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Shusterman E, Kliuk Ben-Bassat O, Zahler D, Kupershmidt A, Weiss-Meilik A, Kehat O, Ablin JN. Risk factors, clinical characteristics and prognostic value of acute kidney injury in COVID-19 compared with influenza virus and respiratory syncytial virus. J Nephrol 2023; 36:1349-1359. [PMID: 36971979 PMCID: PMC10041485 DOI: 10.1007/s40620-023-01591-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/29/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Acute Kidney Injury (AKI) complicates a substantial part of patients with COVID-19. Direct viral penetration of renal cells through the Angiotensin Converting Enzyme 2 receptor, and indirect damage by the aberrant inflammatory response characteristic of COVID-19 are likely mechanisms. Nevertheless, other common respiratory viruses such as Influenza and Respiratory Syncytial Virus (RSV) are also associated with AKI. METHODS We retrospectively compared the incidence, risk factors and outcomes of AKI among patients who were admitted to a tertiary hospital because of infection with COVID-19, influenza (A + B) or RSV. RESULTS We collected data of 2593 patients hospitalized with COVID-19, 2041 patients with influenza and 429 with RSV. Patients affected by RSV were older, had more comorbidities and presented with higher rates of AKI at admission and within 7 days (11.7% vs. 13.3% vs. 18% for COVID-19, influenza and RSV, respectively p = 0.001). Nevertheless, patients hospitalized with COVID-19 had higher mortality (18% with COVID-19 vs. 8.6% and 13.5% for influenza and RSV, respectively P < 0.001) and higher need of mechanical ventilation (12.4% vs. 6.5% vs.8.2% for COVID-19, influenza and RSV, respectively, P = 0.002). High ferritin levels and low oxygen saturation were independent risk factors for severe AKI only in the COVID-19 group. AKI in the first 48 h of admission and in the first 7 days of hospitalization were strong independent risk factors for adverse outcome in all groups. CONCLUSION Despite many reports of direct kidney injury by SARS-COV-2, AKI was less in patients with COVID-19 compared to influenza and RSV patients. AKI was a prognostic marker for adverse outcome across all viruses.
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Affiliation(s)
- Eden Shusterman
- Internal Medicine H, Sourasky Medical Centre, Tel Aviv, Israel.
| | - Orit Kliuk Ben-Bassat
- Department of Nephrology, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zahler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | | | | | - Jacob N Ablin
- Internal Medicine H, Sourasky Medical Centre, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Setiawan I, Salsabila S, Prasetyawan B, Ilmawan M, Gunawan A, Daryanto B, Fajar J. Diabetes mellitus and hypertension as risk factors of acute kidney injury induced by COVID-19: A systematic review and meta-analysis. PNEUMON 2022. [DOI: 10.18332/pne/154602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Samra T, Ramachandran R, Kumar V, Ray A, Mahajan V, Ganesan R, B NN, Puri GD, Bhalla A, Bhagat H. Biochemical Predictors of Acute Kidney Injury in Critically Ill COVID-19 Patients. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2022; 26:650-659. [PMID: 36454181 DOI: 10.1089/omi.2022.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
It is estimated that 50% of patients with coronavirus disease 2019 (COVID-19) have varying degrees of renal involvement. In this clinical biomarker development research, we examined in a retrospective study design the temporal changes in biochemical laboratory parameters in relation to the development of acute kidney injury (AKI). In a sample of 399 patients admitted from May 2020 to May 2021 to a tertiary health care intensive care unit (ICU), the incidence of AKI was 27.3%, and the median time to AKI was on 7th day of ICU admission. Most common etiology of AKI was kidney hypoperfusion. Within 72 h of developmental of low blood pressure, 63.76% developed AKI. The likelihood of AKI was higher in those with elevated serum ferritin, aspartate transaminase, and thrombocytopenia (low platelet count). A cutoff value of 750.3 ng/mL [area under the ROC curve (AUC) = 0.777] for serum ferritin, and 40.05 U/L for alanine aminotransferase (AUC = 0.677) 1 day before development of AKI displayed, respectively, a sensitivity of 76.2% and 64.3%, whereas the specificity was 69.5% and 64.1%, respectively, for these two biochemical predictors. A cutoff value of platelets (152.50 × 109/L [AUC = 0.75]) measured 4 days before development of AKI, displayed 83.3% sensitivity and 16.4% specificity. Taken together, our study thoroughly examined the temporal association of various clinical and laboratory parameters with AKI and prediction models were developed as per results of the time series data. These observations in a tertiary health care setting contribute to ongoing efforts for biomarker discovery and development using routine biochemical tests so as to forecast AKI in patients with COVID-19.
