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Zhao WJ, Tan RZ, Gao J, Su H, Wang L, Liu J. Research on the global trends of COVID-19 associated acute kidney injury: a bibliometric analysis. Ren Fail 2024; 46:2338484. [PMID: 38832469 DOI: 10.1080/0886022x.2024.2338484] [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: 11/22/2023] [Accepted: 03/29/2024] [Indexed: 06/05/2024] Open
Abstract
Critically ill COVID-19 patients may exhibit various clinical symptoms of renal dysfunction including severe Acute Kidney Injury (AKI). Currently, there is a lack of bibliometric analyses on COVID-19-related AKI. The aim of this study is to provide an overview of the current research status and hot topics regarding COVID-19 AKI. The literature was retrieved from the Web of Science Core Collection (WoSCC) database. Subsequently, we utilized Microsoft Excel, VOSviewer, Citespace, and Pajek software to revealed the current research status, emerging topics, and developmental trends pertaining to COVID-19 AKI. This study encompassed a total of 1507 studies on COVID-19 AKI. The United States, China, and Italy emerged as the leading three countries in terms of publication numbers, contributing 498 (33.05%), 229 (15.20%), and 140 (9.29%) studies, respectively. The three most active and influential institutions include Huazhong University of Science and Technology, Wuhan University and Harvard Medical School. Ronco C from Italy, holds the record for the highest number of publications, with a total of 15 papers authored. Cheng YC's work from China has garnered the highest number of citations, totaling 470 citations. The co-occurrence analysis of author keywords reveals that 'mortality', 'intensive care units', 'chronic kidney disease', 'nephrology', 'renal transplantation', 'acute respiratory distress syndrome', and 'risk factors' emerge as the primary areas of focus within the realm of COVID-19 AKI. In summary, this study analyzes the research trends in the field of COVID-19 AKI, providing a reference for further exploration and research on COVID-19 AKI mechanisms and treatment.
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Affiliation(s)
- Wen-Jing Zhao
- Department of Nephrology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Research Center of Intergated Traditional Chinese and Western Medicine, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Rui-Zhi Tan
- Research Center of Intergated Traditional Chinese and Western Medicine, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Jing Gao
- Department of Nephrology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Research Center of Intergated Traditional Chinese and Western Medicine, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Hongwei Su
- Department of Urology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Li Wang
- Research Center of Intergated Traditional Chinese and Western Medicine, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Jian Liu
- Department of Nephrology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Department of Nephrology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
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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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Borrego-Moreno JC, Cárdenas-de Luna MJ, Márquez-Castillo JC, Reyes-Ruiz JM, Osuna-Ramos JF, León-Juárez M, del Ángel RM, Rodríguez-Carlos A, Rivas-Santiago B, Farfan-Morales CN, García-Herrera AC, De Jesús-González LA. Acute Kidney Injury in the Context of COVID-19: An Analysis in Hospitalized Mexican Patients. Infect Dis Rep 2024; 16:458-471. [PMID: 38804444 PMCID: PMC11130795 DOI: 10.3390/idr16030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
During the COVID-19 pandemic, a considerable proportion of patients developed a severe condition that included respiratory failure, shock, or multiple organ dysfunction. Acute Kidney Injury (AKI) has been recognized as a possible cause of severe COVID-19 development. Given this, this study investigates the occurrence and consequences of AKI in Mexican patients to contribute to better knowledge and management of this problem. Methods: Using a retrospective observational cohort methodology, we investigated 313 cases from a cohort of 1019 patients diagnosed with COVID-19 at the IMSS Zacatecas General Hospital of Zone No. 1 in 2020. The prevalence of AKI was determined using the AKIN criteria based on serum creatinine levels and a detailed review of demographic characteristics, medical history, comorbidities, and clinical development. Results: The data showed a 25.30% prevalence of AKI among patients infected with severe COVID-19. Remarkably, these patients with AKI exhibited an advanced age (>65 years), arterial hypertension, a higher number of white blood cells during admission and the hospital stay, and elevated levels of C-reactive protein, serum creatinine, and blood urea nitrogen (BUN). Clinically, patients with AKI had signs of prostration, pneumonia, and the requirement for ventilatory assistance when compared to those without AKI. Finally, those diagnosed with AKI and COVID-19 had a 74% death rate. Relative risk analyses indicated that age (>65 years), arterial hypertension, high creatinine levels, endotracheal intubation, and pneumonia are associated with the development of AKI. On the other hand, among the protective factors against AKI, high hemoglobin levels and the consumption of statins during COVID-19 were found. Conclusions: The findings of this study underscore the significance of promptly identifying and effectively managing AKI to potentially alleviate the negative consequences of this complication within the Mexican population during COVID-19.
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Affiliation(s)
- Juan Carlos Borrego-Moreno
- Instituto Mexicano del Seguro Social, Hospital General de Zona # 1, Servicio de Epidemiologia, Zacatecas 98000, Mexico;
| | - María Julieta Cárdenas-de Luna
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar # 1, Servicio de Medicina Familiar, Guadalupe, Zacatecas 98608, Mexico;
| | - José Carlos Márquez-Castillo
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar # 57, Servicio de Medicina Familiar, Zacatecas 98085, Mexico;
| | - José Manuel Reyes-Ruiz
- División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional “Adolfo Ruiz Cortines”, Instituto Mexicano del Seguro Social (IMSS), Veracruz 91897, Mexico;
- Facultad de Medicina, Región Veracruz, Universidad Veracruzana (UV), Veracruz 91700, Mexico
| | | | - Moisés León-Juárez
- Laboratorio de Virología Perinatal y Diseño Molecular de Antígenos y Biomarcadores, Departamento de Inmunobioquímica, Instituto Nacional de Perinatología, Mexico City 11000, Mexico;
| | - Rosa María del Ángel
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City 07360, Mexico;
| | - Adrián Rodríguez-Carlos
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas 98000, Mexico; (A.R.-C.); (B.R.-S.); (A.C.G.-H.)
| | - Bruno Rivas-Santiago
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas 98000, Mexico; (A.R.-C.); (B.R.-S.); (A.C.G.-H.)
| | - Carlos Noe Farfan-Morales
- Departamento de Ciencias Naturales, Universidad Autónoma Metropolitana (UAM), Unidad Cuaji-malpa, Mexico City 05348, Mexico;
| | - Ana Cristina García-Herrera
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas 98000, Mexico; (A.R.-C.); (B.R.-S.); (A.C.G.-H.)
| | - Luis Adrián De Jesús-González
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas 98000, Mexico; (A.R.-C.); (B.R.-S.); (A.C.G.-H.)
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Godi I, Pasin L, Ballin A, Martelli G, Bonanno C, Terranova F, Tamburini E, Simoni C, Randon G, Franchetti N, Cattarin L, Nalesso F, Calò L, Tiberio I. Long-term outcome of COVID-19 patients with acute kidney injury requiring kidney replacement therapy. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:32. [PMID: 38725050 PMCID: PMC11083751 DOI: 10.1186/s44158-024-00163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Limited data existed on the burden of coronavirus disease 2019 (COVID-19) renal complications and the outcomes of the most critical patients who required kidney replacement therapy (KRT) during intensive care unit (ICU) stay. We aimed to describe mortality and renal function at 90 days in patients admitted for COVID-19 and KRT. METHODS A retrospective cohort study of critically ill patients admitted for COVID-19 and requiring KRT from March 2020 to January 2022 was conducted in an Italian ICU from a tertiary care hospital. Primary outcome was mortality at 90 days and secondary outcome was kidney function at 90 days. RESULTS A cohort of 45 patients was analyzed. Mortality was 60% during ICU stay and increased from 64% at the time of hospital discharge to 71% at 90 days. Among 90-day survivors, 31% required dialysis, 38% recovered incompletely, and 31% completely recovered renal function. The probability of being alive and dialysis-free at 3 months was 22%. CONCLUSIONS Critically ill patients with COVID-19 disease requiring KRT during ICU stay had elevated mortality rate at 90 days, with low probability of being alive and dialysis-free at 3 months. However, a non-negligible number of patients completely recovered renal function.
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Affiliation(s)
- Ilaria Godi
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy.
| | - Laura Pasin
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy
| | - Andrea Ballin
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy
| | - Gabriele Martelli
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy
| | - Claudio Bonanno
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy
| | - Francesco Terranova
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy
| | - Enrico Tamburini
- Department of Medicine, Section of Anesthesiology and Critical Care, University of Padua, Padua, Italy
| | - Caterina Simoni
- Department of Medicine, Section of Anesthesiology and Critical Care, University of Padua, Padua, Italy
| | - Ginevra Randon
- Department of Medicine, Section of Anesthesiology and Critical Care, University of Padua, Padua, Italy
| | - Nicola Franchetti
- Department of Medicine, Section of Anesthesiology and Critical Care, University of Padua, Padua, Italy
| | - Leda Cattarin
- Department of Nephrology and Dialysis, University Hospital of Padua, Padua, Italy
| | - Federico Nalesso
- Department of Nephrology and Dialysis, University Hospital of Padua, Padua, Italy
| | - Lorenzo Calò
- Department of Nephrology and Dialysis, University Hospital of Padua, Padua, Italy
| | - Ivo Tiberio
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy
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Ooi SH, Ng KP, Sthaneshwar P, Lim SK, Khor PY, Lim JY, Siow WS, Lim KW, Azlan M. A study of hospitalized COVID-19 patients with AKI in a setting of multiracial developing country. BMC Nephrol 2024; 25:122. [PMID: 38580977 PMCID: PMC10998399 DOI: 10.1186/s12882-024-03498-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: 04/23/2023] [Accepted: 02/12/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The commonest indication for hospitalization in COVID-19 patients is hypoxemia or severe respiratory symptoms. However, COVID-19 disease may result in extrapulmonary complications including kidney-related pathology. The reported incidence of renal involvement related to COVID infection varies based on geographical location. OBJECTIVE This study aimed to assess the incidence rate of AKI in hospitalized COVID-19 patients and identify risk factors and prognostic predictors. METHOD In this retrospective study, we recruited hospitalized COVID-19 patients from January 2021 until June 2021 at the University Malaya Medical Center. The inclusion criteria were hospitalized for ≥ 48 h with confirmed COVID-19 infection and at least 18 years old. Patient demographic and clinical data were collected from electronic medical records. The staging of AKI was based on criteria as per KDIGO guidelines. RESULTS One thousand five hundred twenty-nine COVID patients fulfilled the inclusion criteria with a male-to-female ratio of 759 (49.6%) to 770 (50.3%). The median age was 55 (IQR: 36-66). 500 patients (32.7%) had diabetes, 621 (40.6%) had hypertension, and 5.6% (n = 85) had pre-existing chronic kidney disease (CKD). The incidence rate of AKI was 21.1% (n = 323). The percentage of COVID patients in different AKI stages of 1,2 and 3 were 16.3%, 2.1%, and 2.7%, respectively. Fifteen hospitalized patients (0.98%) required renal replacement therapy. 58.8% (n = 190) of AKI group had complete recovery of kidney function. Demographic factors included age (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.012), CKD (p < 0.001), and vaccination status (p = 0.042) were associated with an increased risk of developing AKI. We found that the AKI cohort had statistically significant lower platelet counts and higher ferritin levels than the non-AKI cohort. AKI is a risk predictor of prolonged hospitalization (p < 0.001) and higher mortality rates (P < 0.001). CONCLUSION AKI is a common clinical complication among hospitalized COVID-19 patients. The etiology of AKI is multifactorial and may have an adverse impact on patient morbidity and mortality.
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Affiliation(s)
- S H Ooi
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - K P Ng
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia.
| | | | - S K Lim
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - P Y Khor
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - J Y Lim
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - W S Siow
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - K W Lim
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Muhummad Azlan
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
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Naidu AS, Wang CK, Rao P, Mancini F, Clemens RA, Wirakartakusumah A, Chiu HF, Yen CH, Porretta S, Mathai I, Naidu SAG. Precision nutrition to reset virus-induced human metabolic reprogramming and dysregulation (HMRD) in long-COVID. NPJ Sci Food 2024; 8:19. [PMID: 38555403 PMCID: PMC10981760 DOI: 10.1038/s41538-024-00261-2] [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: 10/12/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
SARS-CoV-2, the etiological agent of COVID-19, is devoid of any metabolic capacity; therefore, it is critical for the viral pathogen to hijack host cellular metabolic machinery for its replication and propagation. This single-stranded RNA virus with a 29.9 kb genome encodes 14 open reading frames (ORFs) and initiates a plethora of virus-host protein-protein interactions in the human body. These extensive viral protein interactions with host-specific cellular targets could trigger severe human metabolic reprogramming/dysregulation (HMRD), a rewiring of sugar-, amino acid-, lipid-, and nucleotide-metabolism(s), as well as altered or impaired bioenergetics, immune dysfunction, and redox imbalance in the body. In the infectious process, the viral pathogen hijacks two major human receptors, angiotensin-converting enzyme (ACE)-2 and/or neuropilin (NRP)-1, for initial adhesion to cell surface; then utilizes two major host proteases, TMPRSS2 and/or furin, to gain cellular entry; and finally employs an endosomal enzyme, cathepsin L (CTSL) for fusogenic release of its viral genome. The virus-induced HMRD results in 5 possible infectious outcomes: asymptomatic, mild, moderate, severe to fatal episodes; while the symptomatic acute COVID-19 condition could manifest into 3 clinical phases: (i) hypoxia and hypoxemia (Warburg effect), (ii) hyperferritinemia ('cytokine storm'), and (iii) thrombocytosis (coagulopathy). The mean incubation period for COVID-19 onset was estimated to be 5.1 days, and most cases develop symptoms after 14 days. The mean viral clearance times were 24, 30, and 39 days for acute, severe, and ICU-admitted COVID-19 patients, respectively. However, about 25-70% of virus-free COVID-19 survivors continue to sustain virus-induced HMRD and exhibit a wide range of symptoms that are persistent, exacerbated, or new 'onset' clinical incidents, collectively termed as post-acute sequelae of COVID-19 (PASC) or long COVID. PASC patients experience several debilitating clinical condition(s) with >200 different and overlapping symptoms that may last for weeks to months. Chronic PASC is a cumulative outcome of at least 10 different HMRD-related pathophysiological mechanisms involving both virus-derived virulence factors and a multitude of innate host responses. Based on HMRD and virus-free clinical impairments of different human organs/systems, PASC patients can be categorized into 4 different clusters or sub-phenotypes: sub-phenotype-1 (33.8%) with cardiac and renal manifestations; sub-phenotype-2 (32.8%) with respiratory, sleep and anxiety disorders; sub-phenotype-3 (23.4%) with skeleto-muscular and nervous disorders; and sub-phenotype-4 (10.1%) with digestive and pulmonary dysfunctions. This narrative review elucidates the effects of viral hijack on host cellular machinery during SARS-CoV-2 infection, ensuing detrimental effect(s) of virus-induced HMRD on human metabolism, consequential symptomatic clinical implications, and damage to multiple organ systems; as well as chronic pathophysiological sequelae in virus-free PASC patients. We have also provided a few evidence-based, human randomized controlled trial (RCT)-tested, precision nutrients to reset HMRD for health recovery of PASC patients.
