Acute kidney injury and electrolyte disorders in COVID-19

Survival of critically ill people with COVID-19 and acute kidney injury undergoing hemodialysis in public and private hospitals in Joinville: a cohort study, 2020-2021

OBJECTIVE

To compare the 90-day survival of critically ill people with COVID-19 and acute kidney injury in intensive care units (ICU) of public and private hospitals.

METHODS

This was a retrospective cohort study of critically ill people with COVID-19 and acute kidney injury undergoing hemodialysis in Joinville, Santa Catarina state.

RESULTS

The 90-day survival rate in public ICU was 15.7% (95%CI 8.4; 25.1), while in private ICU it was 37.7% (95%CI 24.9; 50.5%). In the multivariate analysis adjusted for sociodemographic variables (Hazard ratio (HR) 2.01; 95%CI 1.31; 3.08) and comorbidities (HR 2.09; 95%CI 1.30; 3.37), admission to a public ICU was associated with a higher risk of death. After including severity of illness, admission to a public ICU was not associated with an increased risk of death compared to private ICU (HR 0.79; 95%CI 0.45; 1.42).

CONCLUSION

Measures implemented during the COVID-19 pandemic may have reduced inequalities between health systems for critically ill patients with acute kidney injury.

Inflammatory, Hematological, and Biochemical Biomarkers in COVID-19 Patients

INTRODUCTION

There are few accurate prognostic indications of the illness's development and severity for COVID-19, despite certain biomarkers having been investigated. The unexpected nature of COVID-19's course, which can quickly progress from asymptomatic to life-threatening symptoms, lies at the heart of the disease's intricacy. Predicting SARS-CoV-2 pathogenicity through laboratory biomarkers and as such, identifying the patients' illness severity at the time of their initial admission would be crucial in improving patient care. In this study, we sought to evaluate the potential of hematological, biochemical, and inflammatory biomarkers in predicting the course of COVID-19 at a tertiary hospital in western Kenya.

METHODS

This cross-sectional study involved 48 COVID-19 patients (16 asymptomatic; 16 moderate symptomatic; and 16 severe symptomatic) and 48 age-sex-matched COVID-19-negative clients attending the Moi Teaching and Referral Hospital, Kenya. Demographic information, self-reported chronic illnesses, symptoms, and laboratory results were collected at recruitment.

RESULTS

Significantly, the severity of COVID-19 was associated with; hemoglobin (p < 0.0001), white blood cells (p = 0.0022), hematocrit (p < 0.0001), blood urea nitrogen (p = 0.01), blood sodium (p = 0.0002), potassium (p = 0.0483), C-reactive protein (p = 0.0002), and Lactate Dehydrogenase (p < 0.0001). Regression analysis of CRP revealed a strong positive correlation (p = 0.0006) whereas LDH revealed a weak positive correlation (p < 0.0001) with COVID-19 disease severity. Discriminative accuracy was highest when asymptomatic was compared to severe COVID-19 for CRP and LDH (AUC: 0.8867, 95% CI: 0.7532-1.000) and (AUC: 1.000, 95% CI: 1.000-1.000) respectively.

CONCLUSION

The hematological indices, inflammatory and biochemical biomarkers studied have the potential to predict the course of COVID-19. These parameters may be useful in helping design appropriate care for COVID-19 patients.

Semi-quantitative CT score reflecting the degree of pulmonary infection as a risk factor of hypokalemia in COVID-19 patients: a cross-sectional study

Background

Hypokalemia is a common electrolyte disorder observed in patients afflicted with coronavirus disease 2019 (COVID-19). When COVID-19 is accompanied by pulmonary infection, chest computed tomography (CT) is the preferred diagnostic modality. This study aimed to explore the relationship between CT semi-quantitative score reflecting the degree of pulmonary infection and hypokalemia from COVID-19 patients.

Methods

A single-center, cross-sectional study was conducted to investigate patients diagnosed with COVID-19 between December 2022 and January 2023 who underwent chest CT scans upon admission revealing typical signs. These patients were categorized into two groups based on their blood potassium levels: the normokalemia group and the hypokalemia group. Medical history, symptoms, vital signs, laboratory data, and CT severity score were compared. Binary regression analysis was employed to identify risk factors associated with hypokalemia in COVID-19 patients with pulmonary infection.

