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Nlandu Y, Tannor EK, Bafemika T, Makulo JR. Kidney damage associated with COVID-19: from the acute to the chronic phase. Ren Fail 2024; 46:2316885. [PMID: 38561236 PMCID: PMC10986440 DOI: 10.1080/0886022x.2024.2316885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) infection is well established as a systemic disease including kidney damage. The entry point into the renal cell remains the angiotensin-converting enzyme 2 (ACE-2) receptor and the spectrum of renal lesions is broad, with a clear predominance of structural and functional tubular lesions. The most common form of glomerular injury is collapsing glomerulopathy (CG), which is strongly associated with apolipoprotein L1(APOL-1) risk variants. These acute lesions, which are secondary to the direct or indirect effects of SARS-CoV-2, can progress to chronicity and are specific to long COVID-19 in the absence of any other cause. Residual inflammation associated with SARS-CoV-2 infection, in addition to acute kidney injury (AKI) as a transitional state with or without severe histological lesions, may be responsible for greater kidney function decline in mild-to-moderate COVID-19. This review discusses the evidence for renal histological markers of chronicity in COVID-19 patients and triggers of low-grade inflammation that may explain the decline in kidney function in the post-COVID-19 period.
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Affiliation(s)
- Yannick Nlandu
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Elliot Koranteng Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Titilope Bafemika
- Renal Unit, Uniosun Teaching Hospital Osogbo, Osun State University, Osogbo, Osun State, Nigeria
| | - Jean-Robert Makulo
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
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Yuan L, Mehmood A, Meng L. A meta-analysis of risk factors for acute kidney injury in pneumonia: Effectiveness of nursing interventions. Ther Apher Dial 2024; 28:518-533. [PMID: 38545743 DOI: 10.1111/1744-9987.14124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/10/2024] [Accepted: 03/01/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION The spread of coronavirus disease 2019 (COVID-19) worldwide since November 2019 is of interest to understand its impact on various organs. COVID-19 patients experience a higher incidence of acute kidney injury (AKI) compared with non-COVID-19 patients. METHODS A systematic literature search was conducted that covered the period from November 1, 2019 to February 28, 2021. RESULTS The analysis incorporated a comprehensive review of 19 studies of 21 362 patients. The older age (mean difference [MDs] = 5.11), cardiovascular disease (CVD) (odds ratio [OR] = 1.94), male sex (OR = 1.55), chronic kidney disease (CKD) (OR = 3.82), hypertension (OR = 2.15), diabetes (OR = 1.71), cancer (OR = 1.16), and chronic obstructive pulmonary disease (COPD) (OR = 1.40), mechanical ventilation (OR = 8.66), and vasopressor (OR = 6.30), were significantly associated with risk factor for AKI (P < 0.05). CONCLUSION The analysis revealed independent risk factors for AKI.
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Affiliation(s)
- Liangjuan Yuan
- Department of Respiratory, Shandong Provincial Third Hospital, Jinan, China
| | - Arshad Mehmood
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Meng
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
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Lu X, Chen Y, Zhang G, Zeng X, Lai L, Qu C. Application of interpretable machine learning algorithms to predict acute kidney injury in patients with cerebral infarction in ICU. J Stroke Cerebrovasc Dis 2024; 33:107729. [PMID: 38657830 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is not only a complication but also a serious threat to patients with cerebral infarction (CI). This study aimed to explore the application of interpretable machine learning algorithms in predicting AKI in patients with cerebral infarction. METHODS The study included 3920 patients with CI admitted to the Intensive Care Unit and Emergency Medicine of the Central Hospital of Lishui City, Zhejiang Province. Nine machine learning techniques, including XGBoost, logistics, LightGBM, random forest (RF), AdaBoost, GaussianNB (GNB), Multi-Layer Perceptron (MLP), support vector machine (SVM), and k-nearest neighbors (KNN) classification, were used to develop a predictive model for AKI in these patients. SHapley Additive exPlanations (SHAP) analysis provided visual explanations for each patient. Finally, model effectiveness was assessed using metrics such as average precision (AP), sensitivity, specificity, accuracy, F1 score, precision-recall (PR) curve, calibration plot, and decision curve analysis (DCA). RESULTS The XGBoost model performed better in the internal validation set and the external validation set, with an AUC of 0.940 and 0.887, respectively. The five most important variables in the model were, in order, glomerular filtration rate, low-density lipoprotein, total cholesterol, hemiplegia and serum kalium. CONCLUSION This study demonstrates the potential of interpretable machine learning algorithms in predicting CI patients with AKI.
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Affiliation(s)
- Xiaochi Lu
- Department of Emergency medicine, Lishui Municipal Central Hospital, Lishui, 323000, PR China
| | - Yi Chen
- Department of Emergency medicine, Lishui Municipal Central Hospital, Lishui, 323000, PR China
| | - Gongping Zhang
- Department of Emergency medicine, Lishui Municipal Central Hospital, Lishui, 323000, PR China
| | - Xu Zeng
- Department of Emergency medicine, Lishui Municipal Central Hospital, Lishui, 323000, PR China
| | - Linjie Lai
- Department of Emergency medicine, Lishui Municipal Central Hospital, Lishui, 323000, PR China
| | - Chaojun Qu
- Department of Intensive care unit, Lishui Municipal Central Hospital, Lishui, 323000, PR China.
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Salgueira M, Almenara M, Gutierrez-Pizarraya A, Belmar L, Labrador PJ, Melero R, Serrano M, Portolés JM, Molina A, Poch E, Ramos N, Lloret MJ, Echarri R, Díaz-Mancebo R, González-Lara DM, Sánchez JE, Soler MJ. Characterization of hospitalized patients with acute kidney injury associated with COVID-19 in Spain: renal replacement therapy and mortality. FRA-COVID SEN Registry Data. Nefrologia 2024; 44:527-539. [PMID: 39127584 DOI: 10.1016/j.nefroe.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI- COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed MATERIAL AND METHOD: In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality. RESULTS Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60-78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases. The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4-10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41), and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, and shorter kidney injury onset and recovery time (p < 0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55). CONCLUSIONS Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as a risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor for mortality.
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Affiliation(s)
- M Salgueira
- Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - M Almenara
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - L Belmar
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - P J Labrador
- Complejo Hospitalario Universitario de Cáceres, Spain
| | - R Melero
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Serrano
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - J M Portolés
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - A Molina
- Hospital Clinic, Barcelona, Spain
| | - E Poch
- Hospital Clinic, Barcelona, Spain
| | - N Ramos
- Hospital Vall de Hebron, Barcelona, Spain
| | | | - R Echarri
- Hospital Universitario Infanta Sofía, Madrid, Spain
| | | | | | - J E Sánchez
- Hospital Universitario de Cabueñes, Gijón, Spain
| | - M J Soler
- Hospital Vall de Hebron, Barcelona, Spain
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Mathew S, Ramaswamy S, P V S, Kalanad A, John AG. Retrospective Analysis of Acute Kidney Injury in COVID-19 Infection: A Single-Center Study From Kerala. Cureus 2024; 16:e61772. [PMID: 38975470 PMCID: PMC11227431 DOI: 10.7759/cureus.61772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction The COVID-19 pandemic, caused by SARS-CoV-2, has resulted in significant morbidity and mortality worldwide. While primarily a respiratory illness, COVID-19 can lead to multi-organ involvement, including acute kidney injury (AKI). This study aimed to retrospectively analyze the incidence, risk factors, and outcomes of AKI in COVID-19 patients. Methods A single-center retrospective study involving 232 severe COVID-19 patients requiring ICU admission was analyzed. Patients were categorized into two groups based on renal involvement: group A (with AKI or worsening of pre-existing chronic kidney disease) and group B (without renal injury). Data on demographics, comorbidities, clinical presentation, inflammatory markers, management strategies, and outcomes were collected and analyzed. Results AKI or worsening of pre-existing chronic renal disease was noted in 50.87% of cases, while the remaining 49.13% had severe COVID-19 pneumonia without renal injury. The mean age of patients in group A (with renal involvement) was higher compared to group B (without renal injury), with a significant male predominance observed in group A. AKI occurred within a short duration of fever, and cough was not a significant symptom. Comorbidities such as diabetes, hypertension, and chronic kidney disease were common in both groups, with hypertension significantly associated with AKI. Other significant comorbidities as risk factors for kidney injury included chronic liver disease, coronary artery disease, chronic kidney disease, and malignancy. Elevated inflammatory markers, including C-reactive protein (CRP), serum ferritin, and interleukin-6, were significantly associated with renal injury. There was no significant difference in the mortality rate between the two groups studied. Conclusion AKI or worsening of pre-existing kidney disease is a common event in severe COVID-19 infection. Patients, especially elderly males with comorbidities as mentioned, should be thoroughly monitored for worsening renal function, and steps like avoidance of nephrotoxic drugs and timely hemodynamic support may help avoid this dreaded complication to a certain extent and improve the prognosis in severe COVID-19 infection. Supportive care remains crucial in managing COVID-19 patients with renal involvement, emphasizing the need for the early detection and treatment of renal abnormalities. Long-term follow-up is essential to assess the impact of AKI on future kidney health.
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Affiliation(s)
- Sheela Mathew
- Infectious Diseases, Government Medical College, Kozhikode, Kozhikode, IND
| | - Sreejith Ramaswamy
- Internal Medicine, Government Medical College, Kozhikode, Kozhikode, IND
| | - Shiji P V
- Internal Medicine, Government Medical College, Kozhikode, Kozhikode, IND
| | - Aquil Kalanad
- Internal Medicine, Government Medical College, Kozhikode, Kozhikode, IND
| | - Aaron G John
- Gastrointestinal, Hepatopancreatobiliary, and Multi-Organ Transplant Surgery, Rajagiri Hospital, Aluva, IND
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Choi DE, Kim DK, Park S, Lee SH, Park O, Kim T, Yeo HJ, Jang JH, Cho WH, Lee SI. Clinical characteristics and prognosis of patients with COVID-19 on mechanical ventilation undergoing continuous renal replacement therapy. PLoS One 2024; 19:e0297344. [PMID: 38568934 PMCID: PMC10990228 DOI: 10.1371/journal.pone.0297344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/02/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has significantly strained global healthcare, particularly in the management of patients requiring mechanical ventilation (MV) and continuous renal replacement therapy (CRRT). This study investigated the characteristics and prognoses of these patients. METHODS This multicenter retrospective cohort study gathered data from patients with COVID-19 across 26 medical centers. Logistic analysis was used to identify the factors associated with CRRT implementation. RESULTS Of the 640 patients with COVID-19 who required MV, 123 (19.2%) underwent CRRT. Compared to the non-CRRT group, the CRRT group was older and exhibited higher sequential organ failure assessment scores. The incidence of hypertension, diabetes, cardiovascular disease, chronic neurological disease, and chronic kidney disease was also higher in the CRRT group. Moreover, the CRRT group had higher intensive care unit (ICU) (75.6% vs. 26.9%, p < 0.001) and in-hospital (79.7% vs. 29.6%, p < 0.001) mortality rates. CRRT implementation was identified as an independent risk factor for both ICU mortality (hazard ratio [HR]:1.833, 95% confidence interval [CI]:1.342-2.505, p < 0.001) and in-hospital mortality (HR: 2.228, 95% CI: 1.648-3.014, p < 0.001). Refractory respiratory failure (n = 99, 19.1%) was the most common cause of death in the non-CRRT death group, and shock with multi-organ failure (n = 50, 40.7%) was the most common cause of death in the CRRT death group. Shock with multi-organ failure and cardiac death were significantly more common in the CRRT death group, compared to non-CRRT death group. CONCLUSION This study indicates that CRRT is associated with higher ICU and in-hospital mortality rates in patients with COVID-19 who require MV. Notably, the primary cause of death in the CRRT group was shock with multi-organ failure, emphasizing the severe clinical course for these patients, while refractory respiratory failure was most common in non-CRRT patients.
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Affiliation(s)
- Dae-Eun Choi
- Department of Nephrology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Duk Ki Kim
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Su Hwan Lee
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Onyu Park
- College of Nursing, Research Institute of Nursing Science, Pusan National University, Yangsan, Republic of Korea
| | - Taehwa Kim
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Hye Ju Yeo
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jin Ho Jang
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Woo Hyun Cho
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Song I. Lee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
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Camelo ALM, Zamora Obando HR, Rocha I, Dias AC, Mesquita ADS, Simionato AVC. COVID-19 and Comorbidities: What Has Been Unveiled by Metabolomics? Metabolites 2024; 14:195. [PMID: 38668323 PMCID: PMC11051775 DOI: 10.3390/metabo14040195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
The COVID-19 pandemic has brought about diverse impacts on the global population. Individuals with comorbidities were more susceptible to the severe symptoms caused by the virus. Within the crisis scenario, metabolomics represents a potential area of science capable of providing relevant information for understanding the metabolic pathways associated with the intricate interaction between the viral disease and previous comorbidities. This work aims to provide a comprehensive description of the scientific production pertaining to metabolomics within the specific context of COVID-19 and comorbidities, while highlighting promising areas for exploration by those interested in the subject. In this review, we highlighted the studies of metabolomics that indicated a variety of metabolites associated with comorbidities and COVID-19. Furthermore, we observed that the understanding of the metabolic processes involved between comorbidities and COVID-19 is limited due to the urgent need to report disease outcomes in individuals with comorbidities. The overlap of two or more comorbidities associated with the severity of COVID-19 hinders the comprehension of the significance of each condition. Most identified studies are observational, with a restricted number of patients, due to challenges in sample collection amidst the emergent situation.
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Affiliation(s)
- André Luiz Melo Camelo
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Hans Rolando Zamora Obando
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Isabela Rocha
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Aline Cristina Dias
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Alessandra de Sousa Mesquita
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Ana Valéria Colnaghi Simionato
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
- National Institute of Science and Technology for Bioanalytics—INCTBio, Institute of Chemistry, Universidade Estadual de (UNICAMP), Campinas 13083-970, São Paulo, Brazil
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Klimkiewicz J, Grzywacz A, Michałowski A, Gutowski M, Paryż K, Jędrych E, Lubas A. Acute Kidney Injury and Chronic Kidney Disease and Their Impacts on Prognosis among Patients with Severe COVID-19 Pneumonia: An Expert Center Case-Cohort Study. J Clin Med 2024; 13:1486. [PMID: 38592301 PMCID: PMC10932456 DOI: 10.3390/jcm13051486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Acute kidney injury (AKI) is associated with substantial mortality. In this case-control study, we analyzed the impacts of AKI and chronic kidney disease (CKD) on outcomes in a group of 323 patients with severe COVID-19. The correlation of clinical and laboratory data with AKI and CKD was also analyzed. Methods: A retrospective case-control study was conducted among AKI, CKD, and normal kidney function (NKF) groups hospitalized in a COVID-19 center in 2021. Results: AKI patients had higher in-hospital mortality (55.2 vs. 18.8%, p < 0.001), more frequent transfers from the HDU to ICU (57.5 vs. 12.9%, p < 0.001), and prolonged hospital stays (15.4 ± 10.7 vs. 10.7 ± 6.7 days, p < 0.001) compared to the NKF group. AKI was a predictor of death (OR 4.794, 95%CI: 2.906-7.906, p < 0.001). AKI patients also had broader lung parenchymal involvement and higher inflammatory markers compared to the NKF group. Patients with prior CKD had higher in-hospital mortality compared to the NKF group (64.0 vs. 18.8%, p < 0.001, OR 4.044, 95%CI: 1.723-9.490, p = 0.013); however, transfers from the HDU to ICU were not more frequent (16.0 vs. 12.9%, p = 0.753). Conclusions: AKI among COVID-19 patients was correlated with more ICU transfers, higher morbidity, and greater markers of severe disease. Patients with CKD had a higher mortality; however, the rate of ICU transfer was not substantially higher due to their poor prognosis.
