodsky
- Pulmonary & Critical Care Medicine and Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland
| | - Marlís González-Fernández
- Pulmonary & Critical Care Medicine and Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland; Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - David K Henderson
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; Senior Advisory to the Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Helen Hoenig
- Rehabilitation & Extended Care Lead, Durham VA Health Care System, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina
| | - Holly Russell
- Pulmonary & Critical Care Medicine and Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dale M Needham
- Pulmonary & Critical Care Medicine and Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland; Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Sowmya Kumble
- Pulmonary & Critical Care Medicine and Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leighton Chan
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
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Scheen AJ, Marre M, Thivolet C. Prognostic factors in patients with diabetes hospitalized for COVID-19: Findings from the CORONADO study and other recent reports. DIABETES & METABOLISM 2020; 46:265-271. [PMID: 32447101 PMCID: PMC7241378 DOI: 10.1016/j.diabet.2020.05.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023]
Abstract
Diabetes mellitus is challenging in the context of the COVID-19 pandemic. The prevalence of diabetes patients hospitalized in intensive care units for COVID-19 is two- to threefold higher, and the mortality rate at least double, than that of non-diabetes patients. As the population with diabetes is highly heterogeneous, it is of major interest to determine the risk factors of progression to a more serious life-threatening COVID-19 infection. This brief review discusses the main findings of CORONADO, a prospective observational study in France that specifically addressed this issue as well as related observations from other countries, mainly China and the US. Some prognostic factors beyond old age have been identified: for example, an increased body mass index is a major risk factor for requiring respiratory assistance. Indeed, obesity combines several risk factors, including impaired respiratory mechanics, the presence of other comorbidities and inappropriate inflammatory responses, partly due to ectopic fat deposits. While previous diabetic microvascular (renal) and macrovascular complications also increase risk of death, the quality of past glucose control had no independent influence on hospitalized diabetes patient outcomes, but whether the quality of glucose control might modulate risk of COVID-19 in non-hospitalized diabetes patients is still unknown. In addition, no negative signs regarding the use of RAAS blockers and DPP-4 inhibitors and outcomes of COVID-19 could be identified. Hyperglycaemia at the time of hospital admission is associated with poor outcomes, but it may simply be considered a marker of severity of the infection. Thus, the impact of glucose control during hospitalization on outcomes related to COVID-19, which was not investigated in the CORONADO study, is certainly deserving of specific investigation.
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Affiliation(s)
- A J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, University of Liège, Liège, Belgium.
| | - M Marre
- UMR_S 1138, Metabolic Inflammation in Diabetes and its Complications, Cordeliers Research Centre, 75006 PARIS, France; President of the FFRD and the Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France
| | - C Thivolet
- President of the SFD and DIAB-eCARE, Centre for Diabetes, Hospices Civils de Lyon, University of Lyon, Lyon, France
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Fara A, Mitrev Z, Rosalia RA, Assas BM. Cytokine storm and COVID-19: a chronicle of pro-inflammatory cytokines. Open Biol 2020; 10:200160. [PMID: 32961074 PMCID: PMC7536084 DOI: 10.1098/rsob.200160] [Citation(s) in RCA: 199] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has swept the world, unlike any other pandemic in the last 50 years. Our understanding of the disease has evolved rapidly since the outbreak; disease prognosis is influenced mainly by multi-organ involvement. Acute respiratory distress syndrome, heart failure, renal failure, liver damage, shock and multi-organ failure are strongly associated with morbidity and mortality. The COVID-19 disease pathology is plausibly linked to the hyperinflammatory response of the body characterized by pathological cytokine levels. The term 'cytokine storm syndrome' is perhaps one of the critical hallmarks of COVID-19 disease severity. In this review, we highlight prominent cytokine families and their potential role in COVID-19, the type I and II interferons, tumour necrosis factor and members of the Interleukin family. We address various changes in cellular components of the immune response corroborating with changes in cytokine levels while discussing cytokine sources and biological functions. Finally, we discuss in brief potential therapies attempting to modulate the cytokine storm.
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Affiliation(s)
| | - Zan Mitrev
- Department of Clinical Research, Zan Mitrev Clinic, St. Bledski Dogovor 8, 1000 Skopje, The Republic of North Macedonia
| | - Rodney Alexander Rosalia
- Department of Clinical Research, Zan Mitrev Clinic, St. Bledski Dogovor 8, 1000 Skopje, The Republic of North Macedonia
| | - Bakri M. Assas
- Faculty of Applied Medical Sciences, Department of Medical Laboratory Technology, Immunology group, King Abdul Aziz University, Jeddah, Saudi Arabia
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Mohamed MA, Kaur J, Wani F, Kichloo A, Bhanot R. Renal Transplant Recipient with Concurrent COVID-19 and Stenotrophomonas maltophilia Pneumonia Treated with Trimethoprim/Sulfamethoxazole Leading to Acute Kidney Injury: A Therapeutic Dilemma. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926464. [PMID: 32799217 PMCID: PMC7447293 DOI: 10.12659/ajcr.926464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/06/2020] [Accepted: 07/07/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although coronavirus disease 2019 (COVID-19) manifests primarily as a lung infection, its involvement in acute kidney injury (AKI) is gaining recognition and is associated with increased morbidity and mortality. Concurrent infection, which may require administration of a potentially nephrotoxic agent, can worsen AKI and lead to poor outcomes. Stenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus associated with nosocomial infections, especially in severely immunocompromised and debilitated patients. Trimethoprim/sulfamethoxazole combination (TMP/SMX) is considered the treatment of choice but can itself lead to AKI, posing a significant challenge in the management of patients with concomitant COVID-19 and S. maltophilia pneumonia. CASE REPORT A 64-year-old male with end-stage renal disease and post renal transplant presented with severe respiratory symptoms of COVID-19 and was intubated upon admission. His renal functions were normal at the time of admission. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia requiring administration of TMP/SMX. However, TMP/SMX led to the development of AKI, which continued to worsen despite appropriate management including hemodialysis. This coincided with and most likely resulted in the patient's clinical deterioration and ultimate death. CONCLUSIONS The etiology of kidney disease involvement in patients with COVID-19 is still evolving and appears to be multifactorial. The condition can significantly worsen especially when nephrotoxic agents are given, probably due to a cumulative or synergistic effect. Great caution should be taken when administering nephrotoxic agents in the setting of COVID-19 as it can lead to adverse patient outcomes.
