scholarly journals Clinical characteristics and outcomes of 85 intensive care patients with Covid-19 in South London: A single centre observational study

2020 ◽  
pp. 175114372097154
Author(s):  
Alexander Isted ◽  
Angus J McDonnell ◽  
Eben Jones ◽  
Tomas Grundy ◽  
Swarna Jeyabraba ◽  
...  
Keyword(s):  
Intensive Care ◽  
Observational Study ◽  
Clinical Characteristics ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Binary Logistic Regression ◽  
Patient Characteristics ◽  
Icu Admission ◽  
Reactive Protein ◽  
Global Pandemic

Background In March 2020, Covid-19 secondary to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was declared a global pandemic. Methods This retrospective observational study included patients with Covid-19, managed in a single intensive care unit (ICU). We collected data on patient characteristics, laboratory and radiological findings and ICU management. Data are reported as median (interquartile range). Binary logistic regression modelling was used to identify variables at ICU admission associated with mortality. Results 85 patients (age 57.3 years [49.4–64.2], 75.3% male) were followed up for 34 days (26–40). The commonest comorbidities were hypertension (51.8%), obesity (48.7%), and type 2 diabetes (31.8%). Covid-19 presented with shortness of breath (89.4%), fever (82.4%), and cough (81.2%), first noted 8 days (6–10) prior to ICU admission. PaO2/FiO2-ratios at ICU admission were 8.28 kPa (7.04–11.7). Bilateral infiltrates on chest X-ray, lymphopenia, and raised C-reactive protein and ferritin were typical. 81.2% received invasive mechanical ventilation (IMV). Acute kidney injury occurred in 62.4% with renal replacement therapy required in 20.0%. By the end of the follow-up period, 44.7% had died, 30.6% had been discharged from hospital, 14.1% had been discharged from ICU but remained in hospital and 10.6% remained in ICU. ICU length of stay was 14 days (9–23). Age was the only variable at admission which was associated with mortality. PaO2/FiO2-ratio, driving pressure and peak ferritin and neutrophil count over the first 72-hours of IMV all correlated with mortality. Conclusions We report the clinical characteristics, ICU practices and outcomes of a South London cohort with Covid-19, and have identified factors which correlate with mortality. By sharing our insight, we hope to further understanding of this novel disease.

Combined Renal-Pulmonary Extracorporeal Support with Low Blood Flow Techniques: A Retrospective Observational Study (CICERO Study)

2021 ◽  
pp. 1-10
Author(s):  
Guglielmo Consales ◽  
Lucia Zamidei ◽  
Franco Turani ◽  
Diego Atzeni ◽  
Paolo Isoni ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Multiorgan Failure ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Kidney Injury ◽  
Protective Ventilation ◽  
Retrospective Observational Study ◽  
Organ Support ◽  
Chronic Obstructive

<b><i>Background:</i></b> Critically ill patients with acute respiratory failure frequently present concomitant lung and kidney injury, within a multiorgan failure condition due to local and systemic mediators. To face this issue, extracorporeal carbon dioxide removal (ECCO<sub>2</sub>R) systems have been integrated into continuous renal replacement therapy (CRRT) platforms to provide a combined organ support, with efficient clearance of CO<sub>2</sub> with very low extracorporeal blood flows (&#x3c;400 mL/min). <b><i>Objectives:</i></b> To evaluate efficacy and safety of combined ECCO<sub>2</sub>R-CRRT support with PrismaLung®-Prismaflex® in patients affected by hypercapnic respiratory acidosis associated with AKI in a second level intensive care unit. <b><i>Methods:</i></b> We carried out a retrospective observational study enrolling patients submitted to PrismaLung®-Prismaflex® due to mild to moderate acute respiratory distress syndrome (ARDS) or acute exacerbation of chronic obstructive pulmonary disease (aeCOPD). The primary endpoints were the shift to protective ventilation and extubation of mechanically ventilated patients and the shift to invasive mechanical ventilation of patients receiving noninvasive ventilation (NIV). Clinical-laboratoristic data and operational characteristics of ECCO<sub>2</sub>R-CRRT were recorded. <b><i>Results:</i></b> Overall, 12/17 patients on mechanical ventilation shifted to protective ventilation, CO<sub>2</sub> clearance was satisfactorily maintained during the whole observational period, and pH was rapidly corrected. Treatment prevented NIV failure in 4 out of 5 patients. No treatment-related complications were recorded. <b><i>Conclusion:</i></b> ECCO<sub>2</sub>R-CRRT was effective and safe in patients with aeCOPD and ARDS associated with AKI.

scholarly journals COVID-19 in pediatrics: case report with many complications and a good clinical outcome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Arianne Gaspar ◽  
Paulo João ◽  
Gabriela Kuzma ◽  
Idilla Floriani ◽  
Luana Amancio
Keyword(s):  
Clinical Outcome ◽  
Recurrent Urinary Tract Infection ◽  
Invasive Mechanical Ventilation ◽  
Pediatric Intensive Care ◽  
Older Individuals ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Global Pandemic ◽  
Previous Diagnosis ◽  
Acute Infectious Disease