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Affiliation(s)
- Jakub Klimkiewicz
- Department of Anesthesiology and Intensive Care, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.M.); (M.G.); (K.P.)
| | - Anna Grzywacz
- Department of Nephrology, Internal Diseases and Dialysis, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.G.); (E.J.); (A.L.)
| | - Andrzej Michałowski
- Department of Anesthesiology and Intensive Care, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.M.); (M.G.); (K.P.)
| | - Mateusz Gutowski
- Department of Anesthesiology and Intensive Care, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.M.); (M.G.); (K.P.)
| | - Kamil Paryż
- Department of Anesthesiology and Intensive Care, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.M.); (M.G.); (K.P.)
| | - Ewelina Jędrych
- Department of Nephrology, Internal Diseases and Dialysis, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.G.); (E.J.); (A.L.)
| | - Arkadiusz Lubas
- Department of Nephrology, Internal Diseases and Dialysis, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.G.); (E.J.); (A.L.)
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Tastemel Ozturk T, Düzova A, Oygar PD, Baltu D, Ozcilingir Hakverdi P, Lacinel Gurlevik S, Kurt-Sukur ED, Aykan HH, Ozen S, Ertugrul I, Kesici S, Gulhan B, Ozaltin F, Ozsurekci Y, Cengiz AB, Topaloglu R. Acute kidney injury in children with moderate-severe COVID-19 and multisystem inflammatory syndrome in children: a referral center experience. Pediatr Nephrol 2024; 39:867-877. [PMID: 37676500 DOI: 10.1007/s00467-023-06125-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Data on the characteristics of acute kidney injury (AKI) in pediatric COVID-19 and MIS-C are limited. We aimed to define the frequency, associated factors and early outcome of AKI in moderate, severe or critical COVID-19 and MIS-C; and to present a tertiary referral center experience from Türkiye. METHODS Hospitalized patients ≤ 18 years of age with confirmed COVID-19 or MIS-C at İhsan Doğramacı Children's Hospital, Hacettepe University, between March 2020-December 2021 were enrolled. The characteristics of AKI in the COVID-19 group were investigated in moderate, severe and critically ill patients; patients with mild COVID-19 were excluded. RESULTS The median (Q1-Q3) age in the COVID-19 (n = 66) and MIS-C (n = 111) groups was 10.7 years (3.9-15.2) and 8.7 years (4.5-12.7), respectively. The frequency of AKI was 22.7% (15/66) in COVID-19 and 15.3% (17/111) in MIS-C; all MIS-C patients with AKI and 73.3% (11/15) of COVID-19 patients with AKI had AKI at the time of admission. Multivariate analyses revealed need for vasoactive/inotropic agents [Odds ratio (OR) 19.233, p = 0.002] and presence of vomiting and/or diarrhea (OR 4.465, p = 0.036) as independent risk factors of AKI in COVID-19 patients; and need for vasoactive/inotropic agents (OR 22.542, p = 0.020), procalcitonin and ferritin levels as independent risk factors of AKI in the MIS-C group. Age was correlated with lymphocyte count (r = -0.513, p < 0.001) and troponin level (r = 0.518, p < 0.001) in MIS-C patients. Length of hospital stay was significantly longer in both groups with AKI, compared to those without AKI. Mortality was 9.1% in the COVID-19 group; and was associated with AKI (p = 0.021). There was no mortality in MIS-C patients. AKI recovery at discharge was 63.6% in COVID-19 survivors and 100% in MIS-C patients. CONCLUSIONS Independent risk factors for AKI were need for vasoactive/inotropic agents and vomiting/diarrhea in moderate, severe or critical COVID-19 patients; and need for vasoactive/inotropic agents and severe inflammation in MIS-C patients. Our findings suggest that inflammation and cardiac dysfunction are associated with AKI in MIS-C patients; and the association with age in this group merits further studies in larger groups. Early outcome is favorable; long-term follow-up for kidney functions is needed.
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Affiliation(s)
- Tugba Tastemel Ozturk
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ali Düzova
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
| | - Pembe Derin Oygar
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Demet Baltu
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | | | - Sibel Lacinel Gurlevik
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Eda Didem Kurt-Sukur
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Hayrettin Hakan Aykan
- Division of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
- Life Support Center, Hacettepe University, Ankara, Türkiye
| | - Seza Ozen
- Division of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ilker Ertugrul
- Division of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Selman Kesici
- Life Support Center, Hacettepe University, Ankara, Türkiye
- Division of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Bora Gulhan
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Fatih Ozaltin
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Yasemin Ozsurekci
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ali Bulent Cengiz
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Rezan Topaloglu
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
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10
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Caturano A, Galiero R, Vetrano E, Medicamento G, Alfano M, Beccia D, Brin C, Colantuoni S, Di Salvo J, Epifani R, Nevola R, Marfella R, Sardu C, Coppola C, Scarano F, Maggi P, Calabrese C, De Lucia Sposito P, Rescigno C, Sbreglia C, Fraganza F, Parrella R, Romano A, Calabria G, Polverino B, Pagano A, Numis FG, Bologna C, Nunziata M, Esposito V, Coppola N, Maturo N, Nasti R, Di Micco P, Perrella A, Adinolfi LE, Di Domenico M, Monda M, Russo V, Ruggiero R, Docimo G, Rinaldi L, Sasso FC. Impact of Acute Kidney Injury on the COVID-19 In-Hospital Mortality in Octogenarian Patients: Insights from the COVOCA Study. Life (Basel) 2024; 14:86. [PMID: 38255701 PMCID: PMC10817510 DOI: 10.3390/life14010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND AND AIMS The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has fundamentally reshaped the landscape of global public health, with some people suffering more adverse clinical outcomes than others. The aim of this study is to deepen our understanding of the specific impact of acute kidney injury (AKI) on the in-hospital mortality in octogenarian patients with COVID-19. METHODS This is a prospective observational cohort study, which involved 23 COVID-19 hospital units in the Campania Region, Italy. Exposure variables were collected during hospital admission and at discharge. Only patients aged ≥80 years were deemed eligible for the study. RESULTS 197 patients were included in the study (median age 83.0 [82.0-87.0] years; 51.5% men), with a median duration of hospitalization of 15.0 [8.0-25.0] days. From the multivariable Cox regression analysis, after the application of Šidák correction, only the respiratory rate (HR 1.09, 95% CI: 1.04 to 1.14; p < 0.001) and AKI development (HR: 3.40, 95% CI: 1.80 to 6.40; p < 0.001) were independently associated with the primary outcome. Moreover, the Kaplan-Meier analysis showed a significantly different risk of in-hospital mortality between patients with and without AKI (log-rank: <0.0001). CONCLUSIONS In our investigation, we identified a significant association between AKI and mortality rates among octogenarian patients admitted for COVID-19. These findings raise notable concerns and emphasize the imperative for vigilant monitoring of this demographic cohort.
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Affiliation(s)
- Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Giulia Medicamento
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Maria Alfano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Domenico Beccia
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Chiara Brin
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Sara Colantuoni
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Jessica Di Salvo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Raffaella Epifani
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Riccardo Nevola
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
- Ospedale Evangelico Betania, 80147 Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Carmine Coppola
- Hepatology Unit, Internal Medicine, Area Stabiese Hospital, 80053 Naples, Italy;
| | - Ferdinando Scarano
- COVID Center “S. Anna e SS. Madonna della Neve” Hospital, 80042 Boscotrecase, Italy;
| | - Paolo Maggi
- U.O.C. Infectious and Tropical Diseases, S. Anna e S. Sebastiano Hospital, 81100 Caserta, Italy;
| | - Cecilia Calabrese
- U.O.C. Pneumologia Vanvitelli, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy;
| | | | - Carolina Rescigno
- U.O.C. Infectious Diseases and Neurology, Cotugno Hospital, 80131 Naples, Italy;
| | - Costanza Sbreglia
- U.O.C. Infectious Diseases of the Elderly, Cotugno Hospital, 80131 Naples, Italy;
| | - Fiorentino Fraganza
- U.O.C. Anestesia and Intensive Care Unit, Cotugno Hospital, 80131 Naples, Italy;
| | - Roberto Parrella
- U.O.C. Respiratory Infectious Diseases, Cotugno Hospital, 80131 Naples, Italy;
| | | | - Giosuele Calabria
- IXth Division of Infectious Diseases and Interventional Ultrasound, Cotugno Hospital, 80131 Naples, Italy;
| | | | - Antonio Pagano
- Emergency and Acceptance Unit, “Santa Maria delle Grazie” Hospital, 80078 Pozzuoli, Italy; (A.P.); (F.G.N.)
| | - Fabio Giuliano Numis
- Emergency and Acceptance Unit, “Santa Maria delle Grazie” Hospital, 80078 Pozzuoli, Italy; (A.P.); (F.G.N.)
| | | | | | - Vincenzo Esposito
- IVth Division of Immunodeficiency and Gender Infectious Diseases, Cotugno Hospital, 80131 Naples, Italy;
| | - Nicola Coppola
- COVID Center, Department of Mental Health and Public Medicine, A.O.U. Vanvitelli, 80131 Naples, Italy;
| | - Nicola Maturo
- U.O.S.D. Infectious Diseases Emergency and Acceptance, Cotugno Hospital, 80131 Naples, Italy;
| | - Rodolfo Nasti
- Emergency Division, A.O.R.N. “Antonio Cardarelli”, 80131 Naples, Italy;
| | - Pierpaolo Di Micco
- Department of Internal Medicine, Fatebenefratelli Hospital of Naples, 80123 Naples, Italy;
| | | | - Luigi Elio Adinolfi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Marina Di Domenico
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Marcellino Monda
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Vincenzo Russo
- Department of Biology, College of Science and Technology, Sbarro Institute for Cancer Research and Molecular Medicine, Temple University, Philadelphia, PA 19122, USA;
- Division of Cardiology, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Roberto Ruggiero
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Giovanni Docimo
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Luca Rinaldi
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
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11
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Del Toro-Cisneros N, Berman-Parks N, Uribe-Pérez A, Caballero-Islas AE, Vega-Vega O. A modified renal angina index in critically ill patients with COVID-19. Ren Fail 2023; 45:2205958. [PMID: 37139725 PMCID: PMC10161936 DOI: 10.1080/0886022x.2023.2205958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND The renal angina index (RAI) is a tool that has been validated by several studies in the pediatric population to predict the development of severe acute kidney injury (AKI). The aims of this study were to evaluate the efficacy of the RAI in predicting severe AKI in critically ill patients with COVID-19 and to propose a modified RAI (mRAI) for this population. METHODS This was a prospective cohort analysis of all COVID-19 patients receiving invasive mechanical ventilation (IMV) who were admitted to the intensive care unit (ICU) of a third-level hospital in Mexico City from 03/2020 to 01/2021. AKI was defined according to KDIGO guidelines. The RAI score was calculated for all enrolled patients using the method of Matsuura. Since all patients had the highest score for the condition (due to receiving IMV), the score corresponded to the delta creatinine (ΔSCr) value. The main outcome was severe AKI (stage 2 or 3) at 24 and 72 h after ICU admission. A logistic regression analysis was applied to search for factors associated with the development of severe AKI, and the data were applied to develop a mRAI and compare it vis-à-vis the efficacy of both scores (RAI and mRAI). RESULTS Of the 452 patients studied, 30% developed severe AKI. The original RAI score was associated with AUCs of 0.67 and 0.73 at 24 h and 72 h, respectively, with a cutoff of 10 points to predict severe AKI. In the multivariate analysis adjusted for age and sex, a BMI ≥30 kg/m2, a SOFA score ≥6, and Charlson score were identified as risk factors for the development of severe AKI. In the new proposed score (mRAI), the conditions were summed and multiplied by the ΔSCr value. With these modifications, the AUC improved to 0.72 and 0.75 at 24 h and 72 h, respectively, with a cutoff of 8 points. CONCLUSIONS The original RAI is a limited tool for patients with critical COVID-19 receiving IMV. The mRAI, with the parameters proposed in the present study, improves predictive performance and risk stratification in critically ill patients receiving IMV.
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Affiliation(s)
- Noemi Del Toro-Cisneros
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Nathan Berman-Parks
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Adela Uribe-Pérez
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Adrián E Caballero-Islas
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Olynka Vega-Vega
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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12
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Farah RI, Alfuqaha OA, Younes AR, Mahmoud HA, Al-Jboor AM, Karajeh MM, Al-Masadeh MZ, Murad OI, Obeidat N. Prevalence and Mortality Rates of Acute Kidney Injury among Critically Ill Patients: A Retrospective Study. Crit Care Res Pract 2023; 2023:9966760. [PMID: 38021314 PMCID: PMC10667051 DOI: 10.1155/2023/9966760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Acute kidney injury (AKI) poses a significant challenge in critically ill patients. To determine the prevalence, risk factors, and mortality rate of AKI among nonsurgical critically ill patients in Jordan University Hospital, we conducted a retrospective study using a consecutive sampling method, including 457 nonsurgical critically ill patients admitted to the medical intensive care unit (MICU) from January to June 2021. The mean age was 63.8 ± 18 years, with 196 (42.8%) developing AKI during their stay in the MICU. Among AKI nonsurgical patients, pulmonary diseases (n = 52; 34.5%) emerged as the primary cause for admission, exhibiting the highest prevalence, followed by sepsis (n = 40; 20.4%). Furthermore, we found that older age (adjusted OR (AOR): 1.04; 95% confidence interval (CI): 1.04-1.06; p = 0.003), preadmission use of diuretics (AOR: 2.12; 95% CI: 1.06-4.25; p = 0.03), use of ventilators (2.19; 95% CI: 1.12-2.29; p = 0.02), and vasopressor use during MICU stay (AOR: 4.25; 95% CI: 2.1308.47; p = 0.001) were observed to have higher mortality rates. Prior utilization of statins before admission exhibited a significant association with reduced mortality rate (AOR: 0.42; 95% CI: 0.2-0.85; p = 0.02). Finally, AKI was associated with a higher mortality rate during MICU stay (AOR: 2.44; 95% CI: 1.07-5.56; p = 0.03). The prevalence of AKI among nonsurgical patients during MICU stay is higher than what has been reported previously in the literature, which highlights the nuanced importance of identifying more factors contributing to AKI in developing countries, and hence providing preventive measures and adhering to global strategies are recommended.
