Association between Use of Qingfei Paidu Tang and Mortality in Hospitalized Patients with COVID-19: A national retrospective registry study

ABSTRACTBackgroundQingfei Paidu Tang (QPT), a formula of traditional Chinese medicine, which was suggested to be able to ease symptoms in patients with Coronavirus Disease 2019 (COVID-19), has been recommended by clinical guidelines and widely used to treat COVID-19 in China. However, whether it decreases mortality remains unknown.PurposeWe aimed to explore the association between QPT use and in-hospital mortality among patients hospitalized for COVID-19.Study designA retrospective study based on a real-world database was conducted.MethodsWe identified patients consecutively hospitalized with COVID-19 in 15 hospitals from a national retrospective registry in China, from January through May 2020. Data on patients’ characteristics, treatments, and outcomes were extracted from the electronic medical records. The association of QPT use with mortality was evaluated using Cox proportional hazards models based on propensity score analysis.ResultsOf the 8939 patients included, 28.7% received QPT. The crude mortality was 1.2% (95% confidence interval [CI] 0.8% to 1.7%) among the patients receiving QPT and 4.8% (95% CI 4.3% to 5.3%) among those not receiving QPT. After adjustment for patient characteristics and concomitant treatments, QPT use was associated with a relative reduction of 50% in in-hospital mortality (hazard ratio, 0.50; 95% CI, 0.37 to 0.66 P <0.001). This association was consistent across subgroups by sex and age. Meanwhile, the incidence of acute liver injury (8.9% [95% CI, 7.8% to 10.1%]vs. 9.9% [95% CI, 9.2% to 10.7%]; odds ratio, 0.96 [95% CI, 0.81% to 1.14%], P =0.658) and acute kidney injury (1.6% [95% CI, 1.2% to 2.2%] vs. 3.0% [95% CI, 2.6% to 3.5%]; odds ratio, 0.85 [95% CI, 0.62 to 1.17], P =0.318) was comparable between patients receiving QPT and those not receiving QPT. The major study limitations included that the study was an observational study based on real-world data rather than a randomized control trial, and the quality of data could be affected by the accuracy and completeness of medical records.ConclusionsQPT was associated with a substantially lower risk of in-hospital mortality, without extra risk of acute liver injury or acute kidney injury among patients hospitalized with COVID-19.

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Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211027759 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110277

Author(s):

Tyler Pitre ◽

Angela (Hong Tian) Dong ◽

Aaron Jones ◽

Jessica Kapralik ◽

Sonya Cui ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Cohort Study ◽

Hospital Mortality ◽

Disease Severity ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Kidney Injury ◽

Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

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Variation in Risk and Mortality of Acute Kidney Injury in Critically Ill Patients: A Multicenter Study

American Journal of Nephrology ◽

10.1159/000371748 ◽

2015 ◽

Vol 41 (1) ◽

pp. 81-88 ◽

Cited By ~ 47

Author(s):

Nattachai Srisawat ◽

Florentina E. Sileanu ◽

Raghavan Murugan ◽

Rinaldo Bellomo ◽

Paolo Calzavacca ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Odds Ratio ◽

Disease Incidence ◽

Kidney Injury ◽

Severity Of Illness ◽

Process Of Care ◽

Residual Confounding

Background: Despite standardized definitions of acute kidney injury (AKI), there is wide variation in the reported rates of AKI and hospital mortality for patients with AKI. Variation could be due to actual differences in disease incidence, clinical course, or a function of data ascertainment and application of diagnostic criteria. Using standard criteria may help determine and compare the risk and outcomes of AKI across centers. Methods: In this cohort study of critically ill patients admitted to the intensive care units at six hospitals in four countries, we used KDIGO criteria to define AKI. The main outcomes were the occurrence of AKI and hospital mortality. Results: Of the 15,132 critically ill patients, 32% developed AKI based on serum creatinine criteria. After adjusting for differences in age, sex, and severity of illness, the odds ratio for AKI continued to vary across centers (odds ratio (OR), 2.57-6.04, p < 0.001). The overall, crude hospital mortality of patients with AKI was 27%, which also varied across centers after adjusting for KDIGO stage, differences in age, sex, and severity of illness (OR, 1.13-2.20, p < 0.001). The severity of AKI was associated with incremental mortality risk across centers. Conclusions: In this study, the absolute and severity-adjusted rates of AKI and hospital mortality rates for AKI varied across centers. Future studies should examine whether variation in the risk of AKI among centers is due to differences in clinical practice or process of care or residual confounding due to unmeasured factors.