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Affiliation(s)
- A Satyanarayan Naidu
- Global Nutrition Healthcare Council (GNHC) Mission-COVID, Yorba Linda, CA, USA.
- N-terminus Research Laboratory, 232659 Via del Rio, Yorba Linda, CA, 92887, USA.
| | - Chin-Kun Wang
- Global Nutrition Healthcare Council (GNHC) Mission-COVID, Yorba Linda, CA, USA
- School of Nutrition, Chung Shan Medical University, 110, Section 1, Jianguo North Road, Taichung, 40201, Taiwan
| | - Pingfan Rao
- Global Nutrition Healthcare Council (GNHC) Mission-COVID, Yorba Linda, CA, USA
- College of Food and Bioengineering, Fujian Polytechnic Normal University, No.1, Campus New Village, Longjiang Street, Fuqing City, Fujian, China
| | - Fabrizio Mancini
- Global Nutrition Healthcare Council (GNHC) Mission-COVID, Yorba Linda, CA, USA
- President-Emeritus, Parker University, 2540 Walnut Hill Lane, Dallas, TX, 75229, USA
| | - Roger A Clemens
- Global Nutrition Healthcare Council (GNHC) Mission-COVID, Yorba Linda, CA, USA
- University of Southern California, Alfred E. Mann School of Pharmacy/D. K. Kim International Center for Regulatory & Quality Sciences, 1540 Alcazar St., CHP 140, Los Angeles, CA, 90089, USA
| | - Aman Wirakartakusumah
- International Union of Food Science and Technology (IUFoST), Guelph, ON, Canada
- IPMI International Business School Jakarta; South East Asian Food and Agriculture Science and Technology, IPB University, Bogor, Indonesia
| | - Hui-Fang Chiu
- Department of Chinese Medicine, Taichung Hospital, Ministry of Health & Well-being, Taichung, Taiwan
| | - Chi-Hua Yen
- Department of Family and Community Medicine, Chung Shan Medical University Hospital; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Sebastiano Porretta
- Global Nutrition Healthcare Council (GNHC) Mission-COVID, Yorba Linda, CA, USA
- President, Italian Association of Food Technology (AITA), Milan, Italy
- Experimental Station for the Food Preserving Industry, Department of Consumer Science, Viale Tanara 31/a, I-43121, Parma, Italy
| | - Issac Mathai
- Global Nutrition Healthcare Council (GNHC) Mission-COVID, Yorba Linda, CA, USA
- Soukya International Holistic Health Center, Whitefield, Bengaluru, India
| | - Sreus A G Naidu
- Global Nutrition Healthcare Council (GNHC) Mission-COVID, Yorba Linda, CA, USA
- N-terminus Research Laboratory, 232659 Via del Rio, Yorba Linda, CA, 92887, USA
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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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8
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Zacchetti L, Brivio M, Mezzapesa M, Martinelli A, Punzi V, Monti M, Marchesi F, Scarpa L, Zangari R, Longhi L, Raimondi F, Novelli L, Gritti P, Grazioli L, Villa G, Lorini LF. The Effect of Positive Pressure Ventilation on Acute Kidney Injury in COVID-19 Patients with Acute Respiratory Distress Syndrome: An Observational Study. Blood Purif 2024; 53:396-404. [PMID: 38402859 DOI: 10.1159/000536285] [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: 06/08/2023] [Accepted: 01/11/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Acute kidney injury (AKI) is frequent in critically ill COVID-19 patients and is associated with a higher mortality risk. By increasing intrathoracic pressure, positive pressure ventilation (PPV) may reduce renal perfusion pressure by reducing venous return to the heart or by increasing renal venous congestion. This study's aim was to evaluate the association between AKI and haemodynamic and ventilatory parameters in COVID-19 patients with ARDS. METHODS This is a single-centre retrospective observational study. Consecutive patients diagnosed with COVID-19 who met ARDS criteria and required invasive mechanical ventilation were enrolled. The relationship between respiratory and haemodynamic parameters influenced by PPV and AKI development was evaluated. AKI was defined according to KDIGO criteria. AKI recovery was evaluated a month after ICU admission and patients were classified as "recovered," if serum creatinine (sCr) value returned to baseline, or as having "acute kidney disease" (AKD), if criteria for AKI stage 1 or greater persisted. The 6-month all-cause mortality was collected. RESULTS A total of 144 patients were included in the analysis. AKI occurred in 69 (48%) patients and 26 (18%) required renal replacement therapy. In a multivariate logistic regression analysis, sex, hypertension, cumulative dose of furosemide, fluid balance, and plateau pressure were independently associated with AKI. Mortality at 6 months was 50% in the AKI group and 32% in the non-AKI group (p = 0.03). Among 36 patients who developed AKI and were discharged alive from the hospital, 56% had a full renal recovery after a month, while 14%, 6%, and 14% were classified as having an AKD of stage 0, 2, and 3, respectively. CONCLUSIONS In our cohort, AKI was independently associated with multiple variables, including high plateau pressure, suggesting a possible role of PPV on AKI development. Further studies are needed to clarify the role of mechanical ventilation on renal function.
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Affiliation(s)
- Lucia Zacchetti
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Matteo Brivio
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mario Mezzapesa
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alessandra Martinelli
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Veronica Punzi
- Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Martina Monti
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Federica Marchesi
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Laura Scarpa
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rosalia Zangari
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca Longhi
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Federico Raimondi
- Pulmonary Medicine Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca Novelli
- Pulmonary Medicine Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Gritti
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo Grazioli
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gianluca Villa
- Department of Health Sciences, Section of Anesthesiology, Intensive Care and Pain Medicine, University of Florence, Florence, Italy,
- Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria Careggi, Florence, Italy,
| | - Luca Ferdinando Lorini
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
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9
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Rubin S, Orieux A, Prezelin-Reydit M, Garric A, Picard Y, Mellati N, Le Gall L, Dewitte A, Prevel R, Gruson D, Louis G, Boyer A. Impact of dexamethasone in severe COVID-19-induced acute kidney injury: a multicenter cohort study. Ann Intensive Care 2024; 14:26. [PMID: 38349530 PMCID: PMC10864230 DOI: 10.1186/s13613-024-01258-6] [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: 08/11/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) in intensive care unit (ICU) patients with severe COVID-19 is common (> 50%). A specific inflammatory process has been suggested in the pathogenesis of AKI, which could be improved by dexamethasone (DXM). In a small monocenter study (n = 100 patients), we reported a potential protective effect of DXM on the risk of AKI. This study aimed to investigate the preventive impact of DXM on AKI in a multicenter study of patients with severe COVID-19. METHODS We conducted a multicenter study in three French ICUs from March 2020 to August 2021. All patients admitted to ICU for severe COVID-19 were included. Individuals with preexistent AKI or DXM administration before admission to ICU were excluded. While never used during the first wave, DXM was used subsequently at ICU entry, providing two treatment groups. Multivariate Cause-specific Cox models taking into account changes in ICU practices over time, were utilized to determine the association between DXM and occurrence of AKI. RESULTS Seven hundred and ninety-eight patients were included. Mean age was 62.6 ± 12.1 years, 402/798 (50%) patients had hypertension, and 46/798 (6%) had previous chronic kidney disease. Median SOFA was 4 [3-6] and 420/798 (53%) required invasive mechanical ventilation. ICU mortality was 208/798 (26%). AKI was present in 598/798 (75%) patients: 266/598 (38%), 163/598 (27%), and 210/598 (35%) had, respectively, AKI KDIGO 1, 2, 3, and 61/598 (10%) patients required renal replacement therapy. Patients receiving DXM had a significantly decreased hazard of AKI occurrence compared to patients without DXM (HR 0.67; 95CI 0.55-0.81). These results were consistent in analyses that (1) excluded patients with DXM administration to AKI onset delay of less than 12 h, (2) incorporating the different 'waves' of the COVID-19 pandemic. CONCLUSIONS DXM was associated with a decrease in the risk of AKI in severe COVID-19 patients admitted to ICU. This supports the hypothesis that the inflammatory injury of AKI may be preventable.
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Affiliation(s)
- Sébastien Rubin
- Service de Néphrologie, Transplantation, Dialyse, Aphérèses, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France.
- Univ. Bordeaux, INSERM, BMC, U1034, F-33600, Pessac, France.
| | - Arthur Orieux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Mathilde Prezelin-Reydit
- Maison du REIN-AURAD Aquitaine, Gradignan, France
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Univ. Bordeaux, Bordeaux, France
| | - Antoine Garric
- Service de Néphrologie, Transplantation, Dialyse, Aphérèses, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Yoann Picard
- Service de Réanimation Polyvalente, CHR Metz, Thionville, Hôpital de Mercy, Ars-Laquenexy, France
| | - Nouchan Mellati
- Service de Réanimation Polyvalente, CHR Metz, Thionville, Hôpital de Mercy, Ars-Laquenexy, France
| | - Lisa Le Gall
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Univ. Bordeaux, Bordeaux, France
| | - Antoine Dewitte
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, CHU de Bordeaux, Pessac, France
| | - Renaud Prevel
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
- Univ. Bordeaux, INSERM, CRCTB, U 1045, F-33000, Bordeaux, France
| | - Didier Gruson
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
- Univ. Bordeaux, INSERM, CRCTB, U 1045, F-33000, Bordeaux, France
| | - Guillaume Louis
- Service de Réanimation Polyvalente, CHR Metz, Thionville, Hôpital de Mercy, Ars-Laquenexy, France
| | - Alexandre Boyer
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
- Univ. Bordeaux, INSERM, CRCTB, U 1045, F-33000, Bordeaux, France
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10
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Obrișcă B, Mocanu V, Vornicu A, Jurubiță R, Sorohan B, Dimofte G, Achim C, Andronesi A, Micu G, Bobeică R, Caceaune N, Procop A, Herlea V, Gherghiceanu M, Ismail G. The impact of SARS-CoV-2 infection on renal function in patients with biopsy-proven kidney diseases. PLoS One 2023; 18:e0296168. [PMID: 38134019 PMCID: PMC10745175 DOI: 10.1371/journal.pone.0296168] [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: 08/15/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND We sought to evaluate the long-term effects of COVID-19 on renal function in patients with biopsy-proven kidney diseases. METHODS A total of 451 patients with biopsy-proven kidney disease and at least 12 months of follow-up subsequent to COVID-19 pandemic onset were included in the study. The primary study endpoint was a composite of a persistent decline of more than 30% in eGFR or ESRD. RESULTS 23.1% of patients had COVID-19 during a follow-up period of 2.5 y (0.8-2.6), while 17.6% of patients reached the composite endpoint. Those with COVID-19 were more likely to reach the composite endpoint [26.7% vs. 14.8%; OR, 2.1 (95%CI, 1.23-3.58), p = 0.006). There was a significant eGFR change in the first year of follow-up between the two study groups [-2.24 (95%CI,-4.86; 0.37) vs. +2.31 (95%CI, 0.78; 3.85) ml/min, p = 0.004], with an adjusted mean difference of -4.68 ml/min (95%CI,-7.7; -1.59)(p = 0.03). The trend for worse renal outcomes remained consistent in patients with IgAN, MN and FSGS, but not in those with LN. After multivariate adjustment, the independent predictors of the composite endpoint were baseline eGFR (HR, 0.94; 95%CI, 0.92-0.95), COVID-19 (HR, 1.91; 1.16-3.12) and male gender (HR, 1.64; 95%CI, 1.01-2.66). In multivariate linear regression analysis, COVID-19 independently determined a reduction of eGFR at 12 months by 4.62 ml/min/1.73m2 (β coefficient, -4.62; 95%CI, -7.74 to -1.5, p = 0.004). CONCLUSIONS There is a significant impact of COVID-19 on long-term renal function in patients with biopsy-proven kidney diseases, leading to a greater decline of eGFR and a worse renal survival.
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Affiliation(s)
- Bogdan Obrișcă
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Valentin Mocanu
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Alexandra Vornicu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Roxana Jurubiță
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Bogdan Sorohan
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - George Dimofte
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Camelia Achim
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Andreea Andronesi
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Georgia Micu
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Raluca Bobeică
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Nicu Caceaune
- Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Alexandru Procop
- Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania
| | - Vlad Herlea
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihaela Gherghiceanu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- 5”Victor Babes” National Institute of Pathology, Bucharest, Romania
| | - Gener Ismail
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
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11
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Sitina M, Sramek V, Helan M, Suk P. Prognostic significance of early acute kidney injury in COVID-19 patients requiring mechanical ventilation: a single-center retrospective analysis. Ren Fail 2023; 45:2205954. [PMID: 37133859 PMCID: PMC10158536 DOI: 10.1080/0886022x.2023.2205954] [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: 05/04/2023] Open
Abstract
Acute kidney injury (AKI) is associated with impaired outcomes in critically ill COVID-19 patients. However, the prognostic significance of early AKI is poorly described. We aimed to determine whether AKI on admission to the intensive care unit (ICU) and its development within the first 48 h predict the need for renal replacement therapy (RRT) and increased mortality. An analysis of 372 patients with COVID-19 pneumonia requiring mechanical ventilation without advanced chronic kidney disease from 2020 to 2021 was performed. The AKI stages on ICU admission and Day 2 were determined using adapted KDIGO criteria. The early development of renal function was assessed by the change in AKI score and the Day-2/Day-0 creatinine ratio. Data were compared between three consecutive COVID-19 waves and with data before the pandemic. Both ICU and 90-day mortality (79% and 93% vs. 35% and 44%) and the need for RRT increased markedly with advanced AKI stage on ICU admission. Similarly, an early increase in AKI stage and creatinine implied highly increased mortality. RRT was associated with very high ICU and 90-day mortality (72% and 85%), even surpassing that of patients on ECMO. No difference was found between consecutive COVID-19 waves, except for a lower mortality in the patients on RRT in the last omicron wave. Mortality and need for RRT were comparable in the COVID-19 and pre-COVID-19 patients, except that RRT did not increase ICU mortality in the pre-COVID-19 era. In conclusion, we confirmed the prognostic significance of both AKI on ICU admission and its early development in patients with severe COVID-19 pneumonia.