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Affiliation(s)
- Randa I. Farah
- Nephrology Division, Internal Medicine Department, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Othman A. Alfuqaha
- Counseling and Mental Health Department, Faculty of Educational Sciences, The World Islamic Sciences & Education University W.I.S.E, Amman 11947, Jordan
| | - Ali R. Younes
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Hasan A. Mahmoud
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | | | | | | | - Omar I. Murad
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Nathir Obeidat
- Pulmonary Critical Care Division, Internal Medicine Department, School of Medicine, The University of Jordan, Amman 11942, Jordan
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13
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Tavakolian A, Farhanji M, Shapouran F, Zal A, Taheri Z, Ghobadi T, Moghaddam VF, Mahdavi N, Talkhi N. Investigating the association of acute kidney injury (AKI) with COVID-19 mortality using data-mining scheme. Diagn Microbiol Infect Dis 2023; 107:116026. [PMID: 37598593 DOI: 10.1016/j.diagmicrobio.2023.116026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/27/2023] [Accepted: 07/09/2023] [Indexed: 08/22/2023]
Abstract
COVID-19 has caused significant challenges in kidney research and disease management. Data mining techniques such as logistic regression (LR) and decision tree (DT) were used to model data. All analyses were performed using SPSS 25 and Python 3. The incidence of acute kidney injury (AKI) was 14.1% and the overall mortality risk was 13% among COVID-19 patients. The mortality was associated with, AKI, age, marital status, smoking status, heart failure, chronic obstructive pulmonary disease, malignancy, and SPO2 level using LR. The accuracy, sensitivity, specificity, and area under the curve of the DT (and LR) classifier were 70% (85%), 73% (75%), 78% (79%), and 77% (81%), respectively. Based on the DT model, the variable most significantly associated with COVID-19 mortality was AKI followed by age, high WBC count, BMI, and lymphocyte count. It was concluded that the incidence of AKI was high, and AKI was identified as one of the important factors that played an effective role in mortality due to COVID-19.
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Affiliation(s)
- Ayoub Tavakolian
- Emergency Medicine Department, Deputy of Treatment, Faculty of Medicine, Mashhad University of Medical Science, Mashed, Iran
| | - Mahdieh Farhanji
- Department of Nursing, Faculty of Nursing and Midwifery, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Farhang Shapouran
- Medical Student Research Committee, Sabzevar University of Medical Science, Sabzevar, Iran
| | - Arghavan Zal
- Medical Student Research Committee, Sabzevar University of Medical Science, Sabzevar, Iran
| | - Zahra Taheri
- Medical Student Research Committee, Sabzevar University of Medical Science, Sabzevar, Iran
| | - Tina Ghobadi
- Medical Student Research Committee, Sabzevar University of Medical Science, Sabzevar, Iran
| | | | - Neda Mahdavi
- Department of Epidemiology & Biostatistics, School of public health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Talkhi
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran; International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.
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Mnguni AT, Schietekat D, Ebrahim N, Sonday N, Boliter N, Schrueder N, Gabriels S, Cois A, Tamuzi JL, Tembo Y, Davies MA, English R, Nyasulu PS. The interface between SARS-CoV-2 and non-communicable diseases (NCDs) in a high HIV/TB burden district level hospital setting, Cape Town, South Africa. PLoS One 2023; 18:e0277995. [PMID: 37796879 PMCID: PMC10553288 DOI: 10.1371/journal.pone.0277995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/22/2022] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND COVID-19 experiences on noncommunicable diseases (NCDs) from district-level hospital settings during waves I and II are scarcely documented. The aim of this study is to investigate the NCDs associated with COVID-19 severity and mortality in a district-level hospital with a high HIV/TB burden. METHODS This was a retrospective observational study that compared COVID-19 waves I and II at Khayelitsha District Hospital in Cape Town, South Africa. COVID-19 adult patients with a confirmed SARS-CoV-2 polymerase chain reaction (PCR) or positive antigen test were included. In order to compare the inter wave period, clinical and laboratory parameters on hospital admission of noncommunicable diseases, the Student t-test or Mann-Whitney U for continuous data and the X2 test or Fishers' Exact test for categorical data were used. The role of the NCD subpopulation on COVID-19 mortality was determined using latent class analysis (LCA). FINDINGS Among 560 patients admitted with COVID-19, patients admitted during wave II were significantly older than those admitted during wave I. The most prevalent comorbidity patterns were hypertension (87%), diabetes mellitus (65%), HIV/AIDS (30%), obesity (19%), Chronic Kidney Disease (CKD) (13%), Congestive Cardiac Failure (CCF) (8.8%), Chronic Obstructive Pulmonary Disease (COPD) (3%), cerebrovascular accidents (CVA)/stroke (3%), with similar prevalence in both waves except HIV status [(23% vs 34% waves II and I, respectively), p = 0.022], obesity [(52% vs 2.5%, waves II and I, respectively), p <0.001], previous stroke [(1% vs 4.1%, waves II and I, respectively), p = 0.046]. In terms of clinical and laboratory findings, our study found that wave I patients had higher haemoglobin and HIV viral loads. Wave II, on the other hand, had statistically significant higher chest radiography abnormalities, fraction of inspired oxygen (FiO2), and uraemia. The adjusted odds ratio for death vs discharge between waves I and II was similar (0.94, 95%CI: 0.84-1.05). Wave I had a longer average survival time (8.0 vs 6.1 days) and a shorter average length of stay among patients discharged alive (9.2 vs 10.7 days). LCA revealed that the cardiovascular phenotype had the highest mortality, followed by diabetes and CKD phenotypes. Only Diabetes and hypertension phenotypes had the lowest mortality. CONCLUSION Even though clinical and laboratory characteristics differed significantly between the two waves, mortality remained constant. According to LCA, the cardiovascular, diabetes, and CKD phenotypes had the highest death probability.
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Affiliation(s)
- Ayanda Trevor Mnguni
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Khayelitsha District Hospital, Cape Town, South Africa
| | | | | | | | | | - Neshaad Schrueder
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shiraaz Gabriels
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annibale Cois
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jacques L. Tamuzi
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yamanya Tembo
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Health Impact Assessment Directorate, Western Cape Government, Cape Town, South Africa
| | - Rene English
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S. Nyasulu
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine and Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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15
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Lu JY, Boparai MS, Shi C, Henninger EM, Rangareddy M, Veeraraghavan S, Mirhaji P, Fisher MC, Duong TQ. Long-term outcomes of COVID-19 survivors with hospital AKI: association with time to recovery from AKI. Nephrol Dial Transplant 2023; 38:2160-2169. [PMID: 36702551 DOI: 10.1093/ndt/gfad020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Although coronavirus disease 2019 (COVID-19) patients who develop in-hospital acute kidney injury (AKI) have worse short-term outcomes, their long-term outcomes have not been fully characterized. We investigated 90-day and 1-year outcomes after hospital AKI grouped by time to recovery from AKI. METHODS This study consisted of 3296 COVID-19 patients with hospital AKI stratified by early recovery (<48 hours), delayed recovery (2-7 days) and prolonged recovery (>7-90 days). Demographics, comorbidities and laboratory values were obtained at admission and up to the 1-year follow-up. The incidence of major adverse cardiovascular events (MACE) and major adverse kidney events (MAKE), rehospitalization, recurrent AKI and new-onset chronic kidney disease (CKD) were obtained 90-days after COVID-19 discharge. RESULTS The incidence of hospital AKI was 28.6%. Of the COVID-19 patients with AKI, 58.0% experienced early recovery, 14.8% delayed recovery and 27.1% prolonged recovery. Patients with a longer AKI recovery time had a higher prevalence of CKD (P < .05) and were more likely to need invasive mechanical ventilation (P < .001) and to die (P < .001). Many COVID-19 patients developed MAKE, recurrent AKI and new-onset CKD within 90 days, and these incidences were higher in the prolonged recovery group (P < .05). The incidence of MACE peaked 20-40 days postdischarge, whereas MAKE peaked 80-90 days postdischarge. Logistic regression models predicted 90-day MACE and MAKE with 82.4 ± 1.6% and 79.6 ± 2.3% accuracy, respectively. CONCLUSION COVID-19 survivors who developed hospital AKI are at high risk for adverse cardiovascular and kidney outcomes, especially those with longer AKI recovery times and those with a history of CKD. These patients may require long-term follow-up for cardiac and kidney complications.
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Affiliation(s)
- Justin Y Lu
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Montek S Boparai
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Caroline Shi
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Erin M Henninger
- Center for Health Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Mahendranath Rangareddy
- Center for Health Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Sudhakar Veeraraghavan
- Center for Health Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Parsa Mirhaji
- Center for Health Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Molly C Fisher
- Department of Medicine, Nephrology Division, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tim Q Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
- Center for Health Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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16
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Avotins L, Kroica J, Petersons A, Zentina D, Kravale Z, Saulite A, Racenis K. eGFR cystatinC/eGFR creatinine ratio < 0.6 in patients with SARS-CoV-2 pneumonia: a prospective cohort study. BMC Nephrol 2023; 24:269. [PMID: 37704948 PMCID: PMC10500727 DOI: 10.1186/s12882-023-03315-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Shrunken Pore Syndrome (SPS), defined as a reduced ratio between two estimated filtration rates (based on cystatin C and creatinine) is an increasingly recognized risk factor for long-term mortality. Although some patients with other conditions might be erroneously identified as SPS. Our aim was to bring the focus on possible pathophysiologic mechanisms influencing the ratio in the setting of SARS-CoV-2 pneumonia and acute kidney injury. METHODS A single-centered prospective cohort study was conducted to investigate biomarkers in symptomatic COVID-19 pneumonia patients admitted to a hospital in Latvia. Nineteen biomarkers were measured in blood and three in urine samples. Associations were sought between these biomarkers, chronic diseases and the estimated GFRcystatinC/eGFRcreatinine ratio < 0.6, mortality rates, and acute kidney injury development. Data analysis was performed using SPSS Statistics, with significance set at p < 0.05. RESULTS We included 59 patients (average age 65.5 years, 45.8% female) admitted with COVID-19. Acute kidney injury occurred in 27.1%, and 25.4% died. Ratio < 0.6 was seen in 38.6%, associated with female sex, diabetes, hypothyroidism, and higher age. Ratio < 0.6 group had mortality notably higher - 40.9% vs. 16.2% and more cases of acute kidney injury (40.9% vs. 18.9%). Cystatin C showed strong associations with the ratio < 0.6 compared to creatinine. Urea levels and urea/creatinine ratio were higher in the ratio < 0.6 group. After excluding acute kidney injury patients, ratio < 0.6 remained associated with higher cystatin C and urea levels. Other biomarkers linked to a kidney injury as NGAL, and proteinuria did not differ. CONCLUSION We prove that reduced ratio is common in hospitalized patients with SARS-CoV-2 pneumonia and is associated with increased mortality during hospitalization. Factors that influence this ratio are complex and, in addition to the possible shrinkage of pores, other conditions such as thickening of glomerular basal membrane, comorbidities, prerenal kidney failure and others may play an important role and should be addressed when diagnosing SPS. We highlight the need for additional diagnostic criteria for SPS and larger studies to better understand its implications in acute COVID-19 settings.
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Affiliation(s)
- Lauris Avotins
- Rīga Stradiņš University, Riga, Latvia.
- Pauls Stradins Clinical University Hospital, Riga, Latvia.
| | | | - Aivars Petersons
- Rīga Stradiņš University, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Dace Zentina
- Rīga Stradiņš University, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Zaiga Kravale
- Rīga Stradiņš University, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Anna Saulite
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Karlis Racenis
- Rīga Stradiņš University, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
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17
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Bravo E, Maldonado IL, Razo MA, Martinez GV, Lopez S. Association of Neutrophil/Lymphocyte Ratio and Neutrophil/Lymphocyte Platelet Ratio With Acute Kidney Injury in Severe COVID-19. Cureus 2023; 15:e43873. [PMID: 37736444 PMCID: PMC10511298 DOI: 10.7759/cureus.43873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/23/2023] Open
Abstract
Background Severe disease from COVID-19 was the leading cause of admission to the emergency room and hospitalization during the pandemic in Mexico. Acute kidney injury was one of the most prevalent complications in these patients. The neutrophil/lymphocyte (NL) index and the neutrophil/lymphocyte platelet (NLP) index have previously been described as possible markers associated with complications and mortality in this disease. Objective To determine the association of the NL ratio and the NLP ratio in patients with acute kidney injury secondary to severe COVID-19. Materials and methods This is a case-control study, unpaired, of patients diagnosed with severe COVID-19 who presented or did not present acute kidney injury. On admission to the hospital, the hematological ratios were calculated, and Mann-Whitney U tests and multivariate logistic regression were performed. Results A total of 160 patients were included, and a difference in the NLP ratio (4.2 vs. 3.1, p = 0.001) was observed between patients with and without acute kidney injury. Additionally, the NLP ratio was the main risk variable for acute kidney injury in severe COVID-19, with an odds ratio of 2.5 and a 95% confidence interval of 1.108-5.66. Conclusions The NLP ratio has a moderate association and is a risk factor associated with the presence of acute kidney injury in patients with severe COVID-19.