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Abstract 17300: Acute Kidney Injury is Associated With High Mortality in Patients With Atrial Fibrillation

Circulation ◽

10.1161/circ.132.suppl_3.17300 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Siva Harsha Yedlapati ◽

Usman Younus ◽

Scott H Stewart

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Acute Kidney Injury ◽

Hospital Mortality ◽

High Mortality ◽

Mortality Risk ◽

Odds Ratio ◽

Kidney Injury ◽

The United States ◽

Factors Associated

Introduction: The prevalence of atrial fibrillation (AF) is high in patients with chronic kidney disease (CKD). The mortality risk of AF in the presence of CKD is also significantly high. Multiple theories of which importantly, the renin-angiotensin-aldosterone system activation causing increased ventricular remodeling and heart failure, explain the increased incidence of AF in CKD. However, there are no data available on the effects of acute kidney injury (AKI) on mortality in patients with AF. We sought to investigate the prevalence and association of AKI with in-hospital mortality in patients presenting with AF. Methods: We performed a cross-sectional analysis of the 2011 Nationwide Inpatient Sample (NIS). Using logistic regression methods appropriate for the NIS sample design, we estimated the mortality risk associated with AKI in AF patients and evaluated factors that might modify this association. Results: In 2011, AF accounted for 457662 (1.4%) of overall adult admissions in the United States with an in-hospital mortality rate of 1%. Among these hospitalizations 30894 (6.8%) had a concomitant AKI diagnosis. The prevalence of AKI was higher (38%) in patients who died during these AF hospitalizations. The mortality risk in AF hospitalizations with an AKI diagnosis remained high even after adjusting for factors associated with AKI including age, sex, CKD, sepsis, hypertension, diabetes, congestive heart failure (CHF), smoking and heavy alcohol use (odds ratio 5.6; 95% CI (4.7 - 6.6); P<0.0001), relative to patients hospitalized with a non-AF diagnoses (odds ratio 3.3; 95% CI (3.2 - 3.4). The factors that interacted with AKI in predicting mortality risk in AF hospitalizations were underlying CKD, CHF, diabetes and alcoholism. Conclusion: Among hospitalized patients with AF, AKI is associated with significantly high mortality. This mortality was higher when compared to patients hospitalized with a non-AF diagnosis. Interpretation of our results must be conservative given the study design and data limitations. Future research using primary data sources might help identify factors associated with increased mortality in AKI patients presenting with AF.

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Acute kidney injury in patients with Covid-19 in a Brazilian ICU: incidence, predictors and in-hospital mortality

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2020-0144 ◽

2021 ◽

Author(s):

Rafael Lessa da Costa ◽

Taíza Corrêa Sória ◽

Eliene Ferreira Salles ◽

Ana Venâncio Gerecht ◽

Maurício Faria Corvisier ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Electronic Medical Records ◽

Predictive Factors ◽

Medical Records ◽

Distress Syndrome ◽

Estimated Glomerular Filtration Rate ◽

Kidney Injury ◽

Average Survival ◽

High Incidence

Abstract Introduction: There is little data in the literature on acute kidney injury (AKI) in Covid-19 cases, although relevant in clinical practice in the ICU, especially in Brazil. Our goal was to identify the incidence of AKI, predictive factors and impact on hospital mortality. Method: Retrospective cohort of patients with Covid-19 admitted to the ICU. AKI was defined according to KDIGO criteria. Data was collected from electronic medical records between March 17 and April 26. Results: Of the 102 patients, 55.9% progressed with AKI, and the majority (66.7%) was classified as stage 3. Multivariate logistic regression showed age (RC 1.101; 95% CI 1.026 - 1.181; p = 0.0070), estimated glomerular filtration rate - eGFR (RC 1.127; 95% CI 1.022 - 1.243; p = 0.0170) and hypertension (RC 3.212; 95% CI 1.065 - 9.690; p = 0.0380) as independent predictors of AKI. Twenty-three patients died. In the group without kidney injury, there were 8.9% deaths, while in the group with AKI, 33.3% of patients died (RR 5.125; 95% CI 1.598 - 16.431; p = 0.0060). The average survival, in days, was higher in the group without AKI. Cox multivariate analysis showed age (RR 1.054; 95% CI 1.014 - 1.095; p = 0.0080) and severe acute respiratory distress syndrome (RR 8.953; 95% CI 1.128 - 71.048; p = 0.0380) as predictors of hospital mortality. Conclusion: We found a high incidence of AKI; and as predictive factors for its occurrence: age, eGFR and hypertension. AKI was associated with higher hospital mortality.