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Affiliation(s)
- Mohamed A. Mohamed
- Division of Internal Medicine, Central Michigan University, Saginaw, MI, U.S.A
| | - Jasleen Kaur
- Division of Rheumatology, Detroit Medical Center, Wayne State University, Detroit, MI, U.S.A
| | - Farah Wani
- Division of Internal Medicine, Central Michigan University, Saginaw, MI, U.S.A
| | - Asim Kichloo
- Division of Internal Medicine, Central Michigan University, Saginaw, MI, U.S.A
| | - Ravinder Bhanot
- Division of Pulmonary and Critical Care, Ascension St Mary’s Hospital, Saginaw, MI, U.S.A
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Taher A, Alalwan AA, Naser N, Alsegai O, Alaradi A. Acute Kidney Injury in COVID-19 Pneumonia: A Single-Center Experience in Bahrain. Cureus 2020; 12:e9693. [PMID: 32802627 PMCID: PMC7425827 DOI: 10.7759/cureus.9693] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/12/2020] [Indexed: 12/29/2022] Open
Abstract
Background Kidney disease accompanying coronavirus disease 2019 (COVID-19) is not well understood, and information about the presentation of acute kidney injury (AKI), its risk factors, and outcomes is scarce, particularly in Bahrain and the Gulf region. In this study, we aimed to determine the rate of AKI among patients hospitalized with COVID-19 pneumonia at a tertiary hospital in Bahrain and to describe the various aspects of AKI in these patients, including its relationship with respiratory failure and in-hospital mortality. Methods This retrospective observational cohort study of patients admitted with COVID-19 pneumonia from April 1 to May 31, 2020, excluded those aged less than 18 years, those with end-stage renal disease, and those with renal transplants. Clinical and laboratory patient data were collected. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define AKI. Results The mean age across the 73 included patients was approximately 54 years; about 60% were men, and nearly 58% were Bahraini nationals. Of the patients, 39.7% (29) developed AKI during hospitalization, out of which 11.0% reached stage 1, 15.1% reached stage 2, and 13.7% reached stage 3. Of all patients, seven (9.6%) required hemodialysis. Chronic kidney disease conferred an increased risk for AKI (P = 0.003) as did critical COVID-19 status (P < 0.001) and the necessity for mechanical ventilation or intensive care admission (P < 0.001 for both). Additionally, AKI was significantly associated with a lower PaO2/FiO2 (partial pressure of arterial oxygen/percentage of inspired oxygen) ratio (P < 0.001) and a greater number of medications for COVID-19 pneumonia (P = 0.003). Finally, in-hospital death tolls were remarkably higher in patients with AKI (P < 0.001). No association was found between AKI and each of the following therapies: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, tocilizumab, and convalescent plasma. Conclusions The rate of AKI in patients hospitalized with COVID-19 pneumonia at our institution is relatively high and is strongly associated with disease severity, respiratory failure, and in-hospital mortality. Awareness of kidney disease in COVID-19 patients is crucial and of vital importance.
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Affiliation(s)
| | | | - Naser Naser
- Pulmonary Medicine, Salmaniya Medical Complex, Manama, BHR
| | - Ola Alsegai
- Pathology and Laboratory Medicine, Salmaniya Medical Complex, Manama, BHR
| | - Ali Alaradi
- Nephrology, Salmaniya Medical Complex, Manama, BHR
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Managing central venous access during a health care crisis. J Vasc Surg 2020; 72:1184-1195.e3. [PMID: 32682063 PMCID: PMC7362805 DOI: 10.1016/j.jvs.2020.06.112] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/22/2020] [Indexed: 01/30/2023]
Abstract
Objective During the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns, and outcomes of these vascular access teams during the COVID-19 pandemic. Methods We conducted a cross-sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. To participate in the study, hospitals were required to meet one of the following criteria: development of a formal plan for a central venous access line team during the pandemic; implementation of a central venous access line team during the pandemic; placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice; or management of an iatrogenic complication related to central venous access in a patient with COVID-19. Results Participants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis (Santa Clara, Calif) catheters, and nontunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience in placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of the hospitals. Less than 50% (24 [41%]) of the participating sites reported managing thrombosed central lines in COVID-19 patients. Twenty-three of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group). Conclusions Implementation of a dedicated central venous access line team during a pandemic or other health care crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed health care system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained intensive care unit, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future health care crises.
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Bhaskar LVKS, Roshan B, Nasri H. The Fuzzy Connection between SARS-CoV-2 Infection and Loss of Renal Function. Am J Nephrol 2020; 51:572-573. [PMID: 32599598 PMCID: PMC7360496 DOI: 10.1159/000508087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/20/2020] [Indexed: 01/17/2023]
Affiliation(s)
- L V K S Bhaskar
- Department of Zoology, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
| | - Bijan Roshan
- Division of Nephrology, Scripps Clinic, La Jolla, La Jolla, California, USA
| | - Hamid Nasri
- Department of Nephropathology, Nickan Research Institute, Isfahan, Iran,
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