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Affiliation(s)
- Tanvir Samra
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vinod Kumar
- Department of Dermatology, and Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ananya Ray
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Varun Mahajan
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajarajan Ganesan
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Naik B
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Hemant Bhagat
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Goh BL, Shanmuganathan M, Peariasamy K, Misnan NA, Chidambaram SK, Wong EFS, Pathmanathan MD, Ang KL, Wong HS, Yeap LLL. COVID-19 Death and Kidney Disease in a Multiracial Asian Country. Nephrology (Carlton) 2022; 27:566-576. [PMID: 35438223 PMCID: PMC9115296 DOI: 10.1111/nep.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION COVID-19 infection and kidney disease (KD) carry a considerable risk of mortality. Understanding predictors of death and KD may help improve management and patient outcome. METHODS This is a prospective multi-centre observational study conducted in a multiracial Asian country to identify predictors of death and AKI in hospitalized COVID-19 patients from January to June 2020. RESULTS A total of 6078 patients were included in this study. Mean age was 37.3(±16.8) years, 71% were male, 59.4% Malay, 6.7% Chinese, 2.3% Indian and 31.7% other ethnicities. Acute kidney injury (AKI) was seen in 3.5% of patients while 1.6% had pre-existing chronic kidney disease (CKD). Overall case fatality rate (CFR) was 1.3%. Patients with KD (AKI and CKD) had CFR of 20%. Many factors were associated with increased risk of death and AKI. However, significant predictors of death after adjustment for covariates were age (>70 years), Chinese ethnicity, diabetes mellitus (DM) and KD. Adjusted predictors of AKI were age (>51 years), DM and severity at presentation. Chinese were 2.58 times more likely to die (P=0.036) compared to Malay. Centre capacity to manage, ventilate and dialyze patients significantly influenced death. Among those with AKI, the most common symptoms were fever, cough, and dyspnea. They had lower absolute lymphocyte count, were more likely to be admitted to ICU, required more ventilation and longer hospitalization. CONCLUSION Patient and centre factors influence death and AKI among COVID-19 patients. This study also demonstrates death disparities across different racial groups and centre capacities in this multiracial Asian country.
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Affiliation(s)
- Bak Leong Goh
- Clinical Research Centre, Hospital Serdang, Kajang, Selangor, Malaysia.,Department of Nephrology, Hospital Serdang, Kajang, Selangor, Malaysia
| | | | - Kalaiarasu Peariasamy
- Institute for Clinical Research, National Institute of Health, Setia Alam, Selangor, Malaysia
| | - Nor Arisah Misnan
- Department of Infectious Disease, Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia
| | | | | | - Mohan Dass Pathmanathan
- Institute for Clinical Research, National Institute of Health, Setia Alam, Selangor, Malaysia
| | - Kim Liong Ang
- Clinical Research Centre, Hospital Serdang, Kajang, Selangor, Malaysia
| | - Hin Seng Wong
- Department of Nephrology, Hospital Selayang, Selayang, Selangor, Malaysia
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Rasool G, Riaz M, Abbas M, Fatima H, Qamar MM, Zafar F, Mahmood Z. COVID-19: Clinical laboratory diagnosis and monitoring of novel coronavirus infected patients using molecular, serological and biochemical markers: A review. Int J Immunopathol Pharmacol 2022; 36:3946320221115316. [PMID: 35840546 PMCID: PMC9289644 DOI: 10.1177/03946320221115316] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/06/2022] [Indexed: 01/08/2023] Open
Abstract
COVID-19, a novel coronavirus disease, has provoked a variety of health and safety concerns, and socioeconomic challenges around the globe. The laboratory diagnosis of SARS-CoV-2 was quickly established utilizing nucleic acid amplification techniques (NAAT) after the disease causing virus has been identified, and its genetic sequence has been determined. In addition to NAAT, serological tests based on antibodies testing against SARS-CoV-2 were introduced for diagnostic and epidemiologic studies. Other biochemical investigations include monitoring of peripheral blood cells count, platelets/lymphocyte ratio, coagulation profile, cardiac, and inflammatory markers such as cytokines storm are also crucial in combating COVID-19 pandemic. Further, accurate and reliable laboratory results for SARS-CoV-2 play very important role in the initiation of early treatment and timely management of COVID-19 patients, provide support in clinical decision-making process to control infection, and detection of asymptomatic cases. The Task Force on Coronavirus-19 constituted by International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) has recognized informational framework for epidemiology, pathogenesis, and recommended the PCR-based analysis, serological and biochemical assays for analysis, monitoring, and management of disease. This literature review provides an overview of the currently used diagnostic techniques in clinical laboratories for the diagnosis, treatment monitoring, and management of COVID-19 patients. We concluded that each assays differ in their performance characteristics and the utilization of multiple techniques is necessary for the accurate diagnosis and management of SARS-CoV-2 infection.