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POS-068 RED BLOOD CELL DISTRIBUTION WIDTH AS PREDICTOR OF IN-HOSPITAL MORTALITY IN PATIENTS WITH SEPSIS INDUCED ACUTE KIDNEY INJURY: 5 YEAR RETROSPECTIVE REVIEW STUDY FROM 2014-2018

Kidney International Reports ◽

10.1016/j.ekir.2021.03.075 ◽

2021 ◽

Vol 6 (4) ◽

pp. S30

Author(s):

L.A. CAROLINO ◽

R.J. Laguesma

Keyword(s):

Acute Kidney Injury ◽

Blood Cell ◽

Hospital Mortality ◽

Red Blood Cell ◽

Retrospective Review ◽

Kidney Injury ◽

Cell Distribution ◽

Distribution Width ◽

Review Study ◽

Red Blood Cell Distribution

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Serum lactate dehydrogenase level is associated with in-hospital mortality in critically Ill patients with acute kidney injury

International Urology and Nephrology ◽

10.1007/s11255-021-02792-z ◽

2021 ◽

Author(s):

Dan Zhang ◽

Lin Shi

Keyword(s):

Acute Kidney Injury ◽

Lactate Dehydrogenase ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Lactate Dehydrogenase Level ◽

Serum Lactate ◽

Serum Lactate Dehydrogenase ◽

Serum Lactate Dehydrogenase Level

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Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study

BMC Nephrology ◽

10.1186/s12882-021-02238-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Wen En Joseph Wong ◽

Siew Pang Chan ◽

Juin Keith Yong ◽

Yen Yu Sherlyn Tham ◽

Jie Rui Gerald Lim ◽

...

Keyword(s):

Acute Kidney Injury ◽

High Risk ◽

Hospital Mortality ◽

Structural Equation Model ◽

Structural Equation ◽

Injury Risk ◽

Kidney Injury ◽

Equation Model ◽

Surgical Icu ◽

One Year

Abstract Background Acute kidney injury is common in the surgical intensive care unit (ICU). It is associated with poor patient outcomes and high healthcare resource usage. This study’s primary objective is to help identify which ICU patients are at high risk for acute kidney injury. Its secondary objective is to examine the effect of acute kidney injury on a patient’s prognosis during and after the ICU admission. Methods A retrospective cohort of patients admitted to a Singaporean surgical ICU between 2015 to 2017 was collated. Patients undergoing chronic dialysis were excluded. The outcomes were occurrence of ICU acute kidney injury, hospital mortality and one-year mortality. Predictors were identified using decision tree algorithms. Confirmatory analysis was performed using a generalized structural equation model. Results A total of 201/940 (21.4%) patients suffered acute kidney injury in the ICU. Low ICU haemoglobin levels, low ICU bicarbonate levels, ICU sepsis, low pre-ICU estimated glomerular filtration rate (eGFR) and congestive heart failure was associated with the occurrence of ICU acute kidney injury. Acute kidney injury, together with old age (> 70 years), and low pre-ICU eGFR, was associated with hospital mortality, and one-year mortality. ICU haemoglobin level was discretized into 3 risk categories for acute kidney injury: high risk (haemoglobin ≤9.7 g/dL), moderate risk (haemoglobin between 9.8–12 g/dL), and low risk (haemoglobin > 12 g/dL). Conclusion The occurrence of acute kidney injury is common in the surgical ICU. It is associated with a higher risk for hospital and one-year mortality. These results, in particular the identified haemoglobin thresholds, are relevant for stratifying a patient’s acute kidney injury risk.

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Predictors of acute kidney injury in patients after extracorporeal cardiopulmonary resuscitation

Perfusion ◽

10.1177/02676591211049767 ◽

2021 ◽

pp. 026765912110497

Author(s):

Christopher Gaisendrees ◽

Borko Ivanov ◽

Stephen Gerfer ◽

Anton Sabashnikov ◽

Kaveh Eghbalzadeh ◽

...

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

High Risk ◽

Cardiopulmonary Resuscitation ◽

Hospital Mortality ◽

Hospital Stay ◽

Kidney Injury ◽

Dialysis Patients ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Outcome Parameters

Objectives: Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly used due to its beneficial outcomes and results compared with conventional CPR. Data after eCPR for acute kidney injury (AKI) are lacking. We sought to investigate factors predicting AKI in patients who underwent eCPR. Methods: From January 2016 until December 2020, patients who underwent eCPR at our institution were retrospectively analyzed and divided into two groups: patients who developed AKI ( n = 60) and patients who did not develop AKI ( n = 35) and analyzed for outcome parameters. Results: Overall, 63% of patients suffered AKI after eCPR and 45% of patients who developed AKI needed subsequent dialysis. Patients who developed AKI showed higher values of creatinine (1.1 mg/dL vs 1.5 mg/dL, p ⩽ 0.01), urea (34 mg/dL vs 42 mg/dL, p = 0.04), CK (creatine kinase) (923 U/L vs 1707 U/L, p = 0.07) on admission, and CK after 24 hours of ECMO support (1705 U/L vs 4430 U/L, p = 0.01). ECMO explantation was significantly more often performed in patients who suffered AKI (24% vs 48%, p = 0.01). In-hospital mortality (86% vs 70%; p = 0.07) did not differ significantly. Conclusion: Patients after eCPR are at high risk for AKI, comparable to those after conventional CPR. Baseline urea levels predict the development of AKI during the hospital stay.

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