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Affiliation(s)
- Edgar Bravo
- Critical Care Medicine, General Hospital León, León, MEX
| | | | - Marco A Razo
- Critical Care Medicine, General Hospital León, León, MEX
| | | | - Sergio Lopez
- Research Department, University of Guanajuato, León, MEX
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18
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Dong Y, Luo S, Wang Y, Shi Y. Retrospective analysis of COVID-19 among 391 hospitalized patients in the Henan province of China. Medicine (Baltimore) 2023; 102:e34325. [PMID: 37478231 PMCID: PMC10662902 DOI: 10.1097/md.0000000000034325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/22/2023] [Indexed: 07/23/2023] Open
Abstract
This study investigated the clinical characteristics and risk factors of coronavirus disease 2019 (COVID-19) in patients in designated hospitals (Port Hospital) in the Henan province. A total of 391 COVID-19 patients with complete case information from August 6, 2021 to February 26, 2022 were selected. Logistic regression was used to analyze the differences between the clinical types, ages, and sex of the patients. Multivariate regression analysis of the severe group indicated that underlying diseases [odds ratio (OR):6.76, 95% confidence interval (CI):1.83-24.93], increased urea levels (OR: 1.41, 95% CI: 1.04-1.91), old age (OR: 1.05, 95% CI: 1.00-1.10), and increased lactic dehydrogenase (OR: 1.02, 95% CI: 1.01-1.03) levels and decreased hemoglobin (OR: 0.95, 95% CI: 0.91-1.00) levels were predictors of illness severity. Multivariate regression analysis for those > 50 years of age showed that underlying diseases (OR: 7.06, 95% CI: 2.79-17.89) and increased urea (OR: 1.91, 95% CI: 1.47-2.48), total bilirubin (OR: 1.14, 95% CI: 1.08-1.21), total protein (OR: 1.08, 95% CI: 1.00-1.17), and lactic dehydrogenase (OR: 1.01, 95% CI: 1.00-1.02) levels and decreased albumin (OR: 0.66, 95% CI: 0.58-0.76) levels were characteristics of COVID-19. Multivariate regression analysis stratified by sex showed that the characteristics of COVID-19 patients were increased white blood cell count in males (OR: 0.66, 95% CI: 0.55-0.78) as well as increased creatinine levels (OR: 0.89, 95% CI: 0.87-0.91). This retrospective analysis provides useful information to support the clinical management of patients with COVID-19.
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Affiliation(s)
- Yang Dong
- Department of Clinical Pathology, Henan Provincial People's Hospital, Department of Clinical Pathology of Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Suyan Luo
- Department of Clinical Microbiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yali Wang
- Department of Clinical Microbiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yujie Shi
- Department of Clinical Pathology, Henan Provincial People's Hospital, Department of Clinical Pathology of Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
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19
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Zhang Y, Li X, Zhang S, Chen W, Lu J, Xie Y, Wu S, Zhuang F, Bi X, Chu M, Wang F, Huang Y, Ding F, Hu C, Pan Y. Clinical Features and Predictive Nomogram of Acute Kidney Injury in Aging Population Infected with SARS-CoV-2 Omicron Variant. J Inflamm Res 2023; 16:2967-2978. [PMID: 37484995 PMCID: PMC10362882 DOI: 10.2147/jir.s413318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
Background Since little is known about the acute kidney injury (AKI) in aging population infected with SARS-CoV-2 Omicron variant, we investigated the incidence, clinical features, risk factors and mid-term outcomes of AKI in hospitalized geriatric patients with and without COVID-19 and established a prediction model for mortality. Methods A real-time data from the Shanghai Ninth People's Hospital information system of inpatients with COVID-19 from 1 April 2022 to 30 June 2022 were extracted. Clinical spectrum, laboratory results, and clinical prognosis were included for the risk analyses. Moreover, Cox and Lasso regression analyses were applied to predict the 90-day death and a nomogram was established. Results A total of 1607 SARS-CoV-2 infected patients were enrolled; hypertension was the most common comorbidity, followed by chronic cardiovascular disease, diabetes mellitus, and lung disease. Most of the participants were non-vaccinated and the mean age of patients was 82.6 years old (range, 60-103 years). The AKI incidence was higher in relatively older patients (16.29% vs 3.63% in patients older than 80 years and 60 to 80 years, respectively). Linear regression models identified some variables associated with the incidence of AKI, such as older age, clinical spectrum, D-dimer level, number of comorbidities, baseline eGFR, and antibiotic or corticosteroid treatment. In this cohort, 11 patients died in-hospital and 21 patients died at 90-day follow-up. The predictive nomogram of 90-day death achieved a good C-index of 0.823 by using 5 predictor variables: ICU admission, D-dimer, peak of serum creatinine, rate of serum creatinine decline and white blood cell count (WBC). Conclusion Older age, clinical spectrum, D-dimer level, number of comorbidities, baseline eGFR, and antibiotic or corticosteroid treatment are clinical risk factors for the incidence of AKI in geriatric COVID-19 patients. The prediction nomogram achieved an excellent performance at the prediction of 90-day mortality.
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Affiliation(s)
- Yumei Zhang
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xin Li
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Suning Zhang
- Division of Emergency, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Wei Chen
- Division of Neurology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jianxin Lu
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yingxin Xie
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Shengbin Wu
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Feng Zhuang
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xiao Bi
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Mingzi Chu
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Feng Wang
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yemin Huang
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Feng Ding
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Chun Hu
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yu Pan
- Division of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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20
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Anumas S, Chueachinda S, Tantiyavarong P, Pattharanitima P. The Prediction Score of Acute Kidney Injury in Patients with Severe COVID-19 Infection. J Clin Med 2023; 12:4412. [PMID: 37445447 DOI: 10.3390/jcm12134412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The incidence and risk factors for acute kidney injury in COVID-19 patients vary across studies, and predicting models for AKI are limited. This study aimed to identify the risk factors for AKI in severe COVID-19 infection and develop a predictive model for AKI. METHOD Data were collected from patients admitted to the ICU at Thammasat University Hospital in Thailand with PCR-confirmed COVID-19 between 1 January 2021, and 30 June 2022. RESULTS Among the 215 severe-COVID-19-infected patients, 102 (47.4%) experienced AKI. Of these, 45 (44.1%), 29 (28.4%), and 28 (27.4%) patients were classified as AKI stage 1, 2, and 3, respectively. AKI was associated with 30-day mortality. Multivariate logistic regression analysis revealed that prior diuretic use (odds ratio [OR] 7.87, 95% confidence interval [CI] 1.98-31.3; p = 0.003), use of a mechanical ventilator (MV) (OR 5.34, 95%CI 1.76-16.18; p = 0.003), and an APACHE II score ≥ 12 (OR 1.14, 95%CI 1.05-1.24; p = 0.002) were independent risk factors for AKI. A predictive model for AKI demonstrated good performance (AUROC 0.814, 95%CI 0.757-0.870). CONCLUSIONS Our study identified risk factors for AKI in severe COVID-19 infection, including prior diuretic use, an APACHE II score ≥ 12, and the use of a MV. The predictive tool exhibited good performance for predicting AKI.
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Affiliation(s)
- Suthiya Anumas
- Chulabhorn International College of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Supoj Chueachinda
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Pichaya Tantiyavarong
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Pattharawin Pattharanitima
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
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21
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Romero-Rodríguez E, Vélez-Santamaría R, Pérula-de-Torres LÁ, González-Lama J, Castro-Jiménez RÁ, Simón-Vicente L, Jiménez-García C, González-Bernal JJ, Santamaría-Peláez M, Fernández-Solana J, González-Santos J. Clinical and Epidemiological Profiles of Primary Healthcare Professionals with COVID-19 Infection and Long COVID: An Observational Study. Healthcare (Basel) 2023; 11:1677. [PMID: 37372794 DOI: 10.3390/healthcare11121677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Health professionals have been one of the groups most affected by the SARS-CoV-2 virus. Currently, there is little scientific evidence on the similarities and differences between COVID-19 infection and the development of long COVID in primary care (PC) workers. Therefore, it is necessary to analyse their clinical and epidemiological profiles in depth. This study was observational and descriptive, including PC professionals who were divided into three comparison groups based on the diagnostic test for acute SARS-CoV-2 infection. The responses were analysed using descriptive and bivariate analysis to examinate the relationship between independent variables and the presence or not of long COVID. Binary logistic regression analysis was also conducted, with each symptom as the dependent variable and each group as the independent variable. The results describe the sociodemographic characteristics of these population groups, revealing that women in the health sector are the most affected by long COVID and that being in this group is associated with its development. Furthermore, individuals with long COVID exhibited the highest number of symptoms and pathologies. Certain symptoms were found to be associated with long COVID development in this population, including an altered sense of smell, pneumonia, fever, and sore throat, among others. Similarly, altered senses of smell and taste, chest tightness, and joint pain, among others, were found to be associated with acute COVID-19 infection. Additionally, patients with pre-existing overweight or obesity were more likely to experience acute COVID-19 and develop long COVID. The data obtained can be crucial for improving the detection, diagnosis, and treatment of long COVID patients, ultimately leading to an enhancement in their quality of life.
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Affiliation(s)
- Esperanza Romero-Rodríguez
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba University, 14004 Córdoba, Spain
- Córdoba and Guadalquivir Health District, 14011 Córdoba, Spain
- Carlos Castilla del Pino Clinical Management Unit, 14011 Córdoba, Spain
| | | | - Luis Ángel Pérula-de-Torres
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba University, 14004 Córdoba, Spain
| | - Jesús González-Lama
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba University, 14004 Córdoba, Spain
- Cabra Clinical Management Unit, "Matrona Antonia Mesa Fernández" Health Center, AGS South of Córdoba, 14940 Córdoba, Spain
| | - Rafael Ángel Castro-Jiménez
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba University, 14004 Córdoba, Spain
- Especialista en Medicina Familiary Comunitaria, Reina Sofía University Hospital, 14004 Córdoba, Spain
| | | | - Celia Jiménez-García
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba University, 14004 Córdoba, Spain
- Córdoba and Guadalquivir Health District, 14011 Córdoba, Spain
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22
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Yang XL, Wang CX, Wang JX, Wu SM, Yong Q, Li K, Yang JR. In silico evidence implicating novel mechanisms of Prunella vulgaris L . as a potential botanical drug against COVID-19-associated acute kidney injury. Front Pharmacol 2023; 14:1188086. [PMID: 37274117 PMCID: PMC10232756 DOI: 10.3389/fphar.2023.1188086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
COVID-19-associated acute kidney injury (COVID-19 AKI) is an independent risk factor for in-hospital mortality and has the potential to progress to chronic kidney disease. Prunella vulgaris L., a traditional Chinese herb that has been used for the treatment of a variety of kidney diseases for centuries, could have the potential to treat this complication. In this study, we studied the potential protective role of Prunella vulgaris in COVID-19 AKI and explored its specific mechanisms applied by network pharmacology and bioinformatics methods. The combination of the protein-protein interaction network and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment -target gene network revealed eight key target genes (VEGFA, ICAM1, IL6, CXCL8, IL1B, CCL2, IL10 and RELA). Molecular docking showed that all these eight gene-encoded proteins could be effectively bound to three major active compounds (quercetin, luteolin and kaempferol), thus becoming potential therapeutic targets. Molecular dynamics simulation also supports the binding stability of RELA-encoded protein with quercetin and luteolin. Together, our data suggest that IL6, VEGFA, and RELA could be the potential drug targets by inhibiting the NF-κB signaling pathway. Our in silico studies shed new insights into P. vulgaris and its ingredients, e.g., quercetin, as potential botanical drugs against COVID-19 AKI, and warrant further studies on efficacy and mechanisms.
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Affiliation(s)
- Xue-Ling Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chun-Xuan Wang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia-Xing Wang
- Core Research Laboratory, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Shi-Min Wu
- Beijing Key Laboratory of Bioprocess, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Qing Yong
- Core Research Laboratory, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Ke Li
- Core Research Laboratory, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Ju-Rong Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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23
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Žulpaitė G, Rimševičius L, Jančorienė L, Zablockienė B, Miglinas M. The Association between COVID-19 Infection and Kidney Damage in a Regional University Hospital. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050898. [PMID: 37241132 DOI: 10.3390/medicina59050898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Kidneys are one of the main targets for SARS-CoV-2. Early recognition and precautionary management are essential in COVID-19 patients due to the multiple origins of acute kidney injury and the complexity of chronic kidney disease management. The aims of this research were to investigate the association between COVID-19 infection and renal injury in a regional hospital. Materials and Methods: The data of 601 patients from the Vilnius regional university hospital between 1 January 2020 and 31 March 2021 were collected for this cross-sectional study. Demographic data (gender, age), clinical outcomes (discharge, transfer to another hospital, death), length of stay, diagnoses (chronic kidney disease, acute kidney injury), and laboratory test data (creatinine, urea, C-reactive protein, potassium concentrations) were collected and analyzed statistically. Results: Patients discharged from the hospital were younger (63.18 ± 16.02) than those from the emergency room (75.35 ± 12.41, p < 0.001), transferred to another hospital (72.89 ± 12.06, p = 0.002), or who died (70.87 ± 12.83, p < 0.001). Subsequently, patients who died had lower creatinine levels on the first day than those who survived (185.00 vs. 311.17 µmol/L, p < 0.001), and their hospital stay was longer (Spearman's correlation coefficient = -0.304, p < 0.001). Patients with chronic kidney disease had higher first-day creatinine concentration than patients with acute kidney injury (365.72 ± 311.93 vs. 137.58 ± 93.75, p < 0.001). Patients with acute kidney injury and chronic kidney disease complicated by acute kidney injury died 7.81 and 3.66 times (p < 0.001) more often than patients with chronic kidney disease alone. The mortality rate among patients with acute kidney injury was 7.79 (p < 0.001) times higher than among patients without these diseases. Conclusions: COVID-19 patients who developed acute kidney injury and whose chronic kidney disease was complicated by acute kidney injury had a longer hospital stay and were more likely to die.
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Affiliation(s)
- Giedrė Žulpaitė
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania
| | - Laurynas Rimševičius
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania
| | - Ligita Jančorienė
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania
| | - Birutė Zablockienė
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania
| | - Marius Miglinas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania
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24
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Shchepalina A, Chebotareva N, Akulkina L, Brovko M, Sholomova V, Androsova T, Korotchaeva Y, Kalmykova D, Tanaschuk E, Taranova M, Lebedeva M, Beketov V, Moiseev S. Acute Kidney Injury in Hospitalized Patients with COVID-19: Risk Factors and Serum Biomarkers. Biomedicines 2023; 11:biomedicines11051246. [PMID: 37238917 DOI: 10.3390/biomedicines11051246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND AKI is one of the COVID-19 complications with high prognostic significance. In our research, we studied the prognostic role of several biomarkers that could help us understand AKI pathogenesis in patients with COVID-19. METHODS We evaluated the medical data of 500 patients hospitalized with COVID-19 in Tareev Clinic from 5 October 2020 to 1 March 2022. The diagnosis of COVID-19 was confirmed with positive RNA PCR in nasopharyngeal swabs and/or typical radiological findings on CT scans. Kidney function was assessed in accordance with KDIGO criteria. In the selected 89 patients, we evaluated serum levels of angiopoetin-1, KIM-1, MAC, and neutrophil elastase 2 and their prognostic significance. RESULTS The incidence of AKI in our study was 38%. The main risk factors for kidney injury were male sex, cardiovascular diseases, and chronic kidney disease. High serum angiopoetin-1 levels and a decrease in blood lymphocyte count and fibrinogen level also increased the risk of AKI. CONCLUSIONS AKI is an independent risk factor for death in patients with COVID-19. We propose the prognostic model of AKI development, which includes the combination of serum levels of angiopoetin-1 and KIM-1 on admission. Our model can help to prevent AKI development in patients with coronavirus disease.