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Affiliation(s)
- Michal Sitina
- Department of Anesthesiology and Intensive Care Medicine, St. Anne's University Hospital Brno, Brno, Czech Republic
- Biostatistics, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vladimir Sramek
- Department of Anesthesiology and Intensive Care Medicine, St. Anne's University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Helan
- Department of Anesthesiology and Intensive Care Medicine, St. Anne's University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Intensive Care Research, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Pavel Suk
- Department of Anesthesiology and Intensive Care Medicine, St. Anne's University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Intensive Care Research, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
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12
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Mayerhöfer T, Perschinka F, Klein SJ, Peer A, Lehner GF, Bellmann R, Gasteiger L, Mittermayr M, Breitkopf R, Eschertzhuber S, Mathis S, Fiala A, Fries D, Ströhle M, Foidl E, Hasibeder W, Helbok R, Kirchmair L, Stögermüller B, Krismer C, Heiner T, Ladner E, Thomé C, Preuß-Hernandez C, Mayr A, Potocnik M, Reitter B, Brunner J, Zagitzer-Hofer S, Ribitsch A, Joannidis M. Incidence, risk factors and outcome of acute kidney injury in critically ill COVID-19 patients in Tyrol, Austria: a prospective multicenter registry study. J Nephrol 2023; 36:2531-2540. [PMID: 37837501 PMCID: PMC10703973 DOI: 10.1007/s40620-023-01760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/06/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Acute kidney injury is a frequent complication in critically ill patients with and without COVID-19. The aim of this study was to evaluate the incidence of, and risk factors for, acute kidney injury and its effect on clinical outcomes of critically ill COVID-19 patients in Tyrol, Austria. METHODS This multicenter prospective registry study included adult patients with a SARS-CoV-2 infection confirmed by polymerase chain reaction, who were treated in one of the 12 dedicated intensive care units during the COVID-19 pandemic from February 2020 until May 2022. RESULTS In total, 1042 patients were included during the study period. The median age of the overall cohort was 66 years. Of the included patients, 267 (26%) developed acute kidney injury during their intensive care unit stay. In total, 12.3% (n = 126) required renal replacement therapy with a median duration of 9 (IQR 3-18) days. In patients with acute kidney injury the rate of invasive mechanical ventilation was significantly higher with 85% (n = 227) compared to 41% (n = 312) in the no acute kidney injury group (p < 0.001). The most important risk factors for acute kidney injury were invasive mechanical ventilation (OR = 4.19, p < 0.001), vasopressor use (OR = 3.17, p < 0.001) and chronic kidney disease (OR = 2.30, p < 0.001) in a multivariable logistic regression analysis. Hospital and intensive care unit mortality were significantly higher in patients with acute kidney injury compared to patients without acute kidney injury (Hospital mortality: 52.1% vs. 17.2%, p < 0.001, ICU-mortality: 47.2% vs. 14.7%, p < 0.001). CONCLUSION As in non-COVID-19 patients, acute kidney injury is clearly associated with increased mortality in critically ill COVID-19 patients. Among known risk factors, invasive mechanical ventilation has been identified as an independent and strong predictor of acute kidney injury.
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Affiliation(s)
- Timo Mayerhöfer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Fabian Perschinka
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sebastian J Klein
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Internal Medicine II, Gastroenterology, Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, St. Pölten, Austria
| | - Andreas Peer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Georg F Lehner
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Romuald Bellmann
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Lukas Gasteiger
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Mittermayr
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Robert Breitkopf
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | - Simon Mathis
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Fiala
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Dietmar Fries
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Mathias Ströhle
- Department of Anesthesia and Intensive Care Medicine, Hospital Kufstein, Kufstein, Austria
| | - Eva Foidl
- Department of Anesthesia and Intensive Care Medicine, Hospital Kufstein, Kufstein, Austria
| | - Walter Hasibeder
- Department of Anesthesiology and Critical Care Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
| | - Lukas Kirchmair
- Department of Anesthesia and Critical Care Medicine, Hospital Schwaz, Schwaz, Austria
| | - Birgit Stögermüller
- Department of Anesthesia and Critical Care Medicine, Hospital Schwaz, Schwaz, Austria
| | - Christoph Krismer
- Department of Internal Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Tatjana Heiner
- Department of Anesthesia and Intensive Care Medicine, Hospital Reutte, Reutte, Austria
| | - Eugen Ladner
- Department of Anesthesia and Intensive Care Medicine, Hospital Reutte, Reutte, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | | | - Andreas Mayr
- Department of Anesthesia and Intensive Care Medicine, Hospital Lienz, Lienz, Austria
| | - Miriam Potocnik
- Department of Anesthesia and Intensive Care Medicine, Hospital St. Johann in Tyrol, St. Johann in Tyrol, Austria
| | - Bruno Reitter
- Department of Anesthesia and Intensive Care Medicine, Hospital St. Johann in Tyrol, St. Johann in Tyrol, Austria
| | - Jürgen Brunner
- Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
- Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria
| | | | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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13
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Zhang Y, Zhao Y, Wang J, Zheng X, Xu D, Lv J, Yang L. Long-term renal outcomes of patients with COVID-19: a meta-analysis of observational studies. J Nephrol 2023; 36:2441-2456. [PMID: 37787893 DOI: 10.1007/s40620-023-01731-8] [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: 04/14/2023] [Accepted: 07/03/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Kidney involvement is common in hospitalized coronavirus disease 2019 (COVID-19) patients during the acute phase, little is known about the long-term impact of COVID-19 on the kidney. METHODS This is a systematic review and meta-analysis on long-term renal outcomes among COVID-19 patients. We carried out a systematic literature search in PUBMED, EMBASE, SCOPUS, and Cochrane COVID-19 study register and performed the random-effects meta-analysis of rates. The search was last updated on November 23, 2022. RESULTS The study included 12 moderate to high-quality cohort studies involving 6976 patients with COVID-19-associated acute kidney injury and 5223 COVID-19 patients without acute kidney injury. The summarized long-term renal non-recovery rate, dialysis-dependent rate, and complete recovery rate among patients with COVID-19-associated AKI was 22% (12-33%), 6% (2-12%), and 63% (44-81%) during a follow-up of 90-326.5 days. Heterogeneity could be explained by differences in the prevalence of chronic kidney disease and proportion of acute kidney injury requiring renal replacement therapy using meta-regression; patients with more comorbidities or higher renal replacement therapy rate had higher non-recovery rates. The summarized long-term kidney function decrease rate among patients without acute kidney injury was 22% (3-51%) in 90-199 days, with heterogeneity partially explained by severity of infection. CONCLUSION Patients with more comorbidities tend to have a higher renal non recovery rate after COVID-19-associated acute kidney injury; for COVID-19 patients without acute kidney injury, decrease in kidney function may occur during long-term follow-up. Regular evaluation of kidney function during the post-COVID-19 follow-up among high-risk patients may be necessary.
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Affiliation(s)
- Yuhui Zhang
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Youlu Zhao
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Jinwei Wang
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Xizi Zheng
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Damin Xu
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Jicheng Lv
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Li Yang
- Renal Division, Peking University First Hospital, Beijing, China.
- Institute of Nephrology, Peking University, Beijing, China.
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.
- Research Units of Diagnosis and Treatment of lmmune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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14
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Atiquzzaman M, Thompson JR, Shao S, Djurdjev O, Bevilacqua M, Wong MMY, Levin A, Birks PC. Long-term effect of COVID-19 infection on kidney function among COVID-19 patients followed in post-COVID-19 recovery clinics in British Columbia, Canada. Nephrol Dial Transplant 2023; 38:2816-2825. [PMID: 37349962 DOI: 10.1093/ndt/gfad121] [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: 12/05/2022] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND We investigated the effect of Post-Acute COVID Syndrome or "long-COVID" on kidney function among patients followed in post-COVID recovery clinics (PCRC) in British Columbia, Canada. METHODS Long-COVID patients referred to PCRC between July 2020 to April 2022, aged ≥18 years who had an estimated glomerular filtration rate (eGFR) value recorded at 3 months from the coronavirus disease 2019 (COVID-19) diagnosis (index) date were included. Those requiring renal replacement therapy prior to index date were excluded. Primary outcome was change in eGFR and urine albumin-creatinine ratio (UACR) after COVID-19 infection. The proportion of patients in each of the six eGFR categories (<30, 30-44, 45-59, 60-89, 90-120 and >120 mL/min/1.73 m2) and three UACR categories (<3, 3-30 and >30 mg/mmol) in all of the study time points were calculated. Linear mixed model was used to investigate change in eGFR over time. RESULTS The study sample included 2212 long-COVID patients. Median age was 56 years, 51% were male. Half (∼47%-50%) of the study sample had normal eGFR (≥90 mL/min/1.73 m2) from COVID-19 diagnosis to 12 months post-COVID and <5% of patients had an eGFR <30 mL/min/1.73 m2. There was an estimated 2.96 mL/min/1.73 m2 decrease in eGFR within 1 year after COVID-19 infection that was equivalent to 3.39% reduction from the baseline. Decline in eGFR was highest in patients hospitalized for COVID-19 (6.72%) followed by diabetic patients (6.15%). More than 40% of patients were at risk of CKD. CONCLUSIONS People with long-COVID experienced a substantial decline in eGFR within 1 year from the infection date. The prevalence of proteinuria appeared to be high. Close monitoring of kidney function is prudent among patients with persistent COVID-19 symptoms.
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Affiliation(s)
- Mohammad Atiquzzaman
- BC Renal, Vancouver, British Columbia, Canada
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordyn R Thompson
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Selena Shao
- BC Renal, Vancouver, British Columbia, Canada
| | - Ognjenka Djurdjev
- BC Renal, Vancouver, British Columbia, Canada
- Provincial Health Services Authority (PHSA), Vancouver, British Columbia, Canada
| | - Micheli Bevilacqua
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle M Y Wong
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adeera Levin
- BC Renal, Vancouver, British Columbia, Canada
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter C Birks
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Jozwiak M, Doyen D, Denormandie P, Goury A, Marey J, Pène F, Cariou A, Mira JP, Dellamonica J, Nguyen LS. Impact of sex differences on cardiac injury in critically ill patients with COVID-19. Respir Res 2023; 24:292. [PMID: 37986157 PMCID: PMC10662091 DOI: 10.1186/s12931-023-02581-5] [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: 09/09/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND COVID-19 infections are associated with accrued inflammatory responses which may result in cardiac injury. Immune response to infection appears different between men and women, suggesting that COVID-19 patients' outcomes may differ according to biological sex. However, the impact of biological sex on the occurrence of cardiac injury during intensive care unit (ICU) stay in COVID-19 patients remain unclear. METHODS In this multicenter and prospective study, we included consecutive patients admitted to ICU for severe COVID-19 pneumonia, during the first two pandemic waves. Biological, electrocardiogram (ECG) and echocardiographic variables were collected on ICU admission. Cardiac injury was defined by increased troponin above 99th percentile of upper norm value and newly diagnosed ECG and/or echocardiographic abnormalities. The primary endpoint was the proportion of patients with cardiac injury during ICU stay according to biological sex. The impact of biological sex on other subsequent clinical outcomes was also evaluated. RESULTS We included 198 patients with a median age of 66 (56-73) years, 147 (74%) patients were men and 51 (26%) were women. Overall, 119 (60%) patients had cardiac injury during ICU stay and the proportion of patients with cardiac injury during ICU stay was not different between men and women (60% vs. 61%, p = 1.00). Patients with cardiac injury during ICU stay showed more cardiovascular risk factors and chronic cardiac disease and had a higher ICU mortality rate. On ICU admission, they had a more marked lymphopenia (0.70 (0.40-0.80) vs. 0.80 (0.50-1.10) × 109/L, p < 0.01) and inflammation (C-Reactive Protein (155 (88-246) vs. 111 (62-192) mg/L, p = 0.03); D-Dimers (1293 (709-2523) vs. 900 (560-1813) µg/L, p = 0.03)). Plasmatic levels of inflammatory biomarkers on ICU admission correlated with SAPS-2 and SOFA scores but not with the different echocardiographic variables. Multivariate analysis confirmed cardiovascular risk factors (OR = 2.31; 95%CI (1.06-5.02), p = 0.03) and chronic cardiac disease (OR = 8.58; 95%CI (1.01-73.17), p = 0.04) were independently associated with the occurrence of cardiac injury during ICU stay, whereas biological sex (OR = 0.88; 95%CI (0.42-1.84), p = 0.73) was not. Biological sex had no impact on the occurrence during ICU stay of other clinical outcomes. CONCLUSIONS Most critically ill patients with COVID-19 were men and experienced cardiac injury during ICU stay. Nevertheless, biological sex had no impact on the occurrence of cardiac injury during ICU stay or on other clinical outcomes. Clinical trial registration NCT04335162.
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Affiliation(s)
- Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France.
- Université Paris Cité, Paris, France.
- UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.
| | - Denis Doyen
- UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Pierre Denormandie
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Antoine Goury
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Reims, Rue du Général Koenig, 51092, Reims, France
| | - Jonathan Marey
- Unité de Soins Intensifs Pneumologiques, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Frédéric Pène
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université Paris Cité, Paris, France
| | - Alain Cariou
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université Paris Cité, Paris, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université Paris Cité, Paris, France
| | - Jean Dellamonica
- UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Lee S Nguyen
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Recherche et Innovation, Groupe hospitalier privé Ambroise Paré, Hartmann, 48Ter Bd Victor Hugo, 92200, Neuilly-Sur-Seine, France
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La Rosa R, Grechi B, Ragazzi R, Alvisi V, Montanari G, Marangoni E, Volta CA, Spadaro S, Scaramuzzo G. Incidence and Determinants of Acute Kidney Injury after Prone Positioning in Severe COVID-19 Acute Respiratory Distress Syndrome. Healthcare (Basel) 2023; 11:2903. [PMID: 37958047 PMCID: PMC10647784 DOI: 10.3390/healthcare11212903] [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: 08/30/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Acute kidney injury (AKI) is common among critically ill COVID-19 patients, but its temporal association with prone positioning (PP) is still unknown, and no data exist on the possibility of predicting PP-associated AKI from bedside clinical variables. (2) Methods: We analyzed data from 93 COVID-19-related ARDS patients who underwent invasive mechanical ventilation (IMV) and at least one PP cycle. We collected hemodynamic variables, respiratory mechanics, and circulating biomarkers before, during, and after the first PP cycle. PP-associated AKI (PP-AKI) was defined as AKI diagnosed any time from the start of PP to 48 h after returning to the supine position. A t-test for independent samples was used to test for the differences between groups, while binomial logistical regression was performed to assess variables independently associated with PP-associated AKI. (3) Results: A total of 48/93 (52%) patients developed PP-AKI, with a median onset at 24 [13.5-44.5] hours after starting PP. No significant differences in demographic characteristics between groups were found. Before starting the first PP cycle, patients who developed PP-AKI had a significantly lower cumulative fluid balance (CFB), even when normalized for body weight (p = 0.006). Central venous pressure (CVP) values, measured before the first PP (OR 0.803, 95% CI [0.684-0.942], p = 0.007), as well as BMI (OR 1.153, 95% CI = [1.013-1.313], p = 0.031), were independently associated with the development of PP-AKI. In the multivariable regression analysis, a lower CVP before the first PP cycle was independently associated with ventilator-free days (OR 0.271, 95% CI [0.123-0.936], p = 0.011) and with ICU mortality (OR:0.831, 95% CI [0.699-0.989], p = 0.037). (4) Conclusions: Acute kidney injury occurs frequently in invasively ventilated severe COVID-19 ARDS patients undergoing their first prone positioning cycle. Higher BMI and lower CVP before PP are independently associated with the occurrence of AKI during prone positioning.
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Affiliation(s)
- Riccardo La Rosa
- Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (B.G.); (R.R.); (C.A.V.); (S.S.)
| | - Benedetta Grechi
- Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (B.G.); (R.R.); (C.A.V.); (S.S.)
| | - Riccardo Ragazzi
- Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (B.G.); (R.R.); (C.A.V.); (S.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
| | - Valentina Alvisi
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
| | - Giacomo Montanari
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
| | - Elisabetta Marangoni
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
| | - Carlo Alberto Volta
- Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (B.G.); (R.R.); (C.A.V.); (S.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
| | - Savino Spadaro
- Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (B.G.); (R.R.); (C.A.V.); (S.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
| | - Gaetano Scaramuzzo
- Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (B.G.); (R.R.); (C.A.V.); (S.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
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Nlandu Y, Makulo JR, Essig M, Sumaili E, Lumaka A, Engole Y, Mboliasa MF, Mokoli V, Tshiswaka T, Nkodila A, Bukabau J, Longo A, Kajingulu F, Zinga C, Nseka N. Factors associated with acute kidney injury (AKI) and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit: a single-center prospective study. Ren Fail 2023; 45:2263583. [PMID: 37870858 PMCID: PMC11001370 DOI: 10.1080/0886022x.2023.2263583] [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: 04/30/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a complication of severe coronavirus disease 2019 (COVID-19). Kidney damage associated with COVID-19 could take specific features due to environmental and socio-cultural factors. This study evaluates the incidence of AKI, the associated factors, and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit. METHODS In a prospective cohort study conducted in the intensive care unit (ICU) of the Centre Médical de Kinshasa (CMK), consecutive patients admitted for COVID-19 were screened for the presence of AKI between 27 March, 2020 and 27 January 2022. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. The primary outcome was occurrence of AKI. The secondary outcome was 48 days' mortality and recovery of the renal function at intensive care unit (ICU) discharge. Survival (time-to death) curves were built using the Kaplan Meier methods. Multivariate analyses were performed by logistic regression to identify factors associated with AKI and Cox regression to explore the association between AKI and in-hospital mortality. The significance level of the p-value was set at 0.05. RESULTS The median(IQR) sequential organ failure assessment score (SOFA) score and mean age of patients (215) including in our cohort were respectively 3(2-4) and 58.9 ± 14.9 years. The incidence of AKI was 28.4% with stages 1, 2, or 3 AKI accounted for 39.3%, 11.5%, and 49.2%, respectively. Hemodialysis was required in 16 out 215 (7.4%) patients. Dyspnea (adjusted odds ratio (aOR):2.27 [1.1--4.57] p = 0.021), SOFA ≥5 (aOR:3.11[1.29-7.53] p = 0.012), AST/ALT ratio (aOR: 1.53 [1.09-1.79] p = 0.015), N/L ratio (aOR:2.09 [1.09-3.20] p = 0.016), mechanical ventilation (aOR: 3.20 [1.66-10.51] p = 0.005) and Amikacin (aOR: 2.91 [1.37-6.18] p = 0.006) were the main factors associated with AKI. Patients with AKI had a mortality rate of 52.5% and 67.2% of the survivors did not recover kidney function at the end of hospitalization. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (HR:2.96 [1.93-4.65] p = 0.013) compared to non-AKI patients. CONCLUSIONS AKI was present in three out of ten COVID-19 patients. The most significant factors associated with AKI were dyspnea, SOFA ≥ 5, AST/ALT and N/L ratio, mechanical ventilation and Amikacin. AKI has been associated with an almost threefold increase in overall mortality and seven out of ten survivors did not recover kidney function after AKI.
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Affiliation(s)
- Yannick Nlandu
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Robert Makulo
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Marie Essig
- Nephrology Department, Ambroise Paré Hospital, AP-HP University Paris-Saclay, Boulogne-Billancourt, France
| | - Ernest Sumaili
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Aimé Lumaka
- Center for Human Genetics, Department of Pediatrics, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Yannick Engole
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Marie-France Mboliasa
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Vieux Mokoli
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Trésor Tshiswaka
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Aliocha Nkodila
- Department of Family Medicine and Primary Care, Protestant University in Congo, Kinshasa, Democratic Republic of Congo
| | - Justine Bukabau
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Augustin Longo
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - François Kajingulu
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Chantal Zinga
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nazaire Nseka
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Soto-Santillán P, Pazos-Pérez F, Anda-Garay JC, Silva-Rueda R, Castillo-Cruz J, Roy-García IA, Rivas-Ruiz R, Palma-Díaz E, Hernández-Rivera JCH, Paniagua-Sierra R. [Severe post-COVID-19 dialysis dependence and inpatient acute kidney injury]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:S372-S379. [PMID: 37934678 PMCID: PMC10730131 DOI: 10.5281/zenodo.8319782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/24/2023] [Indexed: 11/09/2023]
Abstract
Background COVID-19 challenged our health system, within the broad clinical spectrum acute kidney injury was presented as a catastrophic event, acute kidney injury and the risk of dependency after dialysis constitute a clinical problem with high repercussions in the funcionality. Objective To identify risk factors for dialysis dependence after acute kidney injury from COVID-19. Material and methods A retrospective observational cohort study was carried out at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI, of the Mexican Institute of Social Security, from March 2020 to March 2021. 317 patients were included, we performed descriptive statistics, we compared differences between the stages of acute kidney injury, finding a difference in obesity with a frequency of 2.2% in stage 1, 20.82% stage 2 and 14.51% stage 3, with p value = 0.018. Results We found dialysis dependence one year after hospital-acquired acute kidney injury induced by COVID-19 in 58 patients (18.9%), we analyzed by KDIGO stage, in those patients who had AKI KDIGO 1 (2.83%) it depended on dialysis at one year, in the KDIGO stage 2 (3.78%), in the KDIGO stage 3 (11.67%). Conclusions Our study allowed us to identify that the risk factors associated with dialysis dependence are: male gender, type 2 diabetes mellitus, obesity, cardiovascular disease.
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Affiliation(s)
- Pamela Soto-Santillán
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Servicio de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
- Instituto Politécnico Nacional, Escuela Superior de Medicina, Departamento de Posgrado, Maestría en Ciencias de la Salud. Ciudad de México, MéxicoInstituto Politécnico NacionalMéxico
| | - Fabiola Pazos-Pérez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Servicio de Nefrología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Juan Carlos Anda-Garay
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Servicio de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Rogelio Silva-Rueda
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Servicio de Nefrología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Juan Castillo-Cruz
- Instituto Politécnico Nacional, Escuela Superior de Medicina, Departamento de Posgrado, Maestría en Ciencias de la Salud. Ciudad de México, MéxicoInstituto Politécnico NacionalMéxico
| | - Ivonne Analí Roy-García
- Instituto Mexicano del Seguro Social, Centro de Adiestramiento en Investigación Clínica CAIC. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Rodolfo Rivas-Ruiz
- Instituto Mexicano del Seguro Social, Centro de Adiestramiento en Investigación Clínica CAIC. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Edwin Palma-Díaz
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Servicio de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Juan Carlos H Hernández-Rivera
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Unidad de Investigación en Enfermedades Nefrológicas. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Ramon Paniagua-Sierra
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Unidad de Investigación en Enfermedades Nefrológicas. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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19
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Sever MS, Luyckx V, Tonelli M, Kazancioglu R, Rodgers D, Gallego D, Tuglular S, Vanholder R. Disasters and kidney care: pitfalls and solutions. Nat Rev Nephrol 2023; 19:672-686. [PMID: 37479903 DOI: 10.1038/s41581-023-00743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
Patients with kidney disease, especially those with kidney failure, are particularly susceptible to the adverse effects of disasters because their survival depends on functional infrastructure, advanced technology, the availability of specific drugs and well-trained medical personnel. The risk of poor outcomes across the entire spectrum of patients with kidney diseases (acute kidney injury, chronic kidney disease and kidney failure on dialysis or with a functioning transplant) increases as a result of disaster-related logistical challenges. Patients who are displaced face even more complex problems owing to additional threats that arise during travel and after reaching their new location. Overall, risks may be mitigated by pre-disaster preparedness and training. Emergency kidney disaster responses depend on the type and severity of the disaster and include medical and/or surgical treatment of injuries, treatment of mental health conditions, appropriate diet and logistical interventions. After a disaster, patients should be evaluated for problems that were not detected during the event, including those that may have developed as a result of the disaster. A retrospective review of the disaster response is vital to prevent future mistakes. Important ethical concerns include fair distribution of limited resources and limiting harm. Patients with kidney disease, their care-givers, health-care providers and authorities should be trained to respond to the medical and logistical problems that occur during disasters to improve outcomes.
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Affiliation(s)
- Mehmet Sukru Sever
- Istanbul University, Istanbul School of Medicine, Department of Nephrology, Istanbul, Turkey.
| | - Valerie Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard, Medical School, Boston, MA, USA
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rumeyza Kazancioglu
- Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Darlene Rodgers
- Independent Nurse Consultant, American Society of Nephrology, Washington, DC, USA
| | - Dani Gallego
- European Kidney Health Alliance, Brussels, Belgium
- European Kidney Patient Federation, Wien, Austria
| | - Serhan Tuglular
- Marmara University, School of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
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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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21
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Bouguezzi N, Ben Saida I, Toumi R, Meddeb K, Ennouri E, Bedhiafi A, Hamdi D, Boussarsar M. Clinical Features and Outcomes of Acute Kidney Injury in Critically Ill COVID-19 Patients: A Retrospective Observational Study. J Clin Med 2023; 12:5127. [PMID: 37568528 PMCID: PMC10419665 DOI: 10.3390/jcm12155127] [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: 01/21/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND An alarming number of COVID-19 patients, especially in severe cases, have developed acute kidney injury (AKI). AIM The study aimed to assess the frequency, risk factors, and impact of AKI on mortality in critically ill COVID-19 patients. METHODS The study was a retrospective observational study conducted in the MICU. Univariate and multivariate analyses were performed to identify risk factors for AKI and clinical outcomes. RESULTS During the study period, 465 consecutive COVID-19 patients were admitted to the MICU. The patients' characteristics were median age, 64 [54-71] years; median SAPSII, 31 [24-38]; and invasive mechanical ventilation (IMV), 244 (52.5%). The overall ICU mortality rate was 49%. Two hundred twenty-nine (49.2%) patients developed AKI. The factors independently associated with AKI were positive fluid balance (OR, 2.78; 95%CI [1.88-4.11]; p < 0.001), right heart failure (OR, 2.15; 95%CI [1.25-3.67]; p = 0.005), and IMV use (OR, 1.55; 95%CI [1.01-2.40]; p = 0.044). Among the AKI patients, multivariate analysis identified the following factors as independently associated with ICU mortality: age (OR, 1.05; 95%CI [1.02-1.09]; p = 0.012), IMV use (OR, 48.23; 95%CI [18.05-128.89]; p < 0.001), and septic shock (OR, 3.65; 95%CI [1.32-10.10]; p = 0.012). CONCLUSION The present study revealed a high proportion of AKI among critically ill COVID-19 patients. This complication seems to be linked to a severe cardiopulmonary interaction and fluid balance management, thus accounting for a poor outcome.