Results

A total of 288 COVID-19 patients with pulmonary infection were enrolled in the study, of which 68 (23.6%) patients had hypokalemia. The CT severity score was found to be higher in the hypokalemia group compared to the normokalemia group [4.0 (3.0-5.0) vs. 3.0 (2.0-4.0), p = 0.001]. The result of binary logistic regression analysis revealed that after adjusting for sex, vomiting, sodium, and using potassium-excretion diuretics, higher CT severity score was identified as an independent risk factor for hypokalemia (OR = 1.229, 95% CI = 1.077-1.403, p = 0.002).

Conclusion

In this cohort of patients, semi-quantitative CT score reflecting the degree of pulmonary infection may serve as a risk factor of hypokalemia in COVID-19 patients.

Hematological and Biochemical Laboratory Parameters in COVID-19 Patients: A Retrospective Modeling Study of Severity and Mortality Predictors

Background

It is well known that laboratory markers could help in identifying risk factors of severe illness and predicting outcomes of diseases. Here, we performed a retrospective modeling study of severity and mortality predictors of hematological and biochemical laboratory parameters in Iranian COVID-19 patients.

Methods

Data were obtained retrospectively from medical records of 564 confirmed Iranian COVID-19 cases. According to the disease severity, the patients were categorized into two groups (severe or nonsevere), and based on the outcome of the disease, patients were divided into two groups (recovered or deceased). Demographic and laboratory data were compared between groups, and statistical analyses were performed to define predictors of disease severity and mortality in the patients.

Results

The study identified a panel of hematological and biochemical markers associated with the severe outcome of COVID-19 and constructed different predictive models for severity and mortality. The disease severity and mortality rate were significantly higher in elderly inpatients, whereas gender was not a determining factor of the clinical outcome. Age-adjusted white blood cells (WBC), platelet cells (PLT), neutrophil-to-lymphocyte ratio (NLR), red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), erythrocyte sedimentation rate (ESR), mean corpuscular hemoglobin (MCHC), blood urea nitrogen (BUN), and creatinine (Cr) also showed high accuracy in predicting severe cases at the time of hospitalization, and logistic regression analysis suggested grouped hematological parameters (age, WBC, NLR, PLT, HGB, and international normalized ratio (INR)) and biochemical markers (age, BUN, and lactate dehydrogenase (LDH)) as the best models of combined laboratory predictors for severity and mortality.

Conclusion

The findings suggest that a panel of several routine laboratory parameters recorded on admission could be helpful for clinicians to predict and evaluate the risk of disease severity and mortality in COVID-19 patients.

What is the aetiology of dysnatraemia in COVID-19 and how is this related to outcomes in patients admitted during earlier and later COVID-19 waves? A multicentre, retrospective observational study in 11 Dutch hospitals

OBJECTIVES

To evaluate the relationship among dysnatraemia at hospital presentation and duration of admission, risk of intensive care unit (ICU) admission and all-cause mortality and to assess the underlying pathophysiological mechanism of hyponatraemia in patients with COVID-19. Our hypothesis is that both hyponatraemia and hypernatraemia at presentation are associated with adverse outcomes.

DESIGN

Observational study.

SETTING

Secondary care; 11 Dutch hospitals (2 university and 9 general hospitals).

PARTICIPANTS

An analysis was performed within the retrospective multicentre cohort study COVIDPredict. 7811 patients were included (60% men, 40% women) between 24 February 2020 and 9 August 2022. Patients who were ≥18 years with PCR-confirmed COVID-19 or CT with COVID-19 reporting and data system score≥4 and alternative diagnosis were included. Patients were excluded when serum sodium levels at presentation were not registered in the database or when they had been transferred from another participating hospital.

OUTCOME MEASURES

We studied demographics, medical history, symptoms and outcomes. Patients were stratified according to serum sodium concentration and urinary sodium excretion.