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Affiliation(s)
- Anastasia Shchepalina
- Tareev Clinic of Internal Diseases, Department of Internal Diseases, Occupational Diseases and Reumatology, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Natalia Chebotareva
- Tareev Clinic of Internal Diseases, Department of Internal Diseases, Occupational Diseases and Reumatology, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
- Faculty of Fundamental Medicine, Lomonosov Moscow State University, Build. 1, 119991 Moscow, Russia
| | - Larissa Akulkina
- Tareev Clinic of Internal Diseases, Department of Internal Diseases, Occupational Diseases and Reumatology, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Mikhail Brovko
- Tareev Clinic of Internal Diseases, Department of Internal Diseases, Occupational Diseases and Reumatology, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Viktoria Sholomova
- Tareev Clinic of Internal Diseases, Department of Internal Diseases, Occupational Diseases and Reumatology, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Tatiana Androsova
- Tareev Clinic of Internal Diseases, Department of Internal Diseases, Occupational Diseases and Reumatology, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Yulia Korotchaeva
- Tareev Clinic of Internal Diseases, Department of Internal Diseases, Occupational Diseases and Reumatology, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Diana Kalmykova
- Department of Nursing, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Elena Tanaschuk
- Tareev Clinic of Internal Diseases, Department of Internal Diseases, Occupational Diseases and Reumatology, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Marina Taranova
- Tareev Clinic of Internal Diseases, Department of Internal Diseases, Occupational Diseases and Reumatology, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Marina Lebedeva
- Tareev Clinic of Internal Diseases, Department of Internal Diseases, Occupational Diseases and Reumatology, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Vladimir Beketov
- Tareev Clinic of Internal Diseases, Department of Internal Diseases, Occupational Diseases and Reumatology, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Department of Internal Diseases, Occupational Diseases and Reumatology, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
- Faculty of Fundamental Medicine, Lomonosov Moscow State University, Build. 1, 119991 Moscow, Russia
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25
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Salgueira M, Almenara M, Gutierrez-Pizarraya A, Belmar L, Labrador PJ, Melero R, Serrano ML, Portolés JM, Molina A, Poch E, Ramos N, Lloret MJ, Echarri R, Díaz Mancebo R, González-Lara DM, Sánchez JE, Soler MJ. [Characterization of hospitalized patients with acute kidney injury associated with COVID-19 in Spain: Renal replacement therapy and mortality. FRA-COVID SEN Registry Data]. Nefrologia 2023:S0211-6995(23)00057-7. [PMID: 37359780 PMCID: PMC10076078 DOI: 10.1016/j.nefro.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/31/2023] [Indexed: 06/28/2023] Open
Abstract
Background and objectives Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI-COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed. Material and method In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality. Results Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60-78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases.The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4-10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41) and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, shorter kidney injury onset and recovery time (p < 0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55). Conclusions Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor for mortality.
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Affiliation(s)
- Mercedes Salgueira
- Unidad de Nefrología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Marina Almenara
- Unidad de Nefrología, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - Lara Belmar
- Unidad de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Pedro Jesús Labrador
- Unidad de Nefrología, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - Rosa Melero
- Unidad de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - María Luisa Serrano
- Unidad de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - José María Portolés
- Unidad de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Alicia Molina
- Unidad de Nefrología, Hospital Clinic, Barcelona, España
| | - Esteban Poch
- Unidad de Nefrología, Hospital Clinic, Barcelona, España
| | - Natalia Ramos
- Unidad de Nefrología, Hospital Vall d'Hebron, Barcelona, España
| | | | - Rocío Echarri
- Unidad de Nefrología, Hospital Universitario Infanta Sofía, Madrid, España
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26
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Zampieri FG, Palomba H, Bozza FA, Cubos DC, Romano TG. Acute kidney injury in hospitalized patients with COVID-19: a retrospective cohort. CRITICAL CARE SCIENCE 2023; 35:236-238. [PMID: 37712816 PMCID: PMC10406411 DOI: 10.5935/2965-2774.20230428-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/03/2023] [Indexed: 09/16/2023]
Affiliation(s)
| | - Henrique Palomba
- Intensive Care Unit, Hospital Vila Nova Star - São Paulo
(SP), Brazil
| | | | - Daniel C. Cubos
- Intensive Care Unit, Hospital Vila Nova Star - São Paulo
(SP), Brazil
| | - Thiago G Romano
- Intensive Care Unit, Hospital Vila Nova Star - São Paulo
(SP), Brazil
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27
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e Silva Malzone JR, Ribeiro AP, de Souza TS, Wilbert DD, Novo NF, Juliano Y. Clinical and Epidemiological Characteristics of Patients with COVID-19 Admitted to the Intensive Care Unit: A Two-Year Retrospective Analysis. Life (Basel) 2023; 13:life13030741. [PMID: 36983896 PMCID: PMC10059043 DOI: 10.3390/life13030741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/05/2023] [Accepted: 02/18/2023] [Indexed: 03/12/2023] Open
Abstract
In March 2020, COVID-19 was characterized as a pandemic by the World Health Organization. Hospitalized patients affected by COVID-19 presented with severe respiratory and motor impairment, especially those who required intensive treatment and invasive mechanical ventilation, with sequelae that extended after the period of hospitalization. Thus, the aim of the current study was to verify the clinical and epidemiological characteristics of patients with COVID-19 admitted to the Intensive Care Unit in 2020 and 2021, according to age group. Methods: A retrospective cohort study. Data were collected through the “ICUs Brasileiras” between March 2020 and November 2021 for severe acute respiratory syndrome (SARS) due to COVID-19. The following were analyzed: the number of hospital admissions, days in the ICU and hospital, clinical aspects (non-invasive or invasive ventilatory support, comorbidities, frailty, SAPS 3 and SOFA severity scales, use of amines and renal support), and ICU and hospital mortality rate. Results: A total of 166,966 ICU hospital admissions were evaluated over the evaluated quarters. The main results showed a peak in the number of hospitalizations between March and May 2021, with a higher percentage of males. The peak of ICU admissions for 7 days was between March and May 2021 and 21 days between March and May 2020. In addition, higher deaths were observed in the age groups between 40 and 80 years between 2020 and 2021, with the group above 81 being the age group with the highest mortality. Mortality in the ICU of ventilated patients was higher in the age group above 70 years. Another observation was the predominance of SAPS 3 and the peak of mechanical ventilation for more than 7 days between June and August 2021. Conclusion: The clinical and epidemiological characteristics of patients with COVID-19 were influenced by age group, showing higher mortality over 81 years and over 70 years in the ICU supported by mechanical ventilation, maintained for 7 days from June to August 2021. The years 2020 and 2021 also showed differences for patients with COVID-19, with greater hospitalization between March and May 2021, especially in the ICU for 7 days, and between March and May 2020 for the 21-day period.
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Affiliation(s)
| | - Ana Paula Ribeiro
- Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
- Physical Therapy Department, School of Medicine, University of Sao Paulo, São Paulo 05360-160, Brazil
- Correspondence: or ; Tel.: +55-11-99139-2168
| | - Tatiane Silva de Souza
- Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
| | - Debora Driemeyer Wilbert
- Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
| | - Neil Ferreira Novo
- Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
| | - Yara Juliano
- Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
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28
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Ramatillah DL, Michael M, Khan K, Natasya N, Sinaga E, Hartuti S, Fajriani N, Farrukh MJ, Gan SH. Factors Contributing to Chronic Kidney Disease following COVID-19 Diagnosis in Pre-Vaccinated Hospitalized Patients. Vaccines (Basel) 2023; 11:vaccines11020433. [PMID: 36851310 PMCID: PMC9966430 DOI: 10.3390/vaccines11020433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
In this study, we aim to evaluate the factors that may contribute to the development of chronic kidney disease following COVID-19 infection among hospitalized patients in two private hospitals in Jakarta, Indonesia. This is a retrospective cohort study between March 2020 and September 2021. Patient selection was conducted with a convenience sampling. All patients (n = 378) meeting the inclusion criteria during the study period were enrolled. Various sociodemographic, laboratory test, and diagnostic parameters were measured before the determination of their correlation with the outcome of COVID-19 infection. In this study, all pre-vaccinated patients with COVID-19 had no history of chronic kidney disease (CKD) prior to hospital admission. From this number, approximately 75.7% of the patients developed CKD following COVID-19 diagnosis. Overall, significant correlations were established between the clinical outcome and the CKD status (p = 0.001). Interestingly, there was a significant correlation between serum creatinine level, glomerular filtration rate (GFR), and CKD (p < 0.0001). Oxygen saturation (p = 0.03), admission to the intensive care unit (ICU) (p < 0.0001), and sepsis (p = 0.005) were factors that were significantly correlated with CKD status. Additionally, the type of antibiotic agent used was significantly correlated with CKD (p = 0.011). While 82.1% of patients with CKD survived, the survival rate worsened if the patients had complications from hyperuricemia (p = 0.010). The patients who received levofloxacin and ceftriaxone had the highest (100%) survival rate after approximately 50 days of treatment. The patients who received the antiviral agent combination isoprinosine + oseltamivir + ivermectin fared better (100%) as compared to those who received isoprinosine + favipiravir (8%). Factors, such as hyperuricemia and the antibiotic agent used, contributed to CKD following COVID-19 hospitalization. Interestingly, the patients who received levofloxacin + ceftriaxone and the patients without sepsis fared the best. Overall, patients who develop CKD following COVID-19 hospitalization have a low survival rate.
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Affiliation(s)
- Diana Laila Ramatillah
- Faculty of Pharmacy, Universitas 17 Agustus 1945 Jakarta, North Jakarta 14350, Indonesia
- Correspondence:
| | - Michael Michael
- Faculty of Pharmacy, Universitas 17 Agustus 1945 Jakarta, North Jakarta 14350, Indonesia
| | - Kashifullah Khan
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail 2440, Saudi Arabia
| | - Nia Natasya
- Faculty of Pharmacy, Universitas 17 Agustus 1945 Jakarta, North Jakarta 14350, Indonesia
| | - Elizabeth Sinaga
- Faculty of Pharmacy, Universitas 17 Agustus 1945 Jakarta, North Jakarta 14350, Indonesia
| | - Silvy Hartuti
- Faculty of Pharmacy, Universitas 17 Agustus 1945 Jakarta, North Jakarta 14350, Indonesia
| | - Nuzul Fajriani
- Faculty of Pharmacy, Universitas 17 Agustus 1945 Jakarta, North Jakarta 14350, Indonesia
| | | | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Malaysia
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29
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Almazmomi MA, Alsieni M. Targeting TLR-4 Signaling to Treat COVID-19-induced Acute Kidney Injury. J Pharmacol Pharmacother 2023. [DOI: 10.1177/0976500x221147798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has turned into a potentially fatal pandemic illness. Numerous acute kidney injury (AKI) cases have been reported, although diffuse alveolar destruction and acute respiratory failure are the major symptoms of SARS-CoV-2 infection. The AKI, often known as a sudden loss of kidney function, carries a greater risk of mortality and morbidity. AKI was the second most frequent cause of death after acute respiratory distress syndrome (ARDS) in critically ill patients with coronavirus disease 2019 (COVID-19). While most patients with COVID-19 have moderate symptoms, some have severe symptoms, such as septic shock and ARDS. Also, it has been proven that some patients have severe symptoms, such as the failure of several organs. The kidneys are often affected either directly or indirectly. The major signs of kidney involvement are proteinuria and AKI. It is hypothesized that multiple mechanisms contribute to kidney injury in COVID-19. Direct infection of podocytes and proximal tubular cells in the kidneys may lead to acute tubular necrosis and collapsing glomerulopathy. SARS-CoV2 may also trigger a cascade of immunological responses that lead to AKI, including cytokine storm (CS), macrophage activation syndrome, and Toll-like receptor type-4 activation (TLR-4). Other proposed processes of AKI include interactions between organs, endothelial failure, hypercoagulability, rhabdomyolysis, and sepsis. Furthermore, ischemic damage to the kidney might result from the decreased oxygen supply. This article focuses on kidney injury’s epidemiology, etiology, and pathophysiological processes. Specifically, it focuses on the CS and the role of TLR-4 in this process. To effectively manage and treat acute kidney damage and AKI in COVID-19, it is crucial to understand the underlying molecular pathways and pathophysiology.
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Affiliation(s)
- Meaad A. Almazmomi
- Pharmaceutical Care Department, Ministry of National Guard—Health Affairs, Jeddah, Saudi Arabia
- Pharmacology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Alsieni
- Pharmacology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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30
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Lin L, Deng J, Tan W, Li J, Wu Z, Zheng L, Yang J. Pathogenesis and histological changes of nephropathy associated with COVID-19. J Med Virol 2023; 95:e28311. [PMID: 36377540 DOI: 10.1002/jmv.28311] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
Coronavirus disease 2019 (COVID-19) can cause damage to multiple organ, not only to the lungs, but also to the kidneys. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause acute and chronic kidney disease through direct viral infection, indirect injury, and vaccination-related injury. Like lung injury, kidney injury is also an important aspect affecting the severity and prognosis of SARS-CoV-2. This article summarizes the pathogenesis, pathological manifestations, and clinical features of SARS-CoV-2 direct or indirect renal injury. Including direct injury, indirect injury, special comorbidities (receiving kidney transplantation and chronic kidney disease), and vaccine-related renal injury, and exploring the possible therapeutic effect of anti-SARS-CoV-2 therapy on renal injury. The purpose is to provide reference for understanding COVID-19-related renal injury, guiding clinical and pathological diagnosis and treatment, and evaluating prognosis.
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Affiliation(s)
- Lirong Lin
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Junhui Deng
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Wei Tan
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Jie Li
- Department of Nephrology, Yongchuan People's Hospital of Chongqing, Chongqing, China
| | - Zhifeng Wu
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Luquan Zheng
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Jurong Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
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31
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Mallhi TH, Khan YH, Alzarea AI, Khan FU, Alotaibi NH, Alanazi AS, Butt MH, Alatawi AD, Salman M, Alzarea SI, Almalki ZS, Alghazi MA, Algarni MA. Incidence, risk factors and outcomes of acute kidney injury among COVID-19 patients: A systematic review of systematic reviews. Front Med (Lausanne) 2022; 9:973030. [PMID: 36405588 PMCID: PMC9672072 DOI: 10.3389/fmed.2022.973030] [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: 06/19/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
The COVID-19 associated acute kidney injury (CAKI) has emerged as a potential intricacy during the management of patients. Navigating the rapidly growing body of scientific literature on CAKI is challenging, and ongoing critical appraisal of this complication is essential. This study aimed to summarize and critically appraise the systematic reviews (SRs) on CAKI to inform the healthcare providers about its prevalence, risk factors and outcomes. All the SRs were searched in major databases (PubMed, EMBASE, Web of Science) from inception date to December 2021. This study followed SR of SRs methodology, all the records were screened, extracted and subjected to quality assessment by assessing the methodological quality of systematic reviews (AMSTAR-2). The extracted data were qualitatively synthesized and tabulated. This review protocol was registered in PROSPERO (CRD42022299444). Of 3,833 records identified; 42 SRs were included in this overview. The quality appraisal of the studies showed that 17 SRs were of low quality, while 8 moderate and 17 were of high-quality SRs. The incidence of CAKI ranged from 4.3% to 36.4% in overall COVID-19 patients, 36%-50% in kidney transplant recipients (KTRs), and up to 53% in severe or critical illness. Old age, male gender, cardiovascular disease, chronic kidney disease, diabetes mellitus and hypertension were frequently reported risk factors of CAKI. The need of renal replacement therapy (RRT) was up to 26.4% in overall COVID-19 patients, and 39% among those having CAKI. The occurrence of acute kidney injury (AKI) was found independent predictor of death, where mortality rate among CAKI patients ranged from 50% to 93%. This overview of SRs underscores that CAKI occurs frequently among COVID-19 patients and associated with high mortality, need of RRT and adverse outcomes. However, the confidence of these results is moderate to low which warrants the need of more SRs having established methodological standards. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299444], identifier [CRD42022299444].