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Affiliation(s)
- Nabil Bouguezzi
- Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, Farhat Hached University Hospital, Sousse 4000, Tunisia
| | - Imen Ben Saida
- Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, Farhat Hached University Hospital, Sousse 4000, Tunisia
| | - Radhouane Toumi
- Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, Farhat Hached University Hospital, Sousse 4000, Tunisia
| | - Khaoula Meddeb
- Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, Farhat Hached University Hospital, Sousse 4000, Tunisia
| | - Emna Ennouri
- Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, Farhat Hached University Hospital, Sousse 4000, Tunisia
| | - Amir Bedhiafi
- Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, Farhat Hached University Hospital, Sousse 4000, Tunisia
| | - Dhouha Hamdi
- Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, Farhat Hached University Hospital, Sousse 4000, Tunisia
| | - Mohamed Boussarsar
- Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, Farhat Hached University Hospital, Sousse 4000, Tunisia
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22
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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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23
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Lavrentieva A, Kaimakamis E, Voutsas V, Bitzani M. An observational study on factors associated with ICU mortality in Covid-19 patients and critical review of the literature. Sci Rep 2023; 13:7804. [PMID: 37179397 PMCID: PMC10182846 DOI: 10.1038/s41598-023-34613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
The novel pandemic caused by SARS-CoV-2 has been associated with increased burden on healthcare system. Recognizing the variables that independently predict death in COVID-19 is of great importance. The study was carried out prospectively in a single ICU in northern Greece. It was based on the collection of data during clinical practice in 375 adult patients who were tested positive for SARS-CoV-2 between April 2020 and February 2022. All patients were intubated due to acute respiratory insufficiency and received Invasive Mechanical Ventilation. The primary outcome was ICU mortality. Secondary outcomes were 28-day mortality and independent predictors of mortality at 28 days and during ICU hospitalization. For continuous variables with normal distribution, t-test was used for means comparison between two groups and one-way ANOVA for multiple comparisons. When the distribution was not normal, comparisons were performed using the Mann-Whitney test. Comparisons between discrete variables were made using the x2 test, whereas the binary logistic regression was employed for the definition of factors affecting survival inside the ICU and after 28 days. Of the total number of patients intubated due to COVID-19 during the study period, 239 (63.7%) were male. Overall, the ICU survival was 49.6%, whereas the 28-day survival reached 46.9%. The survival rates inside the ICU for the four main viral variants were 54.9%, 50.3%, 39.7% and 50% for the Alpha, Beta, Delta and Omicron variants, respectively. Logistic regressions for outcome revealed that the following parameters were independently associated with ICU survival: wave, SOFA @day1, Remdesivir use, AKI, Sepsis, Enteral Insufficiency, Duration of ICU stay and WBC. Similarly, the parameters affecting the 28-days survival were: duration of stay in ICU, SOFA @day1, WBC, Wave, AKI and Enteral Insufficiency. In this observational cohort study of critically ill COVID-19 patients we report an association between mortality and the wave sequence, SOFA score on admission, the use of Remdesivir, presence of AKI, presence of gastrointestinal failure, sepsis and WBC levels. Strengths of this study are the large number of critically ill COVID-19 patients included, and the comparison of the adjusted mortality rates between pandemic waves within a two year-study period.
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Affiliation(s)
- Athina Lavrentieva
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, 57010, Thessaloniki, Greece
| | - Evangelos Kaimakamis
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, 57010, Thessaloniki, Greece.
| | - Vassileios Voutsas
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, 57010, Thessaloniki, Greece
| | - Militsa Bitzani
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, 57010, Thessaloniki, Greece
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24
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Ruault A, Philipponnet C, Sapin V, Evrard B, Bouzgarrou R, Calvet L, Thouy F, Grapin K, Bonnet B, Adda M, Souweine B, Dupuis C. Epidemiology and Outcome of Early-Onset Acute Kidney Injury and Recovery in Critically Ill COVID-19 Patients: A Retrospective Analysis. Biomedicines 2023; 11:biomedicines11041001. [PMID: 37189619 DOI: 10.3390/biomedicines11041001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Background: The clinical significance of early-onset acute kidney injury (EO-AKI) and recovery in severe COVID-19 intensive care unit (ICU) patients is poorly documented. Objective: The aim of the study was to assess the epidemiology and outcome of EO-AKI and recovery in ICU patients admitted for SARS-CoV-2 pneumonia. Design: This was a retrospective single-centre study. Setting: The study was carried out at the medical ICU of the university hospital of Clermont-Ferrand, France. Patients: All consecutive adult patients aged ≥18 years admitted between 20 March 2020 and 31 August 2021 for SARS-CoV-2 pneumonia were enrolled. Patients with chronic kidney disease, referred from another ICU, and with an ICU length of stay (LOS) ≤72 h were excluded. Interventions: EO-AKI was defined on the basis of serum creatinine levels according to the Kidney Disease Improving Global Outcomes criteria, developing ≤7 days. Depending on renal recovery, defined by the normalization of serum creatinine levels, EO-AKI was transient (recovery within 48 h), persistent (recovery between 3 and 7 days) or AKD (no recovery within 7 days after EO-AKI onset). Measurements: Uni- and multivariate analyses were performed to determine factors associated with EO-AKI and EO-AKI recovery. Main Results: EO-AKI occurred in 84/266 (31.5%) study patients, of whom 42 (50%), 17 (20.2%) and 25 (29.7%) had EO-AKI stages 1, 2 and 3, respectively. EO-AKI was classified as transient, persistent and AKD in 40 (47.6%), 15 (17.8%) and 29 (34.6%) patients, respectively. The 90-day mortality was 87/244 (35.6%) and increased with EO-AKI occurrence and severity: no EO-AKI, 38/168 (22.6%); EO-AKI stage 1, 22/39 (56.4%); stage 2, 9/15 (60%); and stage 3, 18/22 (81.8%) (p < 0.01). The 90-day mortality in patients with transient or persistent AKI and AKD was 20/36 (55.6%), 8/14 (57.1%) and 21/26 (80.8%), respectively (p < 0.01). MAKE-90 occurred in 42.6% of all patients. Conclusions: In ICU patients admitted for SARS-CoV-2 pneumonia, the development of EO-AKI and time to recovery beyond day 7 of onset were associated with poor outcome.
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25
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Iglesias J, Vassallo A, Ilagan J, Ang SP, Udongwo N, Mararenko A, Alshami A, Patel D, Elbaga Y, Levine JS. Acute Kidney Injury Associated with Severe SARS-CoV-2 Infection: Risk Factors for Morbidity and Mortality and a Potential Benefit of Combined Therapy with Tocilizumab and Corticosteroids. Biomedicines 2023; 11:biomedicines11030845. [PMID: 36979824 PMCID: PMC10045336 DOI: 10.3390/biomedicines11030845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Background: Acute kidney injury (AKI) is a common complication in patients with severe COVID-19. Methods: We retrospectively reviewed 249 patients admitted to an intensive care unit (ICU) during the first wave of the pandemic to determine risk factors for AKI. Demographics, comorbidities, and clinical and outcome variables were obtained from electronic medical records. Results: Univariate analysis revealed older age, higher admission serum creatinine, elevated Sequential Organ Failure Assessment (SOFA) score, elevated admission D-Dimer, elevated CRP on day 2, mechanical ventilation, vasopressor requirement, and azithromycin usage as significant risk factors for AKI. Multivariate analysis demonstrated that higher admission creatinine (p = 0.0001, OR = 2.41, 95% CI = 1.56–3.70), vasopressor requirement (p = 0.0001, OR = 3.20, 95% CI = 1.69–5.98), elevated admission D-Dimer (p = 0.008, OR = 1.0001, 95% CI = 1.000–1.001), and elevated C-reactive protein (CRP) on day 2 (p = 0.033, OR = 1.0001, 95% CI = 1.004–1.009) were independent risk factors. Conversely, the combined use of Tocilizumab and corticosteroids was independently associated with reduced AKI risk (p = 0.0009, OR = 0.437, 95% CI = 0.23–0.81). Conclusion: This study confirms the high rate of AKI and associated mortality among COVID-19 patients admitted to ICUs and suggests a role for inflammation and/or coagulopathy in AKI development. One should consider the possibility that early administration of anti-inflammatory agents, as is now routinely conducted in the management of COVID-19-associated acute respiratory distress syndrome, may improve clinical outcomes in patients with AKI.
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Affiliation(s)
- Jose Iglesias
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
- Department of Nephrology, Community Medical Center, RWJBarnabas Health, Toms River, NJ 08757, USA
- Department of Medicine, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
- Correspondence:
| | - Andrew Vassallo
- Department of Pharmacy, Community Medical Center, RWJBarnabas Health, Toms River, NJ 08757, USA
| | - Justin Ilagan
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Song Peng Ang
- Department of Medicine, Community Medical Center, RWJBarnabas Health, Toms River, NJ 08757, USA
| | - Ndausung Udongwo
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Anton Mararenko
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Dylon Patel
- Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Yasmine Elbaga
- Department of Pharmacy, Monmouth Medical Center Southern Campus, RWJBarnabas Health, 600 River Ave., Lakewood, NJ 08701, USA
| | - Jerrold S. Levine
- Department of Medicine, Division of Nephrology, University of Illinois Chicago, Chicago, IL 60612, USA
- Department of Medicine, Division of Nephrology, Jesse Brown Veterans Affairs Medical Center, Chicago, IL 60612, USA
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26
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Schiffl H, Lang SM. Long-term interplay between COVID-19 and chronic kidney disease. Int Urol Nephrol 2023:10.1007/s11255-023-03528-x. [PMID: 36828919 PMCID: PMC9955527 DOI: 10.1007/s11255-023-03528-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE The COVID-19 pandemic may have an impact on the long-term kidney function of survivors. The clinical relevance is not clear. METHODS This review summarises the currently published data. RESULTS There is a bidirectional relationship between chronic kidney disease and COVID-19 disease. Chronic kidney diseases due to primary kidney disease or chronic conditions affecting kidneys increase the susceptibility to COVID-19 infection, the risks for progression and critical COVID-19 disease (with acute or acute-on-chronic kidney damage), and death. Patients who have survived COVID-19 face an increased risk of worse kidney outcomes in the post-acute phase of the disease. Of clinical significance, COVID-19 may predispose surviving patients to chronic kidney disease, independently of clinically apparent acute kidney injury (AKI). The increased risk of post-acute renal dysfunction of COVID-19 patients can be graded according to the severity of the acute infection (non-hospitalised, hospitalised or ICU patients). The burden of chronic kidney disease developing after COVID-19 is currently unknown. CONCLUSION Post-acute COVID-19 care should include close attention to kidney function. Future prospective large-scale studies are needed with long and complete follow-up periods, assessing kidney function using novel markers of kidney function/damage, urinalysis and biopsy studies.
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Affiliation(s)
- Helmut Schiffl
- Universitätsklinikum LMU München, Medizinische Klinik IV, München, Germany.
| | - Susanne M. Lang
- grid.275559.90000 0000 8517 6224Klinik für Innere Medizin V, Universitätsklinikum Jena, Jena, Germany
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27
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Eldaboosy SA, Awad A, Farouk A, Mahdy W, Abdelsalam E, Nour SO, Kabil A, Taha A, Makled S, Lotfi A, Nabway U, Kanany H. Acute kidney injury in Coronavirus disease-19 related pneumonia in the intensive care unit: a retrospective multicenter study, Saudi Arabia. Multidiscip Respir Med 2023; 18:895. [PMID: 36936197 PMCID: PMC10015944 DOI: 10.4081/mrm.2023.895] [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: 11/15/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Background Acute kidney injury (AKI) poses a significant morbidity and mortality risk to critically ill COVID-19 patients. The aim of this study was to investigate the incidence, predictors, and outcomes of AKI in patients admitted to the intensive care unit (ICU) with critically ill COVID-19 pneumonia. Methods A multicenter retrospective study in Saudi Arabia of adult patients aged at least 18 years diagnosed with COVID-19 pneumonia and admitted to the intensive care unit between May 2020 and May 2021 was conducted. The occurrence of AKI and associated risk factors, the need for continous renal replacement therapy (CRRT), and the outcome were reported. Results The study included 340 patients admitted to the ICU with COVID-19. Their mean age was 66.7±13.4 years, ranging from 49 to 84 years, and most of them were men (63.8%). The most common concomitant diseases were hypertension (71.5%), diabetes (62.4%), IHD (37.6%), CKD (20%), heart failure (19.4%), and 81.2% suffered from ARDS. AKI occurred in 60.3% of patients, 38% were stage 1, 16.6% were stage 2, and 45.4% were stage 3. Approximately, 39% of patients required CRRT, out of which 76.2% were stage 3, which was significantly higher than the other stages (p<0.001). AKI patients suffered significantly from asthma and had lower levels of C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and blood urea nitrogen (BUN) and higher creatinine levels than patients without AKI (p<0.05 all). The overall mortality rate was 39.4%, and the mortality rate was significantly higher in patients with AKI than in patients without AKI (48.3% versus 25.9%; p<0.001). Conclusion AKI is common in adults admitted to the ICU with COVID-19 and is associated with an increased risk of death. Early detection of AKI and appropriate treatment can positively impact COVID-19 outcome. CRRT is the preferred dialysis method in critically ill ICU patients with AKI.
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Affiliation(s)
- Safwat A.M. Eldaboosy
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
- Department of Pulmonary Medicine, Almoosa Specialist Hospital, box code 5098, Al Ahsa, Saudi Arabia, Tel. +966.590050316.
| | - Amgad Awad
- Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdullah Farouk
- Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
- Department of Critical Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Waheed Mahdy
- Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
- Department of Chest Diseases, Banha Faculty of Medicine, Banha, Egypt
| | - Eman Abdelsalam
- Department of Internal Medicine, Al-Azhar Faculty of Medicine for Girls, Cairo, Egypt
- King Khalid hospital, Hail, Saudi Arabia
| | - Sameh O. Nour
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Kabil
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmad Taha
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sameh Makled
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Lotfi
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Usama Nabway
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hatem Kanany
- Department of Anesthesia and Critical Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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28
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Hamza M, Alhujaily M, Alosaimi B, El Bakkouri K, AlDughaim MS, Alonazi M, Alanazi MA, Abbass B, Alshehri A, Al-Shouli ST, Alturaiki W, Awadalla M. Association between inflammatory cytokines/chemokines, clinical laboratory parameters, disease severity and in-hospital mortality in critical and mild COVID-19 patients without comorbidities or immune-mediated diseases. J Immunoassay Immunochem 2023; 44:13-30. [PMID: 35915975 DOI: 10.1080/15321819.2022.2104124] [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: 01/11/2023]
Abstract
There are limited data on inflammatory cytokines and chemokines; the humoral immune response; and main clinical laboratory parameters as indicators for disease severity and mortality in patients with critical and mild COVID-19 without comorbidities or immune-mediated diseases in Saudi Arabia. We determined the expression levels of major proinflammatory cytokines and chemokines; C-reactive protein (CRP); procalcitonin; SARS-CoV-2 IgM antibody and twenty-two clinical laboratory parameters and assessed their usefulness as indicators of disease severity and in-hospital death. Our results showed a significant increase in the expression levels of SARS-CoV-2 IgM antibody; IL1-β; IL-6; IL-8; TNF-α and CRP in critical COVID-19 patients; neutrophil count; urea; creatinine and troponin were also increased. The elevation of these biomarkers was significantly associated and positively correlated with in-hospital death in critical COVID-19 patients. Our results suggest that the levels of IL1-β; IL-6; IL-8; TNF-α; and CRP; neutrophil count; urea; creatinine; and troponin could be used to predict disease severity in COVID-19 patients without comorbidities or immune-mediated diseases. These inflammatory mediators could be used as predictive early biomarkers of COVID-19 disease deterioration; shock and death among COVID-19 patients without comorbidities or immune-mediated diseases.