RESULTS

Hyponatraemia was present in 2677 (34.2%) patients and hypernatraemia in 126 (1.6%) patients. Patients with hyponatraemia presented more frequently with diarrhoea, lower blood pressure and tachycardia. Hyponatraemia was, despite a higher risk for ICU admission (OR 1.27 (1.11-1.46; p<0.001)), not associated with mortality or the risk for intubation. Patients with hypernatraemia had higher mortality rates (OR 2.25 (1.49-3.41; p<0.001)) and were at risk for ICU admission (OR 2.89 (1.83-4.58)) and intubation (OR 2.95 (1.83-4.74)).

CONCLUSIONS

Hypernatraemia at presentation was associated with adverse outcomes in patients with COVID-19. Hypovolaemic hyponatraemia was found to be the most common aetiology of hyponatraemia. Hyponatraemia of unknown aetiology was associated with a higher risk for ICU admission and intubation and longer duration of admission.

Standardized Brazilian green propolis extract (EPP-AF®) in COVID-19 outcomes: a randomized double-blind placebo-controlled trial

SARS-CoV-2 and its different variants caused a "wave and wave" pandemic pattern. During the first wave we demonstrated that standardized Brazilian green propolis extract (EPP-AF®) reduces length of hospital stay in adult patients with COVID-19. Afterwards, we decided to evaluate the impact of EPP-AF in hospitalized patients during the third wave of the pandemic. BeeCovid2 was a randomized, double-blind, placebo-controlled clinical trial in hospitalized COVID-19 adult patients. Patients were allocated to receive an oral dose of 900 mg/day of EPP-AF® or placebo for 10 days. The primary outcome was length of hospital stay. Secondary outcomes included safety, secondary infection rate, duration of oxygen therapy dependency, acute kidney injury and need for intensive care. Patients were followed up for 28 days after admission. We enrolled 188 patients; 98 were assigned to the propolis group and 90 to the placebo group. The post-intervention length of hospital stay was of 6.5 ± 6.0 days in the propolis group versus 7.7 ± 7.1 days in the control group (95% CI - 0.74 [- 1.94 to 0.42]; p = 0.22). Propolis did not have significant impact on the need for oxygen supplementation or frequency of AKI. There was a significant difference in the incidence of secondary infection between groups, with 6.1% in the propolis group versus 18.9% in the control group (95% CI - 0.28 [0.1-0.76], p = 0.01). The use of EPP-AF was considered safe and associated with a decrease in secondary infections. The drug was not associated with a significant reduction in length of hospital stay. ClinicalTrials.gov (NCT04800224).

Importance of Magnesium Status in COVID-19

A large amount of published research points to the interesting concept (hypothesis) that magnesium (Mg) status may have relevance for the outcome of COVID-19 and that Mg could be protective during the COVID disease course. As an essential element, Mg plays basic biochemical, cellular, and physiological roles required for cardiovascular, immunological, respiratory, and neurological functions. Both low serum and dietary Mg have been associated with the severity of COVID-19 outcomes, including mortality; both are also associated with COVID-19 risk factors such as older age, obesity, type 2 diabetes, kidney disease, cardiovascular disease, hypertension, and asthma. In addition, populations with high rates of COVID-19 mortality and hospitalization tend to consume diets high in modern processed foods, which are generally low in Mg. In this review, we review the research to describe and consider the possible impact of Mg and Mg status on COVID-19 showing that (1) serum Mg between 2.19 and 2.26 mg/dL and dietary Mg intakes > 329 mg/day could be protective during the disease course and (2) inhaled Mg may improve oxygenation of hypoxic COVID-19 patients. In spite of such promise, oral Mg for COVID-19 has thus far been studied only in combination with other nutrients. Mg deficiency is involved in the occurrence and aggravation of neuropsychiatric complications of COVID-19, including memory loss, cognition, loss of taste and smell, ataxia, confusion, dizziness, and headache. Potential of zinc and/or Mg as useful for increasing drug therapy effectiveness or reducing adverse effect of anti-COVID-19 drugs is reviewed. Oral Mg trials of patients with COVID-19 are warranted.