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Affiliation(s)
- Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
- Health Sciences Research Unit, Jouf University, Sakaka, Saudi Arabia
| | | | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
| | - Nasser Hadal Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Abdullah Salah Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
- Health Sciences Research Unit, Jouf University, Sakaka, Saudi Arabia
| | - Muhammad Hammad Butt
- Department of Medicinal Chemistry, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Ahmed D. Alatawi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Sami I. Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Ziyad Saeed Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mansoor A. Alghazi
- Department of Pharmaceutical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Majed Ahmed Algarni
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
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Anandh U, Noorin A, Kazmi SKS, Bannur S, Shah SSA, Farooq M, Yedlapati G, Amer W, Prasad B, Dasgupta I. Acute kidney injury in critically ill COVID-19 infected patients requiring dialysis: experience from India and Pakistan. BMC Nephrol 2022; 23:308. [PMID: 36076183 PMCID: PMC9452278 DOI: 10.1186/s12882-022-02931-3] [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: 03/31/2022] [Accepted: 06/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background Acute kidney injury (AKI) was common in the first two waves of the SARS-COV-2 pandemic in critically ill patients. A high percentage of these patients required renal replacement therapy and died in the hospital. Methods The present study examines the clinical presentation, laboratory parameters and therapeutic interventions in critically ill patients with AKI admitted to the ICU in two centres, one each in India and Pakistan. Patient and outcome details of all critically ill COVID 19 patients admitted to the ICU requiring renal replacement therapy were collected. Data was analysed to detect patient variables associated with mortality. Results A total of 1,714 critically ill patients were admitted to the ICUs of the two centres. Of these 393 (22.9%) had severe acute kidney injury (AKIN stage 3) requiring dialysis. Of them, 60.5% were men and the mean (± SD) age was 58.78 (± 14.4) years. At the time of initiation of dialysis, 346 patients (88%) were oligo-anuric. The most frequent dialysis modality in these patients was intermittent hemodialysis (48.1%) followed by slow low efficiency dialysis (44.5%). Two hundred and six (52.4%) patients died. The mortality was higher among the Indian cohort (68.1%) than the Pakistani cohort (43.4%). Older age (age > 50 years), low serum albumin altered sensorium, need for slower forms of renal replacement therapy and ventilatory support were independently associated with mortality. Conclusion There was a very high mortality in patients with COVID-19 associated AKI undergoing RRT in the ICUs in this cohort from the Indian sub-continent.
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Affiliation(s)
- Urmila Anandh
- Department of Nephrology, Yashoda Hospitals, Secunderabad, India.
| | - Amna Noorin
- Department of Nephrology, Peshawar Institute of Cardiology, Peshawar, Pakistan
| | | | - Sooraj Bannur
- Department of Nephrology, Yashoda Hospitals, Secunderabad, India
| | | | - Mehrin Farooq
- Department of General Medicine, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | | | - Waseem Amer
- Department of Medicine, Lahore Medical and Dental College and Ghurki Trust Teaching Hospitals, Lahore, Pakistan
| | - Bonthu Prasad
- Department of Statistics, Yashoda Hospitals, Secunderabad, India
| | - Indranil Dasgupta
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK. .,Warwick Medical School, University of Warwick, Coventry, UK.
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Figueiredo FDA, Ramos LEF, Silva RT, Ponce D, de Carvalho RLR, Schwarzbold AV, Maurílio ADO, Scotton ALBA, Garbini AF, Farace BL, Garcia BM, da Silva CTCA, Cimini CCR, de Carvalho CA, Dias CDS, Silveira DV, Manenti ERF, Cenci EPDA, Anschau F, Aranha FG, de Aguiar FC, Bartolazzi F, Vietta GG, Nascimento GF, Noal HC, Duani H, Vianna HR, Guimarães HC, de Alvarenga JC, Chatkin JM, de Morais JDP, Machado-Rugolo J, Ruschel KB, Martins KPMP, Menezes LSM, Couto LSF, de Castro LC, Nasi LA, Cabral MADS, Floriani MA, Souza MD, Souza-Silva MVR, Carneiro M, de Godoy MF, Bicalho MAC, Lima MCPB, Aliberti MJR, Nogueira MCA, Martins MFL, Guimarães-Júnior MH, Sampaio NDCS, de Oliveira NR, Ziegelmann PK, Andrade PGS, Assaf PL, Martelli PJDL, Delfino-Pereira P, Martins RC, Menezes RM, Francisco SC, Araújo SF, Oliveira TF, de Oliveira TC, Sales TLS, Avelino-Silva TJ, Ramires YC, Pires MC, Marcolino MS. Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients. BMC Med 2022; 20:324. [PMID: 36056335 PMCID: PMC9438299 DOI: 10.1186/s12916-022-02503-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. METHODS This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). RESULTS The median age of the model-derivation cohort was 59 (IQR 47-70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918-0.939) and validation (temporal AUROC 0.927, 95% CI 0.911-0.941; geographic AUROC 0.819, 95% CI 0.792-0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). CONCLUSIONS The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.
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Affiliation(s)
- Flávio de Azevedo Figueiredo
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, Belo Horizonte, 190, Brazil. .,Department of Medicine, Universidade Federal de Lavras, R. Tomas Antonio Gonzaga, 277, Lavras, Brazil.
| | - Lucas Emanuel Ferreira Ramos
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Belo Horizonte, 6627, Brazil
| | - Rafael Tavares Silva
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Belo Horizonte, 6627, Brazil
| | - Daniela Ponce
- Botucatu Medical School, Universidade Estadual Paulista "Júlio de Mesquita Filho", Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu, Brazil
| | | | | | | | | | - Andresa Fontoura Garbini
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | | | | | - Christiane Corrêa Rodrigues Cimini
- Hospital Santa Rosália, R. do Cruzeiro, 01, Teófilo Otoni, Brazil.,Mucuri Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, R. Cruzeiro, 01, Teófilo Otoni, Brazil
| | | | - Cristiane Dos Santos Dias
- Department of Pediatrics, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
| | | | | | | | - Fernando Anschau
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | - Filipe Carrilho de Aguiar
- Hospital das Clínicas da Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, Brazil
| | - Frederico Bartolazzi
- Hospital Santo Antônio, Praça Dr. Márcio Carvalho Lopes Filho, 501, Curvelo, Brazil
| | | | | | - Helena Carolina Noal
- Hospital Universitário da Universidade Federal de Santa Maria, Av. Roraima, 1000, Santa Maria, Brazil
| | - Helena Duani
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, Belo Horizonte, 190, Brazil
| | | | | | | | | | | | - Juliana Machado-Rugolo
- Botucatu Medical School, Universidade Estadual Paulista "Júlio de Mesquita Filho", Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu, Brazil
| | - Karen Brasil Ruschel
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, Porto Alegre, 2359, Brazil.,Hospital Mãe de Deus, R. José de Alencar, 286, Porto Alegre, Brazil
| | - Karina Paula Medeiros Prado Martins
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, Porto Alegre, 2359, Brazil.,Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, Belo Horizonte, 190, Brazil
| | - Luanna Silva Monteiro Menezes
- Hospital Luxemburgo, R. Gentios, 1350, Belo Horizonte, Brazil.,Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil
| | | | | | - Luiz Antônio Nasi
- Hospital Moinhos de Vento, R. Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Máderson Alvares de Souza Cabral
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, Belo Horizonte, 190, Brazil
| | | | - Maíra Dias Souza
- Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil
| | - Maira Viana Rego Souza-Silva
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, Belo Horizonte, 190, Brazil
| | - Marcelo Carneiro
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | | | - Maria Aparecida Camargos Bicalho
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, Belo Horizonte, 190, Brazil.,Hospital Júlia Kubitschek, R. Dr. Cristiano Rezende, 2745, Belo Horizonte, Brazil
| | | | - Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | | | | | | | | | | | - Patricia Klarmann Ziegelmann
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, Porto Alegre, 2359, Brazil.,Hospital Tacchini, R. Dr. José Mário Mônaco, 358, Bento Gonçalves, Brazil
| | | | - Pedro Ledic Assaf
- Hospital Metropolitano Doutor Célio de Castro, R. Dona Luiza, 311, Belo Horizonte, Brazil
| | | | - Polianna Delfino-Pereira
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, Belo Horizonte, 190, Brazil.,Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, Porto Alegre, 2359, Brazil
| | | | | | | | | | | | | | - Thaís Lorenna Souza Sales
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, Porto Alegre, 2359, Brazil.,Universidade Federal de São João del-Rei, R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil
| | - Thiago Junqueira Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Faculdade Israelita de Ciencias da Saúde Albert Einstein, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Belo Horizonte, 6627, Brazil
| | - Milena Soriano Marcolino
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, Belo Horizonte, 190, Brazil.,Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, Porto Alegre, 2359, Brazil.,Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, Belo Horizonte, 190, Brazil.,Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil
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Elsadig H, Ismail A, Khalid K, Elsayed F, Ahmed K. Prevalence of acute kidney injury amongst Covid-19 admitted patients in Ribat Teaching Hospital isolation centre: A retrospective cross-sectional study. Ann Med Surg (Lond) 2022; 81:104404. [PMID: 35996634 PMCID: PMC9387061 DOI: 10.1016/j.amsu.2022.104404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Covid-19 sequeale have been a cause of serious health concerns since the start of the Covid-19 pandemic. Studies regarding this are still lacking especially in relation to the prevalence of Covid-19 induced AKI. Therefore, we have aimed to determine the prevalence of AKI amongst Covid-19 hospitalised patients in Ribat isolation centre. Methodology A cross-sectional retrospective study was conducted in the period from March 2020 to July 2021 in Ribat teaching hospital primary isolation centre which includes admitted Covid-19 induced AKI patients. A total of 333 confirmed Covid-19 patients were tested out of which we analyzed 183 files that fit the criteria of our research. The data was collected from the patients' record files using a checklist. Results A total of 77 out of 183 patients (42%) of admitted patients were diagnosed with AKI, out of which 35 patients had stage 3 AKI (46%), followed by 28 (36%) and 14 (18%) regarding stage 1 and stage 2 respectively. Furthermore, 57 out of the total 77 (74%) aged 60 years and above. Conclusion This study substantiates the theory that Covid-19 induces AKI regardless of its severity and the presence of co-morbidities. Additionally, older age (60 years and above) was the most important risk factor associated with it. Furthermore, most cases of Covid-19 induced AKI were stage 3.
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Affiliation(s)
- Hussein Elsadig
- Ribat Isolation Center, Ribat Teaching Hospital, The National Ribat University, Khartoum, Sudan
| | - Abdalla Ismail
- Ribat Isolation Center, Ribat Teaching Hospital, The National Ribat University, Khartoum, Sudan
| | - Khalda Khalid
- Ribat Isolation Center, Ribat Teaching Hospital, The National Ribat University, Khartoum, Sudan
| | - Faisal Elsayed
- Ribat Isolation Center, Ribat Teaching Hospital, The National Ribat University, Khartoum, Sudan
| | - Khalid Ahmed
- Ribat Isolation Center, Ribat Teaching Hospital, The National Ribat University, Khartoum, Sudan
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Lin L, Tian E, Ren J, Wu Z, Deng J, Yang J. Traditional Chinese Medicine in Treating Primary Podocytosis: From Fundamental Science to Clinical Research. Front Pharmacol 2022; 13:932739. [PMID: 36003509 PMCID: PMC9393213 DOI: 10.3389/fphar.2022.932739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
Podocytes form a key component of the glomerular filtration barrier. Damage to podocytes is referred to as “podocyte disease.” There are many causes of podocyte injury, including primary injury, secondary injury, and gene mutations. Primary podocytosis mostly manifests as nephrotic syndrome. At present, first-line treatment is based on glucocorticoid administration combined with immunosuppressive therapy, but some patients still progress to end-stage renal disease. In Asia, especially in China, traditional Chinese medicine (TCM) still plays an important role in the treatment of kidney diseases. This study summarizes the potential mechanism of TCM and its active components in protecting podocytes, such as repairing podocyte injury, inhibiting podocyte proliferation, reducing podocyte apoptosis and excretion, maintaining podocyte skeleton structure, and upregulating podocyte-related protein expression. At the same time, the clinical efficacy of TCM in the treatment of primary podocytosis (including idiopathic membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis) is summarized to support the development of new treatment strategies for primary podocytosis.
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Affiliation(s)
- Lirong Lin
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | - En Tian
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | - Jiangwen Ren
- Department of Nephrology, Rheumatism and Immunology, Jiulongpo District People’s Hospital of Chongqing, Chongqing, China
| | - Zhifeng Wu
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | | | - Jurong Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
- *Correspondence: Jurong Yang,
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36
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Shchepalina AA, Chebotareva NV, Kitbalian AA, Potapov PP, Nartova AA, Akulkina LA, Brovko MY, Sholomova VI, Moiseev SV. Risk factors of kidney injury in patients with COVID-19. TERAPEVT ARKH 2022; 94:743-747. [DOI: 10.26442/00403660.2022.06.201568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022]
Abstract
Aim. To determine the incidence and risk factors of acute kidney injury (AKI) in Russian cohort of patients with COVID-19.
Materials and methods. We included 315 patients, who were hospitalized with COVID-19 from October 2020 till February 2021. The diagnosis was established on the basis of the positive SARS-CoV-2 swab test and/or typical radiologic findings on CT scans.
Results. AKI complicated the clinical course in 92 (29.21%) cases. The independent risk factors of AKI were female sex, underline chronic kidney disease and the highest level of C-reactive protein during hospitalization. In the general group of patients were 41 (13%) lethal cases, in the group with AKI 32 (34.8%). Compared with those without AKI, patients with AKI had 4.065 (95% confidence interval 2.154 to 7.671) times the odds of death. Respiratory support, the highest serum creatinine and glucose levels appeared to be the risk factors of death among patients with AKI in the multivariable Cox regression.