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Affiliation(s)
- Muaawia Hamza
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia.,Faculty of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Muhanad Alhujaily
- Department of Clinical Laboratory, College of Applied Medicine, University of Bisha, Bisha, Saudi Arabia
| | - Bandar Alosaimi
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia.,Faculty of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Karim El Bakkouri
- Department Project Manage; Microbiology Department, Laboratoire national de santé, Dudelange, Luxembourg
| | | | - Mona Alonazi
- Biochemistry Department, College of Science, King Saud University, Saudi Arabia
| | - Mona Awad Alanazi
- Second Health Cluster, Ministry of Healt, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Basma Abbass
- Department of Biological Sciences, College of Science, University of Jeddah, Saudi Arabia
| | - Abdulsalam Alshehri
- Second Health Cluster, Ministry of Healt, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Samia T Al-Shouli
- Immunology Unit, Pathology department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Wael Alturaiki
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
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Tan BW, Tan BW, Tan AL, Schriver ER, Gutiérrez-Sacristán A, Das P, Yuan W, Hutch MR, García Barrio N, Pedrera Jimenez M, Abu-el-rub N, Morris M, Moal B, Verdy G, Cho K, Ho YL, Patel LP, Dagliati A, Neuraz A, Klann JG, South AM, Visweswaran S, Hanauer DA, Maidlow SE, Liu M, Mowery DL, Batugo A, Makoudjou A, Tippmann P, Zöller D, Brat GA, Luo Y, Avillach P, Bellazzi R, Chiovato L, Malovini A, Tibollo V, Samayamuthu MJ, Serrano Balazote P, Xia Z, Loh NHW, Chiudinelli L, Bonzel CL, Hong C, Zhang HG, Weber GM, Kohane IS, Cai T, Omenn GS, Holmes JH, Ngiam KY. Long-term kidney function recovery and mortality after COVID-19-associated acute kidney injury: An international multi-centre observational cohort study. EClinicalMedicine 2023; 55:101724. [PMID: 36381999 PMCID: PMC9640184 DOI: 10.1016/j.eclinm.2022.101724] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022] Open
Abstract
Background While acute kidney injury (AKI) is a common complication in COVID-19, data on post-AKI kidney function recovery and the clinical factors associated with poor kidney function recovery is lacking. Methods A retrospective multi-centre observational cohort study comprising 12,891 hospitalized patients aged 18 years or older with a diagnosis of SARS-CoV-2 infection confirmed by polymerase chain reaction from 1 January 2020 to 10 September 2020, and with at least one serum creatinine value 1-365 days prior to admission. Mortality and serum creatinine values were obtained up to 10 September 2021. Findings Advanced age (HR 2.77, 95%CI 2.53-3.04, p < 0.0001), severe COVID-19 (HR 2.91, 95%CI 2.03-4.17, p < 0.0001), severe AKI (KDIGO stage 3: HR 4.22, 95%CI 3.55-5.00, p < 0.0001), and ischemic heart disease (HR 1.26, 95%CI 1.14-1.39, p < 0.0001) were associated with worse mortality outcomes. AKI severity (KDIGO stage 3: HR 0.41, 95%CI 0.37-0.46, p < 0.0001) was associated with worse kidney function recovery, whereas remdesivir use (HR 1.34, 95%CI 1.17-1.54, p < 0.0001) was associated with better kidney function recovery. In a subset of patients without chronic kidney disease, advanced age (HR 1.38, 95%CI 1.20-1.58, p < 0.0001), male sex (HR 1.67, 95%CI 1.45-1.93, p < 0.0001), severe AKI (KDIGO stage 3: HR 11.68, 95%CI 9.80-13.91, p < 0.0001), and hypertension (HR 1.22, 95%CI 1.10-1.36, p = 0.0002) were associated with post-AKI kidney function impairment. Furthermore, patients with COVID-19-associated AKI had significant and persistent elevations of baseline serum creatinine 125% or more at 180 days (RR 1.49, 95%CI 1.32-1.67) and 365 days (RR 1.54, 95%CI 1.21-1.96) compared to COVID-19 patients with no AKI. Interpretation COVID-19-associated AKI was associated with higher mortality, and severe COVID-19-associated AKI was associated with worse long-term post-AKI kidney function recovery. Funding Authors are supported by various funders, with full details stated in the acknowledgement section.
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Affiliation(s)
- Byorn W.L. Tan
- Department of Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228
| | - Bryce W.Q. Tan
- Department of Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228
| | - Amelia L.M. Tan
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - Emily R. Schriver
- Data Analytics Center, University of Pennsylvania Health System, 3600 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Alba Gutiérrez-Sacristán
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - Priyam Das
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - William Yuan
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - Meghan R. Hutch
- Department of Preventive Medicine, Northwestern University, 750 North Lake Shore Drive, Chicago, IL 60611, USA
| | - Noelia García Barrio
- Department of Health Informatics, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n 28041 Madrid, Spain
| | - Miguel Pedrera Jimenez
- Department of Health Informatics, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n 28041 Madrid, Spain
| | - Noor Abu-el-rub
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Michele Morris
- Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Blvd, Pittsburgh, PA 15206, USA
| | - Bertrand Moal
- IAM Unit, Bordeaux University Hospital, Place Amélie Rabat Léon, 33076 Bordeaux, France
| | - Guillaume Verdy
- IAM Unit, Bordeaux University Hospital, Place Amélie Rabat Léon, 33076 Bordeaux, France
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, 2 Avenue De Lafayette, Boston, MA 02130, USA
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, 2 Avenue De Lafayette, Boston, MA 02130, USA
| | - Lav P. Patel
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Arianna Dagliati
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy, Via Ferrata 5, 27100 Pavia, Italy
| | - Antoine Neuraz
- Department of Biomedical Informatics, Hôpital Necker-Enfants Malade, Assistance Publique Hôpitaux de Paris, University of Paris, 149 Rue de Sèvres, 75015 Paris, France
| | - Jeffrey G. Klann
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Andrew M. South
- Department of Pediatrics-Section of Nephrology, Brenner Children's Hospital, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Blvd, Pittsburgh, PA 15206, USA
| | - David A. Hanauer
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA, 100-107 NCRC, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Sarah E. Maidlow
- Michigan Institute for Clinical and Health Research (MICHR) Informatics, University of Michigan, NCRC Bldg 400, 2800 Plymouth Road, Ann Arbor, MI, United States
| | - Mei Liu
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Danielle L. Mowery
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, 3700 Hamilton Walk, Richards Hall, A202, Philadelphia, PA 19104, USA
| | - Ashley Batugo
- Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, 401 Blockley Hall 423 Guardian Drive Philadelphia, PA 19104, USA
| | - Adeline Makoudjou
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Zinkmattenstraße 6a, DE79108 Freiburg, Germany
| | - Patric Tippmann
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Zinkmattenstraße 6a, DE79108 Freiburg, Germany
| | - Daniela Zöller
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Zinkmattenstraße 6a, DE79108 Freiburg, Germany
| | - Gabriel A. Brat
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - Yuan Luo
- Department of Preventive Medicine, Northwestern University, 750 North Lake Shore Drive, Chicago, IL 60611, USA
| | - Paul Avillach
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - Riccardo Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy, Via Ferrata 5, 27100 Pavia, Italy
| | - Luca Chiovato
- Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Via Maugeri 4, 27100 Pavia, Italy
| | - Alberto Malovini
- Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy., Via Maugeri 4, 27100 Pavia, Italy
| | - Valentina Tibollo
- Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy., Via Maugeri 4, 27100 Pavia, Italy
| | | | - Pablo Serrano Balazote
- Department of Health Informatics, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n 28041 Madrid, Spain
| | - Zongqi Xia
- Department of Neurology, University of Pittsburgh, 3501 5th Avenue, BST-3 Suite 7014, Pittsburgh, PA 15260, USA
| | - Ne Hooi Will Loh
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Lorenzo Chiudinelli
- UOC Ricerca, Innovazione e Brand reputation, ASST Papa Giovanni XXIII, Bergamo, P.zza OMS 1 - 24127 Bergamo, Italy
| | - Clara-Lea Bonzel
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - Chuan Hong
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Durham, NC, United States
| | - Harrison G. Zhang
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - Griffin M. Weber
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - Isaac S. Kohane
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, USA
| | - Gilbert S. Omenn
- Department of Computational Medicine & Bioinformatics, University of Michigan, 2017B Palmer Commons, 100 Washtenaw, Ann Arbor, MI 48109-2218
| | - John H. Holmes
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, 3700 Hamilton Walk, Richards Hall, A202, Philadelphia, PA 19104, USA
- Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, 401 Blockley Hall 423 Guardian Drive Philadelphia, PA 19104, USA
| | - Kee Yuan Ngiam
- Department of Biomedical Informatics, WiSDM, National University Health Systems Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 8, Singapore 119228
- Corresponding author. Department of Biomedical Informatics, WiSDM, National University Health Systems Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 8, Singapore 119228.
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Lumlertgul N, Baker E, Pearson E, Dalrymple KV, Pan J, Jheeta A, Weerapolchai K, Wang Y, Leach R, Barrett NA, Ostermann M. Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort. Ann Intensive Care 2022; 12:118. [PMID: 36575315 PMCID: PMC9794481 DOI: 10.1186/s13613-022-01094-6] [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: 07/13/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to explore the changes in AKI epidemiology between the first and the second COVID wave in the United Kingdom (UK). METHODS This was an observational study of critically ill adult patients with COVID-19 in an expanded tertiary care intensive care unit (ICU) in London, UK. Baseline characteristics, organ support, COVID-19 treatments, and patient and kidney outcomes up to 90 days after discharge from hospital were compared. RESULTS A total of 772 patients were included in the final analysis (68% male, mean age 56 ± 13.6). Compared with wave 1, patients in wave 2 were older, had higher body mass index and clinical frailty score, but lower baseline serum creatinine and C-reactive protein (CRP). The proportion of patients receiving invasive mechanical ventilation (MV) on ICU admission was lower in wave 2 (61% vs 80%; p < 0.001). AKI incidence within 14 days of ICU admission was 76% in wave 1 and 51% in wave 2 (p < 0.001); in wave 1, 32% received KRT compared with 13% in wave 2 (p < 0.001). Patients in wave 2 had significantly lower daily cumulative fluid balance (FB) than in wave 1. Fewer patients were dialysis dependent at 90 days in wave 2 (1% vs. 4%; p < 0.001). CONCLUSIONS In critically ill adult patients admitted to ICU with COVID-19, the risk of AKI and receipt of KRT significantly declined in the second wave. The trend was associated with less MV, lower PEEP and lower cumulative FB. TRIAL REGISTRATION NCT04445259.
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Affiliation(s)
- Nuttha Lumlertgul
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK ,grid.411628.80000 0000 9758 8584Division of Nephrology and Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand ,grid.7922.e0000 0001 0244 7875Centre of Excellence in Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Eleanor Baker
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Emma Pearson
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Kathryn V. Dalrymple
- grid.13097.3c0000 0001 2322 6764Department of Population Health Sciences, King’s College London, London, UK
| | - Jacqueline Pan
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Anup Jheeta
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Kittisak Weerapolchai
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Yanzhong Wang
- grid.13097.3c0000 0001 2322 6764Department of Population Health Sciences, King’s College London, London, UK
| | - Richard Leach
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Nicholas A. Barrett
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Marlies Ostermann
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
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Abstract
PURPOSE OF REVIEW While it is now widely established acute kidney injury (AKI) is a common and important complication of coronavirus disease (COVID-19) disease, there is marked variability in its reported incidence and outcomes. This narrative review provides a mid-2022 summary of the latest epidemiological evidence on AKI in COVID-19. RECENT FINDINGS Large observational studies and meta-analyses report an AKI incidence of 28-34% in all inpatients and 46-77% in intensive care unit (ICU). The incidence of more severe AKI requiring renal replacement therapy (RRT) in ICU appears to have declined over time, in data from England and Wales RRT use declined from 26% at the start of the pandemic to 14% in 2022. The majority of survivors apparently recover their kidney function by hospital discharge; however, these individuals appear to remain at increased risk of future AKI, estimated glomerular filtration rate (eGFR) decline and chronic kidney disease. Importantly even in the absence of overt AKI a significant proportion of survivors of COVID-19 hospitalisation had reduced eGFR on follow-up. SUMMARY This review summarises the epidemiology, risk factors, outcomes and treatment of COVID-19-associated AKI across the global pandemic. In particular the long-term impact of COVID-19 disease on kidney health is uncertain and requires further characterisation.
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Schaubroeck H, Vandenberghe W, Boer W, Boonen E, Dewulf B, Bourgeois C, Dubois J, Dumoulin A, Fivez T, Gunst J, Hermans G, Lormans P, Meersseman P, Mesotten D, Stessel B, Vanhoof M, De Vlieger G, Hoste E. Acute kidney injury in critical COVID-19: a multicenter cohort analysis in seven large hospitals in Belgium. Crit Care 2022; 26:225. [PMID: 35879765 PMCID: PMC9310674 DOI: 10.1186/s13054-022-04086-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/02/2022] [Indexed: 11/11/2022] Open
Abstract
Background Acute kidney injury (AKI) has been reported as a frequent complication of critical COVID-19. We aimed to evaluate the occurrence of AKI and use of kidney replacement therapy (KRT) in critical COVID-19, to assess patient and kidney outcomes and risk factors for AKI and differences in outcome when the diagnosis of AKI is based on urine output (UO) or on serum creatinine (sCr). Methods Multicenter, retrospective cohort analysis of patients with critical COVID-19 in seven large hospitals in Belgium. AKI was defined according to KDIGO within 21 days after ICU admission. Multivariable logistic regression analysis was used to explore the risk factors for developing AKI and to assess the association between AKI and ICU mortality. Results Of 1286 patients, 85.1% had AKI, and KRT was used in 9.8%. Older age, obesity, a higher APACHE II score and use of mechanical ventilation at day 1 of ICU stay were associated with an increased risk for AKI. After multivariable adjustment, all AKI stages were associated with ICU mortality. AKI was based on sCr in 40.1% and UO in 81.5% of patients. All AKI stages based on sCr and AKI stage 3 based on UO were associated with ICU mortality. Persistent AKI was present in 88.6% and acute kidney disease (AKD) in 87.6%. Rapid reversal of AKI yielded a better prognosis compared to persistent AKI and AKD. Kidney recovery was observed in 47.4% of surviving AKI patients. Conclusions Over 80% of critically ill COVID-19 patients had AKI. This was driven by the high occurrence rate of AKI defined by UO criteria. All AKI stages were associated with mortality (NCT04997915). Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04086-x.