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Affiliation(s)
- Ghulam Rasool
- Department of Allied Health Sciences, University of Sargodha, Sargodha, Pakistan
| | - Muhammad Riaz
- Department of Allied Health Sciences, University of Sargodha, Sargodha, Pakistan
| | - Mazhar Abbas
- Department of Biochemistry, University of Veterinary and Animal Sciences, Lahore, (Jhang Campus) Pakistan
| | - Hina Fatima
- Department of Basic and Applied Chemistry, Faculty of Science and Technology, University of Central Punjab, Lahore, Pakistan
- Department of Biochemistry, University of Agriculture Faisalabad, Faisalabad, Pakistan
| | | | - Farzana Zafar
- Department of Biochemistry, University of Agriculture Faisalabad, Faisalabad, Pakistan
| | - Zahed Mahmood
- Department of Biochemistry, Government College University Faisalabad, Faisalabad, Pakistan
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Radulescu D, Tuta LA, David C, Bogeanu C, Onofrei SD, Stepan E, Cuiban E, Ciofalca A, Feier LF, Pana C, Nutu MC, Vacaroiu IA. Acute kidney injury in moderate and severe COVID-19 patients: Report of two university hospitals. Exp Ther Med 2022; 23:37. [PMID: 34849152 PMCID: PMC8613528 DOI: 10.3892/etm.2021.10959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
Acute kidney injury (AKI) is one of the most severe complications of SARS-CoV-2 infection. In a retrospective study, we aimed to describe the influence of COVID-19-related factors on the severity, outcome and timing of AKI in 268 patients admitted in two large COVID-19-designated university hospitals over a period of 6 months. In the univariate analysis, there was a significant relationship between KDIGO stage and the extension of COVID-19 pneumonia on computed tomography (CT), need for oxygen supplementation, serum levels of ferritin, interleukin-6, and procalcitonin, but none of these variables had a value for predicting KDIGO stage in multinomial regression. The odds of recovery of renal function were significantly diminished by d-dimer values. Lack of immunomodulatory treatment was found to be correlated with increased need for renal replacement therapy (RRT). Compared with AKI at admission, hospital-acquired AKI was predicted by the severity of lung damage on CT, evolved more frequently with incomplete recovery of renal function, and was significantly associated with antiviral therapy.
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Affiliation(s)
- Daniela Radulescu
- Clinical Department No. 3, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Liliana-Ana Tuta
- Faculty of Medicine, ‘Ovidius’ University, 900470 Constanta, Romania
- Department of Nephrology, ‘Sf. Apostol Andrei’ Emergency Clinical Hospital, 900591 Constanta, Romania
| | - Cristiana David
- Clinical Department No. 3, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Carmen Bogeanu
- Clinical Department No. 3, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Simona Daniela Onofrei
- Clinical Department No. 3, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Elena Stepan
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Elena Cuiban
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Andreea Ciofalca
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Larisa Florina Feier
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Camelia Pana
- Faculty of Medicine, ‘Ovidius’ University, 900470 Constanta, Romania
- Department of Nephrology, ‘Sf. Apostol Andrei’ Emergency Clinical Hospital, 900591 Constanta, Romania
| | - Magda-Cristina Nutu
- Faculty of Medicine, ‘Ovidius’ University, 900470 Constanta, Romania
- Department of Nephrology, ‘Sf. Apostol Andrei’ Emergency Clinical Hospital, 900591 Constanta, Romania
| | - Ileana Adela Vacaroiu
- Clinical Department No. 3, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
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Menez S, Parikh CR. Overview of acute kidney manifestations and management of patients with COVID-19. Am J Physiol Renal Physiol 2021; 321:F403-F410. [PMID: 34448642 DOI: 10.1152/ajprenal.00173.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Since the start of the COVID-19 pandemic, several manifestations of kidney involvement associated with infection of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus have been described, including proteinuria, hematuria, and acute kidney injury. A growing body of literature has explored the risk factors and pathogenesis of COVID-19-associated acute kidney injury (AKI), including direct and indirect mechanisms, as well as early postdischarge outcomes that may result from various manifestations of kidney involvement. In this review, we explore the current state of knowledge of the epidemiology of COVID-19-associated AKI, potential mechanisms and pathogenesis of AKI, and various management strategies for patients in the acute setting. We highlight how kidney replacement therapy for patients with COVID-19-associated AKI has been affected by the increasing demand for dialysis and how the postacute management of patients, including outpatient follow-up, is vitally important. We also review what is presently known about long-term kidney outcomes after the initial recovery from COVID-19. We provide some guidance as to the management of patients hospitalized with COVID-19 who are at risk for AKI as well as for future clinical research in the setting of COVID-19 and the significance of early identification of patients at highest risk for adverse kidney outcomes.
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Affiliation(s)
- Steven Menez
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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