Conclusion. The clinical course of COVID-19 was complicated by AKI in 29% cases. The independent risk factors of AKI in patients with COVID-19 are underline chronic kidney disease, circulatory disorder and the highest level of C-reactive protein during hospitalization.
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Tempestilli M, Ascoli Bartoli T, Benvenuto D, Stazi GV, Marchioni L, Nicastri E, Agrati C. Interpatient variability in the pharmacokinetics of remdesivir and its main metabolite GS-441524 in treated COVID-19 subjects. J Antimicrob Chemother 2022; 77:2683-2687. [PMID: 35848782 PMCID: PMC9384469 DOI: 10.1093/jac/dkac234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Remdesivir is the first antiviral drug against SARS-CoV-2 approved for use in COVID-19 patients. Objectives To study the pharmacokinetic inter-individual variability of remdesivir and its main metabolite GS-441524 in a real-world setting of COVID-19 inpatients and to identify possible associations with different demographic/biochemical variables. Methods Inpatients affected by SARS-CoV-2 infections, undergoing standard-dose remdesivir treatment, were prospectively enrolled. Blood samples were collected on day 4, immediately after (C0) and at 1 h (C1) and 24 h (C24) after infusion. Remdesivir and GS-441524 concentrations were measured using a validated UHPLC-MS/MS method and the AUC0–24 was calculated. At baseline, COVID-19 severity (ICU or no ICU), sex, age, BMI and renal and liver functions were assessed. Transaminases and estimated glomerular filtration rate (e-GFR) were also evaluated during treatment. Linear regression, logistic regression and multiple linear regression tests were used for statistical comparisons of pharmacokinetic parameters and variables. Results Eighty-five patients were included. The mean (CV%) values of remdesivir were: C0 2091 (99.1%) ng/mL, C1 139.7 (272.4%) ng/mL and AUC0–24 2791 (175.7%) ng·h/mL. The mean (CV%) values of GS-441524 were: C0 90.2 (49.5%) ng/mL, C1 104.9 (46.6%) ng/mL, C24 58.4 (66.9) ng/mL and AUC0–24 1976 (52.6%) ng·h/mL. The multiple regression analysis showed that age (P < 0.05) and e-GFR (P < 0.01) were independent predictors of GS-441524 plasma exposure. Conclusions Our results showed a high interpatient variability of remdesivir and GS-441524 likely due to both age and renal function in COVID-19 inpatients. Further research is required to understand whether the pharmacokinetics of remdesivir and its metabolites may influence drug-related efficacy or toxic effect.
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Affiliation(s)
- Massimo Tempestilli
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, 00149, Rome, Italy
| | - Tommaso Ascoli Bartoli
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, 00149, Rome, Italy
| | - Domenico Benvenuto
- Infectious Disease Unit, Tor Vergata University Hospital, 00133, Rome, Italy
| | - Giulia Valeria Stazi
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, 00149, Rome, Italy
| | - Luisa Marchioni
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, 00149, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, 00149, Rome, Italy
| | - Chiara Agrati
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, 00149, Rome, Italy
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Sharma H, Behera MR, Bhadauria DS, Khushwaha RS, Yachha M, Patel MR, Kaul A, Prasad N. High mortality and residual kidney damage with Coronavirus disease-19-associated acute kidney injury in northern India. Clin Exp Nephrol 2022; 26:1067-1077. [PMID: 35804207 PMCID: PMC9267704 DOI: 10.1007/s10157-022-02247-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with morbidity and mortality in COVID-19 patients. The incidence of AKI and its outcomes vary in different parts of the world. We aimed to analyze the AKI incidence, predictors of AKI, mortality, and renal function outcomes on follow-up in hospitalized patients with COVID-19. MATERIALS AND METHODS The study was designed as a retrospective, observational study of electronically captured data on the hospital information system of laboratory-confirmed COVID-19 patients, with and without AKI, between March 2020 to June 2021. The predictor of AKI and mortality and residual damage in recovered AKI patients were analyzed. RESULTS Of the 3395 patients, 3010 COVID-19 patients were eligible. AKI occurred in 951 (31.5%); with stages 1, 2, and 3 in 605 (63.7%), 138 (14.5%), and 208 (21.8%) patients, respectively. AKI severity increased with COVID-19 severity. Of 951 AKI patients, 403 died, and 548 were discharged. AKI group had higher mortality (42.3%) than the non-AKI (6.6%). At discharge, complete recovery was noticed in 370(67.5%), while 178 (32.5%) had residual damage. At three months of follow-up, 108 (69.6%) of 155 patients showed complete recovery. Residual damage was observed in 47 (30.3%). In 14 (9%) patients, serum creatinine remained elevated above the baseline. Thirty-three (21.2%) patients showed proteinuria (n = 24) and microscopic hematuria (n = 9). CONCLUSIONS AKI is common among patients hospitalized with COVID-19 and is associated with high mortality. Residual kidney damage post-COVID-19 in recovered AKI patients may increase the CKD burden.
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Affiliation(s)
- Harshita Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Manas R Behera
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Dharmendra Singh Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Ravi S Khushwaha
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Monika Yachha
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Manas Ranjan Patel
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Anupama Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
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Abstract
Initial reporting suggested that kidney involvement following COVID-19 infection was uncommon but this is now known not to be the case. Acute kidney injury (AKI) may arise through several mechanisms and complicate up to a quarter of patients hospitalized with COVID-19 infection being associated with an increased risk for both morbidity and death. Mechanisms of injury include direct kidney damage predominantly through tubular injury, although glomerular injury has been reported; the consequences of the treatment of patients with severe hypoxic respiratory failure; secondary infection; and exposure to nephrotoxic drugs. The mainstay of treatment remains the prevention of worsening kidney damage and in some cases they need for renal replacement therapies (RRT). Although the use of other blood purification techniques has been proposed as potential treatments, results to-date have not been definitive.
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Affiliation(s)
- James Hilton
- Department of Critical Care, Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; SPACeR Group (Surrey Peri-Operative, Anaesthesia & Critical Care Collaborative Research Group), Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK
| | - Naomi Boyer
- Department of Critical Care, Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; SPACeR Group (Surrey Peri-Operative, Anaesthesia & Critical Care Collaborative Research Group), Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK
| | - Mitra K Nadim
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 4300, Los Angeles, CA 90033, USA
| | - Lui G Forni
- Department of Critical Care, Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; SPACeR Group (Surrey Peri-Operative, Anaesthesia & Critical Care Collaborative Research Group), Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; Department of Clinical & Experimental Medicine, Faculty of Health Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK.
| | - John A Kellum
- Center for Critical Care Nephrology, University of Pittsburgh, 3347 Forbes Avenue #220, Pittsburgh, PA 15213, USA
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Rapin A, Noujaim PJ, Taiar R, Carazo-Mendez S, Deslee G, Jolly D, Boyer FC. Characteristics of COVID-19 Inpatients in Rehabilitation Units during the First Pandemic Wave: A Cohort Study from a Large Hospital in Champagne Region. BIOLOGY 2022; 11:biology11060937. [PMID: 35741459 PMCID: PMC9219626 DOI: 10.3390/biology11060937] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 06/01/2023]
Abstract
Background: Data describing patients hospitalized in medical rehabilitation wards after the acute phase of COVID-19 could help to better understand the rehabilitation needs in the current pandemic situation. Methods: Cohort including all patients with COVID-19 hospitalized in a single, large university hospital in Northeast France from 25 February to 30 April 2020. Results: 479 patients were admitted with COVID-19 during the study period, of whom 128 died (26.7%). Among the 351 survivors, 111 were referred to rehabilitation units, including 63 (17.9%) referred to physical and rehabilitation medicine (PRM) units. The median age of patients referred to rehabilitation units was 72 years. Patients who had been in intensive care, or who had had a long hospital stay, required referral to PRM units. Two biomarkers were associated with referral to rehabilitation units, namely, elevated troponin (p = 0.03) and impaired renal function (p = 0.03). Age was associated with referral to PRM units (p = 0.001). Conclusions: Almost one-third of COVID-19 patients required post-acute care, but only one-fifth had access to PRM units. The optimal strategy for post-acute management of COVID-19 patients remains to be determined. The need for rehabilitation wards during a pandemic is a primary concern in enabling the long-term functioning of infected patients.
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Affiliation(s)
- Amandine Rapin
- Faculté de Médecine, Université de Reims Champagne Ardennes, UR 3797 VieFra, 51097 Reims, France; (A.R.); (D.J.); (F.C.B.)
- Service de Médecine Physique et de Réadaptation, Hôpital Sébastopol, CHU de Reims, 51092 Reims, France;
| | - Peter-Joe Noujaim
- Unité D’aide Méthodologique, Pôle Recherche et Santé Publique, Hôpital Robert Debré, CHU de Reims, 51092 Reims, France;
| | - Redha Taiar
- Matériaux et Ingénierie Mécanique MATIM, Université de Reims Champagne Ardennes, CEDEX 2, 51687 Reims, France
| | - Sandy Carazo-Mendez
- Service de Médecine Physique et de Réadaptation, Hôpital Sébastopol, CHU de Reims, 51092 Reims, France;
| | - Gaetan Deslee
- Service des Maladies Respiratoires, Hôpital Maison Blanche, CHU de Reims, 51092 Reims, France;
- Inserm UMR-S1250, P3Cell, University of Reims Champagne-Ardenne, SFR CAP-SANTE, 51092 Reims, France
| | - Damien Jolly
- Faculté de Médecine, Université de Reims Champagne Ardennes, UR 3797 VieFra, 51097 Reims, France; (A.R.); (D.J.); (F.C.B.)
- Unité D’aide Méthodologique, Pôle Recherche et Santé Publique, Hôpital Robert Debré, CHU de Reims, 51092 Reims, France;
| | - François Constant Boyer
- Faculté de Médecine, Université de Reims Champagne Ardennes, UR 3797 VieFra, 51097 Reims, France; (A.R.); (D.J.); (F.C.B.)
- Service de Médecine Physique et de Réadaptation, Hôpital Sébastopol, CHU de Reims, 51092 Reims, France;
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Dua P, Mishra A, Reeta KH. Lp-PLA2 as a biomarker and its possible associations with SARS-CoV-2 infection. Biomark Med 2022; 16:821-832. [PMID: 35694871 PMCID: PMC9196258 DOI: 10.2217/bmm-2021-1129] [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] [Indexed: 02/07/2023] Open
Abstract
Lp-PLA2 is an enzyme encoded by the PLA2G7 gene located at chromosome 6p12-21, which is included in different signal transduction pathways. The potential of serum levels of Lp-PLA2 as a marker of inflammation quantifying cardio-metabolic risk, renal impairment and oxidative stress has been explored in earlier studies. It has also been used in chronic obstructive pulmonary disease, hepatic disease, metabolic conditions and exercise tolerance. Additionally, it shows promising evidence for the assessment of risk for certain cardiovascular conditions in otherwise seemingly healthy individuals. COVID-19 has affected life and the economy globally. The identification of biomarkers to assess the sickness and treatment plan is the need of the hour. This review summarizes the pathophysiological inter-relationship between serum levels of Lp-PLA2 and COVID-19. The authors hypothesize that the estimation of Lp-PLA2 levels may help in the early identification of risk and thus may play a beneficial role in the proactive management of COVID-19.
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Affiliation(s)
- Pamila Dua
- Department of Pharmacology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Archana Mishra
- Department of Pharmacology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - K H Reeta
- Department of Pharmacology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Maniero C, Patel D, Pavithran A, Naran P, Ng FL, Prowle J, Sivapathasuntharam D. A retrospective cohort study of risk factors and outcomes in older patients admitted to an inner-city geriatric unit in London during first peak of COVID-19 pandemic. Ir J Med Sci 2022; 191:1037-1045. [PMID: 34228265 PMCID: PMC8258277 DOI: 10.1007/s11845-021-02679-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Compared to younger patients, coronavirus disease 2019 (COVID-19) clinical presentation in older people can be more heterogeneous and fatal. We aim to describe a cohort of older adults admitted in an inner-city London hospital during the first peak of the pandemic. METHODS A retrospective observational study that enrolled older adults consecutively admitted into two geriatric wards with suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We collected socio-demographic data, comorbidities, symptoms at presentation and/or during admission, biochemical and radiological data and outcomes at 28 days. RESULTS One hundred twenty-four patients were included, and 75% were > 80 years old. 19.5% of COVID-19 cases were judged to be hospital-acquired. More than half presented or developed typical symptoms, respiratory failure or fatigue. 46.8% were diagnosed with delirium, 24.2% with falls and dysphagia was present in 13.7%. The mortality rate was 29.8% and was higher among males, those > 80 years, patients with a higher grade of frailty, a history of dementia or chronic kidney disease, as well as those diagnosed with respiratory failure, acute kidney injury or hypernatremia. Independent predictors of mortality were male sex, age > 80 years, respiratory failure and hypernatremia. CONCLUSION We have described a cohort of patients with SARS-CoV-2 infection in the first UK peak of the global pandemic. We found that these patients had significant frailty with multiple comorbidities. There was a high mortality and increased dependency and greater social care need in survivors.