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Geetha D, Kronbichler A, Rutter M, Bajpai D, Menez S, Weissenbacher A, Anand S, Lin E, Carlson N, Sozio S, Fowler K, Bignall R, Ducharlet K, Tannor EK, Wijewickrama E, Hafidz MIA, Tesar V, Hoover R, Crews D, Varnell C, Danziger-Isakov L, Jha V, Mohan S, Parikh C, Luyckx V. Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions. Nat Rev Nephrol 2022; 18:724-737. [PMID: 36002770 PMCID: PMC9400561 DOI: 10.1038/s41581-022-00618-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce.
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Affiliation(s)
- Duvuru Geetha
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | - Megan Rutter
- Department of Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Divya Bajpai
- Department of Nephrology, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, India
| | - Steven Menez
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Shuchi Anand
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Standford, California, USA
| | - Eugene Lin
- Department of Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
| | - Nicholas Carlson
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Research, The Danish Heart Foundation, Copenhagen, Denmark
| | - Stephen Sozio
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin Fowler
- Principal, Voice of the Patient Inc, St. Louis, Missouri, USA
| | - Ray Bignall
- Division of Nephrology and Hypertension, Nationwide Children's Hospital and Department of Paediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kathryn Ducharlet
- Department of Renal Medicine, Eastern Health Clinical School, Monash University, Melbourne, Australia
- Department of Nephrology and Palliative Care, St Vincent's Hospital Melbourne, Australia and Department of Medicine, University of Melbourne, Parkville, Australia
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Eranga Wijewickrama
- Consultant Nephrologist and Professor in the Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- University Medical Unit, National Hospital of Sri Lanka and National Institute of Nephrology, Dialysis & Transplantation, Colombo, Sri Lanka
| | | | - Vladimir Tesar
- Department of Nephrology, Charles University, Prague, Czech Republic
| | - Robert Hoover
- Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Deidra Crews
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charles Varnell
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Paediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Lara Danziger-Isakov
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA
| | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Chirag Parikh
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Valerie Luyckx
- Associate Scientist, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Honorary Associate Professor, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Nephrologist, University Childrens Hospital, Zurich, Switzerland
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Braunsteiner J, Jarczak D, Schmidt-Lauber C, Boenisch O, de Heer G, Burdelski C, Frings D, Sensen B, Nierhaus A, Hoxha E, Huber TB, Wichmann D, Kluge S, Fischer M, Roedl K. Outcomes of critically ill coronavirus disease 2019 patients requiring kidney replacement therapy: A retrospective cohort study. Front Med (Lausanne) 2022; 9:1027586. [PMID: 36341239 PMCID: PMC9630840 DOI: 10.3389/fmed.2022.1027586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has resulted in high hospitalization rates worldwide. Acute kidney injury (AKI) in patients hospitalized for COVID-19 is frequent and associated with disease severity and poor outcome. The aim of this study was to investigate the incidence of kidney replacement therapy (KRT) in critically ill patients with COVID-19 and its implication on outcome. METHODS We retrospectively analyzed all COVID-19 patients admitted to the Department of Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf (Germany) between 1 March 2020 and 31 July 2021. Demographics, clinical parameters, type of organ support, length of intensive care unit (ICU) stay, mortality and severity scores were assessed. RESULTS Three-hundred critically ill patients with COVID-19 were included. The median age of the study population was 61 (IQR 51-71) years and 66% (n = 198) were male. 73% (n = 219) of patients required invasive mechanical ventilation. Overall, 68% (n = 204) of patients suffered from acute respiratory distress syndrome and 30% (n = 91) required extracorporeal membrane oxygenation (ECMO). We found that 46% (n = 139) of patients required KRT. Septic shock (OR 11.818, 95% CI: 5.941-23.506, p < 0.001), higher simplified acute physiology scores (SAPS II) (OR 1.048, 95% CI: 1.014-1.084, p = 0.006) and vasopressor therapy (OR 5.475, 95% CI: 1.127-26.589, p = 0.035) were independently associated with the initiation of KRT. 61% (n = 85) of patients with and 18% (n = 29) without KRT died in the ICU (p < 0.001). Cox regression found that KRT was independently associated with mortality (HR 2.075, 95% CI: 1.342-3.208, p = 0.001) after adjusting for confounders. CONCLUSION Critically ill patients with COVID-19 are at high risk of acute kidney injury with about half of patients requiring KRT. The initiation of KRT was associated with high mortality.
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Affiliation(s)
- Josephine Braunsteiner
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Olaf Boenisch
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Geraldine de Heer
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Burdelski
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Frings
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Sensen
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elion Hoxha
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias B. Huber
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Fischer
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kevin Roedl
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Li Z, Yong H, Wang W, Gao Y, Wang P, Chen X, Lu J, Zheng J, Bai J. GSK3326595 is a promising drug to prevent SARS-CoV-2 Omicron and other variants infection by inhibiting ACE2-R671 di-methylation. J Med Virol 2022; 95:e28158. [PMID: 36114164 PMCID: PMC9537780 DOI: 10.1002/jmv.28158] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/18/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused COVID-19 epidemic is worsening. Binding of the Spike1 protein of SARS-CoV-2 with the angiotensin-converting enzyme 2 (ACE2) receptor mediates entry of the virus into host cells. Many reports show that protein arginine methylation by protein arginine methyltransferases (PRMTs) is important for the functions of these proteins, but it remains unclear whether ACE2 is methylated by PRMTs. Here, we show that PRMT5 catalyses ACE2 symmetric dimethylation at residue R671 (meR671-ACE2). We indicate that PRMT5-mediated meR671-ACE2 promotes SARS-CoV-2 receptor-binding domain (RBD) binding with ACE2 probably by enhancing ACE2 N-glycosylation modification. We also reveal that the PRMT5-specific inhibitor GSK3326595 is able to dramatically reduce ACE2 binding with RBD. Moreover, we discovered that meR671-ACE2 plays an important role in ACE2 binding with Spike1 of the SARS-CoV-2 Omicron, Delta, and Beta variants; and we found that GSK3326595 strongly attenuates ACE2 interaction with Spike1 of the SARS-CoV-2 Omicron, Delta, and Beta variants. Finally, SARS-CoV-2 pseudovirus infection assays uncovered that PRMT5-mediated meR671-ACE2 is essential for SARS-CoV-2 infection in human cells, and pseudovirus infection experiments confirmed that GSK3326595 can strongly suppress SARS-CoV-2 infection of host cells. Our findings suggest that as a clinical phase II drug for several kinds of cancers, GSK3326595 is a promising candidate to decrease SARS-CoV-2 infection by inhibiting ACE2 methylation and ACE2-Spike1 interaction.
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Affiliation(s)
- Zhongwei Li
- Cancer InstituteXuzhou Medical UniversityXuzhouJiangsuChina,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
| | - Hongmei Yong
- Department of OncologyThe Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'anHuaianJiangsuChina
| | - Wenwen Wang
- Cancer InstituteXuzhou Medical UniversityXuzhouJiangsuChina
| | - Yue Gao
- Cancer InstituteXuzhou Medical UniversityXuzhouJiangsuChina
| | - Pengfei Wang
- Cancer InstituteXuzhou Medical UniversityXuzhouJiangsuChina
| | - Xintian Chen
- Cancer InstituteXuzhou Medical UniversityXuzhouJiangsuChina
| | - Jun Lu
- The Key Laboratory of Molecular Epigenetics of Ministry of Education (MOE)Northeast Normal UniversityChangchunChina
| | - Junnian Zheng
- Cancer InstituteXuzhou Medical UniversityXuzhouJiangsuChina,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
| | - Jin Bai
- Cancer InstituteXuzhou Medical UniversityXuzhouJiangsuChina,Center of Clinical Oncology, Affiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
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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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Alberca RW, Ramos YÁL, Pereira NZ, Beserra DR, Branco ACCC, Leão Orfali R, Aoki V, Duarte AJDS, Sato MN. Long-term effects of COVID-19 in diabetic and non-diabetic patients. Front Public Health 2022; 10:963834. [PMID: 36045733 PMCID: PMC9421360 DOI: 10.3389/fpubh.2022.963834] [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: 06/08/2022] [Accepted: 07/28/2022] [Indexed: 01/24/2023] Open
Abstract
The literature presents several reports of the impact of glycemic control and diabetes in the inflammatory and coagulatory response during coronavirus disease 2019 (COVID-19). Nevertheless, the long-term impact of the COVID-19 in diabetic patients is still to be explored. Therefore, we recruited 128 patients and performed a longitudinal analysis on COVID-19-associated biomarkers of patients with COVID-19, tree and 6 months after COVID-19 recovery and put into perspective the possible long-term complication generated after COVID-19. In our investigation, we failed to verify any long-term modification on inflammatory biomarkers, but detected an increase in the glycemia and glycated hemoglobin in patients without any pre-existing history or diagnosis of diabetes (non-diabetic patients). Although diabetic and non-diabetic patients presented elevated levels of glycated hemoglobin, the c-peptide test indicated a normal beta cell function in all patients.
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Characteristics and risk factors for mortality in critically ill patients with COVID-19 receiving invasive mechanical ventilation: the experience of a private network in Sao Paulo, Brazil. J Crit Care Med (Targu Mures) 2022; 8:165-175. [PMID: 36062038 PMCID: PMC9396953 DOI: 10.2478/jccm-2022-0015] [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: 12/12/2021] [Accepted: 06/12/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Introduction
The use of invasive mechanical ventilation (IMV) in COVID-19 represents in an incremental burden to healthcare systems.
Aim of the study
We aimed to characterize patients hospitalized for COVID-19 who received IMV and identify risk factors for mortality in this population.
Material and Methods
A retrospective cohort study including consecutive adult patients admitted to a private network in Brazil who received IMV from March to October, 2020. A bidirectional stepwise logistic regression analysis was used to determine the risk factors for mortality.
Results
We included 215 patients, of which 96 died and 119 were discharged from ICU. The mean age was 62.7 ± 15.4 years and the most important comorbidities were hypertension (62.8%), obesity (50.7%) and diabetes (40%). Non-survivors had lower body mass index (BMI) (28.3 [25.5; 31.6] vs. 31.2 [28.3; 35], p<0.001, and a shorter duration from symptom onset to intubation (8.5 [6.0; 12] days vs. 10 [8.0; 12.5] days, p = 0.005). Multivariable regression analysis showed that the risk factors for mortality were age (OR: 1.07, 95% CI: 1.03 to 1.1, p < 0.001), creatinine level at the intubation date (OR: 3.28, 95% CI: 1.47 to 7.33, p = 0.004), BMI (OR: 0.91, 95% CI: 0.84 to 0.99, p = 0.033), lowest PF ratio within 48 hours post-intubation (OR: 0.988, 95% CI: 0.979 to 0.997, p = 0.011), barotrauma (OR: 5.18, 95% CI: 1.14 to 23.65, p = 0.034) and duration from symptom onset to intubation (OR: 0.76, 95% CI: 0.76 to 0.95, p = 0.006).
Conclusion
In our retrospective cohort we identified the main risk factors for mortality in COVID-19 patients receiving IMV: age, creatinine at the day of intubation, BMI, lowest PF ratio 48-hours post-intubation, barotrauma and duration from symptom onset to intubation.
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Oweis AO, Alshelleh SA, Hawasly L, Alsabbagh G, Alzoubi KH. Acute Kidney Injury among Hospital-Admitted COVID-19 Patients: A Study from Jordan. Int J Gen Med 2022; 15:4475-4482. [PMID: 35518517 PMCID: PMC9064179 DOI: 10.2147/ijgm.s360834] [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: 02/13/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022] Open
Abstract
Objective During the COVID-19 pandemic, many patients have been admitted to hospitals with severe respiratory disease and suffered complications. Acute kidney injury (AKI) is among the more dangerous complications contributing to morbidity and mortality among patients. Methods This retrospective study focused on all hospital-admitted COVID-19 patients between September and December 2020. A total of 1,044 patients were enrolled. Patient demographics, medical records, and laboratory data were gathered. Patients were split into two groups: AKI and non-AKI. Comparisons comprised demographics, labs, ICU transfer, need for ventilation and oxygen therapy, medications, hospital stay, and deaths. Results AKI incidence in the cohort was 25.3%, and a majority were stage 1 (53.3%). Among these, hemodialysis was started in 1.8%. Higher age (P<0.001), diabetes mellitus (P=0.001), hypertension (P=0.001), ACEI/ARB use (P=0.008), erythrocyte-sedimentation rate (P=0.002), CRP (P<0.0001), and ferritin (P=0.01) were predictors of AKI. Among all admitted COVID-19 patients, 30.2% died in hospital. Among those with AKI, 75.9% died in comparison to 24.1% of non-AKI patients (P<0.001). Among COVID-19 patients admitted to the ICU, 80.5% died: 70.5% were from the AKI group and 29.5% from the non-AKI group (P<0.001). Conclusion High mortality and morbidity is associated with COVID-19 infection, and AKI is contributing significantly to the outcomes of hospitalized patients with the infection. Early recognition of and treatment for AKI will decrease mortality and hospitalization in patients with COVID-19.
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Affiliation(s)
- Ashraf O Oweis
- Department of Internal Medicine, Nephrology Division, Jordan University of Science and Technology, Irbid, Jordan
| | - Sameeha A Alshelleh
- Department of Internal Medicine, Nephrology Division, University of Jordan, Amman, Jordan
| | - Lubna Hawasly
- Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ghalia Alsabbagh
- Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Estabraghnia Babaki H, Jarineshin H, Saljoughi F, Hassaniazad M, Rafati S, Sohrabipour S. Clinical Features and Outcomes of ICU Patients Confirmed with COVID-19 Infection in Bandar Abbas, Iran: A Single-Centered Retrospective Study. TANAFFOS 2022; 21:455-465. [PMID: 37583773 PMCID: PMC10423860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 08/01/2022] [Indexed: 08/17/2023]
Abstract
Background The clinical characteristics of COVID-19 are diverse from a simple common cold symptom to acute respiratory distress syndrome (ARDS). In the present study, we attempted to identify the associated factors in surviving COVID-19 intensive care unit (ICU) patients based on their clinical characteristics. Materials and Methods This retrospective study was performed on 114 laboratory-confirmed COVID-19 patients admitted to the intensive care units of Hormozgan University of Medical Sciences, Iran. Demographic, medical, clinical manifestations at admission time, and outcome data were obtained from the patient's medical records. Results Of 114 participants included in this study, 64.9% were men. Their mean age was approximately 54 years old, 69.3% of them died and 30.7% of them were discharged. The mortality rate was 2.96 times higher in people who had ARDS compared to their counterparts, 1.37 times higher in people under non-invasive ventilation, and 3.56 times higher in people under invasive mechanical ventilation.Three common underlying diseases among them were hypertension in 34.2%, diabetes in 23.7%, and cardiovascular diseases in 17.5% of them. Alive and dead patients significantly differed only in the following laboratory tests: D-dimer, urea, troponin, Procalcitonin, and ferritin. Conclusion The mortality rate among COVID-19 patients admitted to ICU is generally high. Dyspnea, as the initial presentation and comorbidity, especially hypertension, diabetes, and cardiovascular diseases, may be associated with a higher risk of developing severe disease and consequent mortality. Therefore, D-dimer, urea, troponin, Procalcitonin, and ferritin at the time of hospital admission could predict the severity of the disease and its probable mortality.
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Affiliation(s)
- Hamideh Estabraghnia Babaki
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hashem Jarineshin
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Fateme Saljoughi
- Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Hassaniazad
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Shideh Rafati
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Shahla Sohrabipour
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Long JD, Strohbehn I, Sawtell R, Bhattacharyya R, Sise ME. COVID-19 Survival and its impact on chronic kidney disease. Transl Res 2022; 241:70-82. [PMID: 34774843 PMCID: PMC8579714 DOI: 10.1016/j.trsl.2021.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 12/16/2022]
Abstract
Up to 87% of patients hospitalized with coronavirus disease 2019 (COVID-19) experience chronic sequelae following infection. The long-term impact of COVID-19 infection on kidney function is largely unknown at this point in the COVID-19 pandemic. In this review, we highlight the current understanding of the pathophysiology of COVID-19-associated kidney injury and the impact COVID-19 may have on long-term kidney function. COVID-19-induced acute kidney injury may lead to tubular injury, endothelial injury, and glomerular injury. We highlight histopathologic correlates from large kidney biopsy and autopsy series. By conducting a comprehensive review of published literature to date, we summarize the rates of recovery from COVID-19-associated-AKI. Finally, we discuss how certain genetic differences, including APOL1 risk alleles (a risk factor for collapsing glomerulopathy), coupled with systemic healthcare disparities, may lead to a disproportionate burden of post-COVID-19-kidney function decline among racial and ethnic minority groups. We highlight the need for prospective studies to determine the true incidence of chronic kidney disease burden after COVID-19.
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Key Words
- aki, acute kidney disease
- aor, adjusted odds ratio
- atn, acute tubular necrosis
- covan, covid-19-associated-nephropathy
- covid-19, coronavirus disease 2019
- ckd, chronic kidney disease
- egfr, estimated glomerular filtration rate
- eskd, end-stage kidney disease
- hr, ratio
- tma, thrombotic microangiopathy
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Affiliation(s)
- Joshua D Long
- Massachusetts General Hospital, Department of Medicine, Division of Nephrology, Boston, Massachusetts
| | - Ian Strohbehn
- Massachusetts General Hospital, Department of Medicine, Division of Nephrology, Boston, Massachusetts
| | - Rani Sawtell
- Massachusetts General Hospital, Department of Medicine, Division of Nephrology, Boston, Massachusetts
| | - Roby Bhattacharyya
- Massachusetts General Hospital, Department of Medicine, Division of Infectious Diseases, Boston, Massachusetts
| | - Meghan E Sise
- Massachusetts General Hospital, Department of Medicine, Division of Nephrology, Boston, Massachusetts.
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Greco M, De Corte T, Ercole A, Antonelli M, Azoulay E, Citerio G, Morris AC, De Pascale G, Duska F, Elbers P, Einav S, Forni L, Galarza L, Girbes ARJ, Grasselli G, Gusarov V, Jubb A, Kesecioglu J, Lavinio A, Delgado MCM, Mellinghoff J, Myatra SN, Ostermann M, Pellegrini M, Povoa P, Schaller SJ, Teboul JL, Wong A, De Waele JJ, Cecconi M. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study. Intensive Care Med 2022; 48:690-705. [PMID: 35596752 PMCID: PMC9123859 DOI: 10.1007/s00134-022-06705-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. METHODS Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. RESULTS 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. CONCLUSIONS ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality.
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Affiliation(s)
- Massimiliano Greco
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy ,grid.417728.f0000 0004 1756 8807IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Thomas De Corte
- grid.5342.00000 0001 2069 7798Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ,grid.410566.00000 0004 0626 3303Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ari Ercole
- grid.5335.00000000121885934Cambridge Centre for Artificial Intelligence in Medicine, University of Cambridge, Cambridge, UK ,grid.120073.70000 0004 0622 5016University of Cambridge Division of Anaesthesia, Addenbrooke’s Hospital, Hills Road, Cambridge, UK
| | - Massimo Antonelli
- grid.8142.f0000 0001 0941 3192Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy ,grid.8142.f0000 0001 0941 3192Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elie Azoulay
- grid.508487.60000 0004 7885 7602Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital, Paris University, Paris, France ,grid.508487.60000 0004 7885 7602Université de Paris, Paris, France
| | - Giuseppe Citerio
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy ,Department Neuroscience, Neurointensive Care, ASST-Monza, Monza, Italy
| | - Andy Conway Morris
- grid.5335.00000000121885934Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK ,grid.5335.00000000121885934Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, UK ,grid.120073.70000 0004 0622 5016JVF Intensive Care Unit, Addenbrookes Hospital, Cambridge, UK
| | - Gennaro De Pascale
- grid.8142.f0000 0001 0941 3192Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy ,grid.8142.f0000 0001 0941 3192Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Frantisek Duska
- grid.4491.80000 0004 1937 116XDepartment of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University, Prague, Czech Republic ,grid.412819.70000 0004 0611 1895FNKV University Hospital in Prague, Prague, Czech Republic
| | - Paul Elbers
- grid.12380.380000 0004 1754 9227Department of Intensive Care Medicine, Laboratory of Critical Care Computational Intelligence, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sharon Einav
- grid.414505.10000 0004 0631 3825General Intensive Care Unit of the Shaare Zedek Medical Center, Jerusalem, Israel ,grid.9619.70000 0004 1937 0538Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Lui Forni
- grid.5475.30000 0004 0407 4824Department of Critical Care, Royal Surrey Hospital and Faculty of Experimental Medicine, University of Surrey, Guildford, UK
| | - Laura Galarza
- grid.470634.2Intensive Care Unit, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Armand R. J. Girbes
- grid.12380.380000 0004 1754 9227Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), UMC, Location VUmc, VU Amsterdam, Amsterdam, The Netherlands
| | - Giacomo Grasselli
- grid.414818.00000 0004 1757 8749Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Vitaly Gusarov
- grid.510503.2Pirogov National Medical and Surgical Center, Moscow, 105203 Russian Federation
| | - Alasdair Jubb
- grid.5335.00000000121885934Division of Anaesthesia, University of Cambridge Department of Medicine, Cambridge, UK ,grid.24029.3d0000 0004 0383 8386Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals, Cambridge, UK ,grid.498239.dCancer Research UK-Cambridge Institute, Cambridge, UK
| | - Jozef Kesecioglu
- grid.5477.10000000120346234Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andrea Lavinio
- grid.24029.3d0000 0004 0383 8386Neurosciences and Trauma Critical Care Unit (NCCU), Anaesthesia Medical Examiner and Clinical Lead Organ Donation-Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Maria Cruz Martin Delgado
- grid.488600.20000 0004 1777 7270Intensive Care Unit, Hospital Universitario de Torrejón, Madrid, Spain ,grid.449795.20000 0001 2193 453XUniversidad Francisco de Vitoria, Madrid, Spain
| | - Johannes Mellinghoff
- grid.12477.370000000121073784School of Sports and Health Sciences, University of Brighton, Brighton, UK
| | - Sheila Nainan Myatra
- grid.450257.10000 0004 1775 9822Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Marlies Ostermann
- grid.420545.20000 0004 0489 3985Department of Critical Care, King’s College London, Guy’s & St Thomas’ Hospital, London, UK
| | - Mariangela Pellegrini
- Intensive Care Unit, AnOpIVA, Akademiska sjukhuset, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Hedenstierna Laboratory, Department of Surgical Science, Uppsala University, Uppsala, Sweden
| | - Pedro Povoa
- grid.10772.330000000121511713CHRC, CEDOC, NOVA Medical School, New University of Lisbon, Lisbon, Portugal ,grid.414462.10000 0001 1009 677XPolyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal ,grid.7143.10000 0004 0512 5013Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | - Stefan J. Schaller
- grid.7468.d0000 0001 2248 7639Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany ,grid.6936.a0000000123222966School of Medicine, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care, Technical University of Munich, Munich, Germany
| | - Jean-Louis Teboul
- grid.413784.d0000 0001 2181 7253Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, AP-HP Université Paris-Saclay, Inserm UMR S_999, Le Kremlin-Bicêtre, France
| | - Adrian Wong
- grid.46699.340000 0004 0391 9020Department of Critical Care, King’s College Hospital, London, UK
| | - Jan J. De Waele
- grid.5342.00000 0001 2069 7798Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ,grid.410566.00000 0004 0626 3303Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Maurizio Cecconi
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy ,grid.417728.f0000 0004 1756 8807IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
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Hsu CM, Gupta S, Tighiouart H, Goyal N, Faugno AJ, Tariq A, Raichoudhury R, Sharma JH, Meyer L, Kshirsagar RK, Jose A, Leaf DE, Weiner DE. Kidney Recovery and Death in Critically Ill Patients With COVID-19-Associated Acute Kidney Injury Treated With Dialysis: The STOP-COVID Cohort Study. Am J Kidney Dis 2021; 79:404-416.e1. [PMID: 34871701 PMCID: PMC8641974 DOI: 10.1053/j.ajkd.2021.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022]
Abstract
Rationale & Objective Acute kidney injury treated with kidney replacement therapy (AKI-KRT) occurs frequently in critically ill patients with coronavirus disease 2019 (COVID-19). We examined the clinical factors that determine kidney recovery in this population. Study Design Multicenter cohort study. Setting & Participants 4,221 adults not receiving KRT who were admitted to intensive care units at 68 US hospitals with COVID-19 from March 1 to June 22, 2020 (the “ICU cohort”). Among these, 876 developed AKI-KRT after admission to the ICU (the “AKI-KRT subcohort”). Exposure The ICU cohort was analyzed using AKI severity as the exposure. For the AKI-KRT subcohort, exposures included demographics, comorbidities, initial mode of KRT, and markers of illness severity at the time of KRT initiation. Outcome The outcome for the ICU cohort was estimated glomerular filtration rate (eGFR) at hospital discharge. A 3-level outcome (death, kidney nonrecovery, and kidney recovery at discharge) was analyzed for the AKI-KRT subcohort. Analytical Approach The ICU cohort was characterized using descriptive analyses. The AKI-KRT subcohort was characterized with both descriptive analyses and multinomial logistic regression to assess factors associated with kidney nonrecovery while accounting for death. Results Among a total of 4,221 patients in the ICU cohort, 2,361 (56%) developed AKI, including 876 (21%) who received KRT. More severe AKI was associated with higher mortality. Among survivors, more severe AKI was associated with an increased rate of kidney nonrecovery and lower kidney function at discharge. Among the 876 patients with AKI-KRT, 588 (67%) died, 95 (11%) had kidney nonrecovery, and 193 (22%) had kidney recovery by the time of discharge. The odds of kidney nonrecovery was greater for lower baseline eGFR, with ORs of 2.09 (95% CI, 1.09-4.04), 4.27 (95% CI, 1.99-9.17), and 8.69 (95% CI, 3.07-24.55) for baseline eGFR 31-60, 16-30, ≤15 mL/min/1.73 m2, respectively, compared with eGFR > 60 mL/min/1.73 m2. Oliguria at the time of KRT initiation was also associated with nonrecovery (ORs of 2.10 [95% CI, 1.14-3.88] and 4.02 [95% CI, 1.72-9.39] for patients with 50-499 and <50 mL/d of urine, respectively, compared to ≥500 mL/d of urine). Limitations Later recovery events may not have been captured due to lack of postdischarge follow-up. Conclusions Lower baseline eGFR and reduced urine output at the time of KRT initiation are each strongly and independently associated with kidney nonrecovery among critically ill patients with COVID-19.
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Affiliation(s)
| | | | | | | | | | - Asma Tariq
- Tufts Medical Center / Tufts University, Boston, MA
| | | | - Jill H Sharma
- University Medical Center / Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV
| | - Leah Meyer
- Tufts Medical Center / Tufts University, Boston, MA
| | | | - Aju Jose
- St. Elizabeth's Medical Center / Boston University School of Medicine, Boston, MA
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44
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Noble RA, Selby NM. The changing nature of COVID-19 associated AKI: Where are we now? Nephrol Dial Transplant 2021; 37:201-202. [PMID: 34792169 PMCID: PMC8690015 DOI: 10.1093/ndt/gfab326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Rebecca A Noble
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, UK.,Department of Renal Medicine, Royal Derby Hospital, Derby, UK
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, UK.,Department of Renal Medicine, Royal Derby Hospital, Derby, UK
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