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Affiliation(s)
- Carmela Maniero
- Clinical Pharmacology Unit, QMUL, Barts NHS Trust, London, UK
| | - Devan Patel
- Older People's Services, Royal London Hospital, Barts NHS Trust, London, UK
| | - Asha Pavithran
- Older People's Services, Royal London Hospital, Barts NHS Trust, London, UK
| | - Prasheena Naran
- Older People's Services, Royal London Hospital, Barts NHS Trust, London, UK
| | - Fu Liang Ng
- Clinical Pharmacology Unit, QMUL, Barts NHS Trust, London, UK
- Department of Clinical Pharmacology, St George's, University of London, London, UK
| | - John Prowle
- Critical Care and Perioperative Medicine Research Group, QMUL, Barts NHS Trust, London, UK
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Ippolito D, Vernuccio F, Maino C, Cannella R, Giandola T, Ragusi M, Bigiogera V, Capodaglio C, Sironi S. Multiorgan Involvement in SARS-CoV-2 Infection: The Role of the Radiologist from Head to Toe. Diagnostics (Basel) 2022; 12:1188. [PMID: 35626344 PMCID: PMC9140872 DOI: 10.3390/diagnostics12051188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 01/08/2023] Open
Abstract
Radiology plays a crucial role for the diagnosis and management of COVID-19 patients during the different stages of the disease, allowing for early detection of manifestations and complications of COVID-19 in the different organs. Lungs are the most common organs involved by SARS-CoV-2 and chest computed tomography (CT) represents a reliable imaging-based tool in acute, subacute, and chronic settings for diagnosis, prognosis, and management of lung disease and the evaluation of acute and chronic complications. Cardiac involvement can be evaluated by using cardiac computed tomography angiography (CCTA), considered as the best choice to solve the differential diagnosis between the most common cardiac conditions: acute coronary syndrome, myocarditis, and cardiac dysrhythmia. By using compressive ultrasound it's possible to study the peripheral arteries and veins and to exclude the deep vein thrombosis, directly linked to the onset of pulmonary embolism. Moreover, CT and especially MRI can help to evaluate the gastrointestinal involvement and assess hepatic function, pancreas involvement, and exclude causes of lymphocytopenia, thrombocytopenia, and leukopenia, typical of COVID-19 patients. Finally, radiology plays a crucial role in the early identification of renal damage in COVID-19 patients, by using both CT and US. This narrative review aims to provide a comprehensive radiological analysis of commonly involved organs in patients with COVID-19 disease.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, PD, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Via del Vespro, 129, 90127 Palermo, PA, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro, 129, 90127 Palermo, PA, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
| | - Maria Ragusi
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
| | - Vittorio Bigiogera
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Carlo Capodaglio
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy
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[Acute kidney injury and COVID-19: lung-kidney crosstalk during severe inflammation]. Med Klin Intensivmed Notfmed 2022; 117:342-348. [PMID: 35476144 PMCID: PMC9044389 DOI: 10.1007/s00063-022-00919-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/15/2022]
Abstract
Eine mit der Coronaviruserkrankung 2019 (COVID-19) assoziierte Nierenschädigung ist vor allem bei Intensivpatient:innen ein häufiges Phänomen. Das Virus selbst dürfte im Sinne eines direkten Befalls der Niere nur in geringem Ausmaß eine Rolle spielen, die mit einer schweren COVID-19-Erkrankungen assoziierte pathologische Entzündungsreaktion dagegen sehr wohl. Einen wesentlichen Einfluss haben die Folgen der invasiven Beatmung und das durch COVID-19 verursachte Acute Respiratory Distress Syndrome (ARDS). Hohe Beatmungsdrücke wirken sich negativ auf die Nierenperfusion aus und können so zur Entstehung einer AKI beitragen. Die durch das ARDS verursachte Entzündungsreaktion sowie die für COVID-19 typische endotheliale Dysfunktion in Kombination mit einer Hyperkoagulabilität sind weitere Faktoren, die die Nierenfunktion negativ beeinflussen können.
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Sabaghian T, Kharazmi AB, Ansari A, Omidi F, Kazemi SN, Hajikhani B, Vaziri-Harami R, Tajbakhsh A, Omidi S, Haddadi S, Shahidi Bonjar AH, Nasiri MJ, Mirsaeidi M. COVID-19 and Acute Kidney Injury: A Systematic Review. Front Med (Lausanne) 2022; 9:705908. [PMID: 35445048 PMCID: PMC9014846 DOI: 10.3389/fmed.2022.705908] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 02/21/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction Acute kidney injury (AKI) has been associated with an increased mortality rate among hospitalized patients with Coronavirus disease 2019 (COVID-19). The current review aimed to evaluate the symptoms, complications, and treatments performed to manage AKI in patients with COVID-19. Methods We searched PubMed/Medline, Web of Science, and Embase for the relevant scientific literature published up to February 1, 2022. The following keywords were used: “COVID-19”, “SARS-CoV-2”, and “Acute kidney injury”. Results Forty-four studies with a total number of 114 COVID-19 patients with AKI (Mean age: 53.6 years) were included in our systematic review. The most common comorbidities in patients with COVID-19 suffering from AKI were the history of diabetes, hypertension, and hyperlipidemia. Twelve out of the 44 included studies reported a history of chronic kidney disease (CKD) in this group of patients. Focal segmental glomerulosclerosis (FSGS) and acute tubular necrosis (ATN) were the most common pathological evidence. The average length of hospital stay was 19 days, and the average duration of need for mechanical ventilation was 3 days. Conclusions The current systematic review shows that AKI frequently complicates the course of COVID-19 hospitalizations and is associated with increased severity of illness, prolonged duration of hospitalization, and poor prognosis. Given the extent of the adverse impact of AKI, early detection of comorbidities and renal complications is essential to improve the outcomes of COVID-19 patients.
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Affiliation(s)
- Tahereh Sabaghian
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Behnam Kharazmi
- Department of Internal Medicine, Imam Hossein Medical Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Ansari
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Omidi
- Department of Cardiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Neda Kazemi
- Department of Obstetrics and Gynecology and Female Infertility Unit, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roya Vaziri-Harami
- Imam Hossein Hospital, Behavioral Science Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ardeshir Tajbakhsh
- Anesthesia Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajjad Omidi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Haddadi
- Department of Pulmonary and Critical Care, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Amir Hashem Shahidi Bonjar
- Clinician Scientist of Dental Materials and Restorative Dentistry, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Mirsaeidi
- Division of Pulmonary and Critical Care, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL, United States
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Ojo B, Campbell CH. Perioperative acute kidney injury: impact and recent update. Curr Opin Anaesthesiol 2022; 35:215-223. [PMID: 35102042 DOI: 10.1097/aco.0000000000001104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) is common in hospitalized patients and is a major risk factor for increased length of stay, morbidity, and mortality in postoperative patients. There are multiple barriers to reducing perioperative AKI - the etiology is multi-factorial and the diagnosis is fraught with issues. We review the recent literature on perioperative AKI and some considerations for anesthesiologists that examine the far-reaching effects of AKI on multiple organ systems. RECENT FINDINGS This review will discuss recent literature that addresses the epidemiology, use of novel biomarkers in risk stratification, and therapeutic modalities for AKI in burn, pediatrics, sepsis, trauma, cardiac, and liver disease, contrast-induced AKI, as well as the evidence assessing goal-directed fluid therapy. SUMMARY Recent studies address the use of risk stratification models and biomarkers, more sensitive than creatinine, in the preoperative identification of patients at risk for AKI. Although exciting, these scores and models need validation. There is a need for research assessing whether early AKI detection improves outcomes. Enhanced recovery after surgery utilizing goal-directed fluid therapy has not been shown to make an appreciable difference in the incidence of AKI. Reducing perioperative AKI requires a multi-pronged and possibly disease-specific approach.
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Affiliation(s)
- Bukola Ojo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Cedric H Campbell
- Department of Anesthesiology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
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Claassen N, van Wyk G, van Staden S, Basson MM. Experiencing COVID-19 at a large district level hospital in Cape Town: A retrospective analysis of the first wave. S Afr J Infect Dis 2022; 37:317. [PMID: 35419453 PMCID: PMC8990512 DOI: 10.4102/sajid.v37i1.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic in tertiary hospitals from South Africa and world wide have been well described, but limited data are published on the findings. This article aimed to describe patients admitted to a large district hospital in Cape Town, South Africa, during the first wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Infections. To compare the clinical features and further investigate survivors and deceased COVID-19 patients. Methods A single centre retrospective review of clinical records and laboratory data of patients admitted with a positive SARS-CoV-2 polymerase chain reaction (PCR) from April 2020 to August 2020. Results A total of 568 patients with a positive SARS-CoV-2 PCR were admitted to the study centre for one night or longer and of these patients 154 (27%) died of COVID-19. The median age of patients who died of COVID-19 was 66 years and 53 years for survivors. Hypertension, diabetes mellitus and obesity were the commonest comorbidities in patients who survived and died of COVID-19. There were no major differences when comparing the severity of infiltrates on chest X-rays (CXR) of COVID-19 survivors with deceased patients. More than half (58%) of deceased patients died within 3 days following admission to hospital. A substantial number of patients who died of COVID-19 had associated acute kidney injury (n = 79, 51%). Conclusion Acute kidney injury had a high prevalence amongst patients who died of COVID-19. Delays in transfer to intensive care unit (ICU), limited ICU capacity and disease severity contributed to a substantial number of patients dying within 3 days of admission.
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Affiliation(s)
- Nadè Claassen
- Department of Internal Medicine, Karl Bremer Hospital, Cape Town, South Africa
| | - Gerhard van Wyk
- Department of Internal Medicine, Karl Bremer Hospital, Cape Town, South Africa
| | - Sanet van Staden
- Department of Internal Medicine, Karl Bremer Hospital, Cape Town, South Africa
| | - Michiel M.D. Basson
- Department of Internal Medicine, Karl Bremer Hospital, Cape Town, South Africa
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Montazeri M, Keykhaei M, Rashedi S, Karbalai Saleh S, Pazoki M, Hadadi A, Sharifnia SH, Sotoodehnia M, Ajloo S, Kafan S, Ashraf H.
Prognostic significance of CHADS 2 and CHA 2DS 2-VASc scores to predict unfavorable outcomes in hospitalized patients with COVID-19. J Cardiovasc Thorac Res 2022; 14:23-33. [PMID: 35620746 PMCID: PMC9106940 DOI: 10.34172/jcvtr.2022.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/05/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction: Owing to the imposed burden of the coronavirus disease 2019 (COVID-19),the need for stratifying the prognosis of patients has never been timelier. Hence, we aimed to ascertain the value of CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-M (one point for male instead of female) scores to predict unfavorable outcomes in COVID-19 patients. Methods: We enrolled consecutive patients above 18 years of age with confirmed COVID-19,who were admitted between February 16 and November 1, 2020. The primary endpoint of this study was three-month all-cause mortality. The secondary endpoints were considered four major in-hospital clinical features, including acute respiratory distress syndrome, cardiac injury,acute kidney injury, and mechanical ventilation. Results: A total of 1,406 hospitalized COVID-19 patients were studied, among which 301(21.40%) patients died during the follow-up period. Regarding the risk scores, CHADS 2≥1,CHA2DS2-VASc≥2, and CHA2DS2-VASc-M≥2 were significantly associated with mortality. The performance of all risk scores for predicting mortality was satisfactory (area under the curve:0.668, 0.668, and 0.681, respectively). Appraising secondary endpoints, we found that all three risk scores were associated with increased risk of acute respiratory distress syndrome, cardiac injury, acute kidney injury, and mechanical ventilation. Lastly, we revealed that all risk scores were significantly correlated with serum levels of laboratory biomarkers. Conclusion: Our analysis illustrated that the CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-Mscores could aid prognostication of unfavorable outcomes in COVID-19 patients. Therefore,these easily calculable methods could be integrated into the overall therapeutic strategy to guide the COVID-19 management more accurately.
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Affiliation(s)
- Mahnaz Montazeri
- Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Keykhaei
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Rashedi
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Karbalai Saleh
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Pazoki
- Department of Pulmonary Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azar Hadadi
- Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Research Center For Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mehran Sotoodehnia
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Ajloo
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Kafan
- Department of Pulmonary Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Ashraf
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Wang C, Zheng J, Wang J, Zou L, Zhang Y. Cox-LASSO Analysis for Hospital Mortality in Patients With Sepsis Received Continuous Renal Replacement Therapy: A MIMIC-III Database Study. Front Med (Lausanne) 2022; 8:778536. [PMID: 35223879 PMCID: PMC8866187 DOI: 10.3389/fmed.2021.778536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/31/2021] [Indexed: 12/14/2022] Open
Abstract
Background Sepsis remains the leading cause of mortality in-hospital in the intensive care unit (ICU). Continuous renal replacement therapy (CRRT) is recommended as an adjuvant therapy for hemodynamics management in patients with sepsis. The aim of this study was to develop an adaptive least absolute shrinkage and selection operator (LASSO) for the Cox regression model to predict the hospital mortality in patients with Sepsis-3.0 undergoing CRRT using Medical Information Martin Intensive Care (MIMIC)-III v1.4. Methods Patients who met the Sepsis-3.0 definition were identified using the MIMIC-III v1.4. Among them, patients who received CRRT during ICU hospitalization were included in this study. According to the survival status, patients were split into death or survival group. Adaptive LASSO for the Cox regression model was constructed by STATA software. At last, nomogram and Kaplan-Meier curves were drawn to validate the model. Results A total of 181 patients who met Sepsis 3.0 criteria received CRRT were included in the study, in which, there were 31 deaths and 150 survivals during hospitalization, respectively. The overall in-hospital mortality was 17.1%. According to the results of multivariate Cox-LASSO regression analysis, use of vasopressor, international normalized ratio (INR) ≥1.5, and quick sequential organ failure assessment (qSOFA) score were associated with hospital mortality in patients with sepsis who underwent CRRT, but lactate level, mechanical ventilation (MV) support, PaO2/FiO2, platelet count, and indicators of acute kidney injury (AKI), such as blood urea nitrogen (BUN) and creatinine, were not independently associated with hospital mortality after adjusted by qSOFA. The risk nomogram and Kaplan-Meier curves verified that the use of vasopressor and INR ≥1.5 possess significant predictive value. Conclusions Using the Cox-LASSO regression model, use of vasopressor, INR ≥1.5, and qSOFA score are found to be associated with hospital mortality in patients with Sepsis-3.0 who received CRRT. This finding may assist clinicians in tailoring precise management and therapy for these patients who underwent CRRT.
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Affiliation(s)
- Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China.,Clinical Research Unit, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianli Zheng
- Institute of Medical Information Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Jinxia Wang
- Clinical Research Unit, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lin Zou
- Clinical Research Unit, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yucai Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ning Q, Wu D, Wang X, Xi D, Chen T, Chen G, Wang H, Lu H, Wang M, Zhu L, Hu J, Liu T, Ma K, Han M, Luo X. The mechanism underlying extrapulmonary complications of the coronavirus disease 2019 and its therapeutic implication. Signal Transduct Target Ther 2022; 7:57. [PMID: 35197452 PMCID: PMC8863906 DOI: 10.1038/s41392-022-00907-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) is a highly transmissible disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that poses a major threat to global public health. Although COVID-19 primarily affects the respiratory system, causing severe pneumonia and acute respiratory distress syndrome in severe cases, it can also result in multiple extrapulmonary complications. The pathogenesis of extrapulmonary damage in patients with COVID-19 is probably multifactorial, involving both the direct effects of SARS-CoV-2 and the indirect mechanisms associated with the host inflammatory response. Recognition of features and pathogenesis of extrapulmonary complications has clinical implications for identifying disease progression and designing therapeutic strategies. This review provides an overview of the extrapulmonary complications of COVID-19 from immunological and pathophysiologic perspectives and focuses on the pathogenesis and potential therapeutic targets for the management of COVID-19.
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Affiliation(s)
- Qin Ning
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Di Wu
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojing Wang
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dong Xi
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Chen
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guang Chen
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongwu Wang
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiling Lu
- National Medical Center for Major Public Health Events, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Wang
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Zhu
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junjian Hu
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Liu
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Ma
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meifang Han
- National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xiaoping Luo
- National Medical Center for Major Public Health Events, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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