Coronavirus disease 2019 (COVID-19) is an acute infectious disease that caused the emergence of the new serious global pandemic. The infection in children is much less prevalent than in adults and most cases are asymptomatic or have mild symptoms. Severe cases represent less than 1% of the total, therefore information about the disease in this age group is scarce compared to data in older individuals. We exposed a case of a 16-year-old male adolescent with a previous diagnosis of myelomeningocele, hydrocephalus with peritoneal ventricle bypass (PVB), recurrent urinary tract infection, epilepsy, and obesity. The patient presented cough and convulsive crises, which worsened during hospitalization with severe acute respiratory syndrome due to SARS-CoV-2, septic shock, and cardiorespiratory arrest and invasive mechanical ventilation (IMV) for 9 days was required. Also presented several other complications and factors of critical prognosis, such as elevated inflammatory markers (C-reactive protein, D-dimer), elevated cardiac troponin, and the necessity of renal replacement therapy. Nevertheless, the clinical outcome was satisfactory and he was discharged after a 40-day stay in the Pediatric Intensive Care Unit.

scholarly journals Evaluation of Aetiology and Outcome of Acute Kidney Injury in a Tertiary Care Hospital of India- A Prospective Observational Study

2020 ◽  
Author(s):  
VS Gaurav Narayan ◽  
SG Ramya ◽  
Sonal Rajesh Kumar ◽  
SK Nellaiappa Ganesan
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Rapid Decline ◽  
Care Hospital ◽  
Medical Intensive Care

Introduction: The Acute Kidney Injury (AKI) is a rapid decline in renal filtration function. The aetiological spectrum, prevalence of AKI and outcome is highly variable. This variation exists due to the difference in the criteria used, study population and demographic features. Huge differences are noted when AKI is compared in developing and developed countries. Hence, it is important to analyse the spectrum of AKI to facilitate earlier diagnosis and treatment which shall help in improving the outcome. Aim: To study the prevalence, aetiology and outcome of AKI in the medical intensive care. Materials and Methods: This was a prospective observational study conducted in a medical intensive care for 18 months where 1490 patients were screened and 403 patients were included as AKI by KDIGO criteria. History, examination, appropriate investigations and treatment details including dialysis were noted. The serum creatinine levels were obtained every day, to know the time of onset of AKI, at the time of death or discharge, and after one month for patients who turned up for follow-up. Patients were categorised based on outcome as survivors and nonsurvivors. Survivors were divided into as fully recovered and partially recovered and those who left the Intensive Care Unit (ICU) against medical advice were termed as lost to follow-up. Results: A total of 403 patients (27.04% of 1490) of medical intensive care admissions were found to have AKI. Sepsis was the most common cause of AKI. At the end of the month, 78.4% of AKI patients fully recovered, 1.2% partially recovered and the mortality was 14.9%. Mortality was higher in AKI associated with chronic medical conditions like cardiac failure, chronic liver disease and stroke. Conclusion: If treated early, AKI is mostly reversible. Regional differences in AKI should be studied extensively and local guidelines should be formulated by experts for prevention and early treatment, to improve the disease outcome.

scholarly journals CLINICAL CHARACTERISTICS OF 28 PATIENTS WITH DIABETES AND COVID-19 IN WUHAN, CHINA

2020 ◽  
Vol 26 (6) ◽  
pp. 668-674 ◽  
Author(s):  
Feng Wang ◽  
Yan Yang ◽  
Kun Dong ◽  
Yongli Yan ◽  
Shujun Zhang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Clinical Characteristics ◽  
Troponin I ◽  
Clinical Laboratory ◽  
Invasive Mechanical Ventilation ◽  
Icu Patients ◽  
Patients With Diabetes

Objective: Previous studies on coronavirus disease 2019 (COVID-19) were based on information from the general population. We aimed to further clarify the clinical characteristics of diabetes with COVID-19. Methods: Twenty-eight patients with diabetes and COVID-19 were enrolled from January 29, 2020, to February 10, 2020, with a final follow-up on February 22, 2020. Epidemiologic, demographic, clinical, laboratory, treatment, and outcome data were analyzed. Results: The average age of the 28 patients was 68.6 ± 9.0 years. Most (75%) patients were male. Only 39.3% of the patients had a clear exposure of COVID-19. Fever (92.9%), dry cough (82.1%), and fatigue (64.3%) were the most common symptoms, followed by dyspnea (57.1%), anorexia (57.1%), diarrhea (42.9%), expectoration (25.0%), and nausea (21.4%). Fourteen patients were admitted to the intensive care unit (ICU). The hemoglobin A1c level was similar between ICU and non-ICU patients. ICU patients had a higher respiratory rate, higher levels of random blood glucose, aspartate transaminase, bilirubin, creatine, N-terminal prohormone of brain natriuretic peptide, troponin I, D-dimers, procalcitonin, C-reactive protein, ferritin, interleukin (IL)-2R, IL-6, and IL-8 than non-ICU patients. Eleven of 14 ICU patients received noninvasive ventilation and 7 patients received invasive mechanical ventilation. Twelve patients died in the ICU group and no patients died in the non-ICU group. Conclusion: ICU cases showed higher rates of organ failure and mortality than non-ICU cases. The poor outcomes of patients with diabetes and COVID-19 indicated that more supervision is required in these patients. Abbreviations: COVID-19 = coronavirus disease 2019; ICU = intensive care unit; MERS-CoV = middle East respiratory syndrome-related coronavirus; 2019- nCoV = 2019 novel coronavirus; NT-proBNP = N-terminal prohormone of brain natriuretic peptide; SARS-CoV = severe acute respiratory syndrome-related coronavirus

scholarly journals Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

2020 ◽  
Vol 45 (6) ◽  
pp. 1018-1032
Author(s):  
Imran Chaudhri ◽  
Richard Moffitt ◽  
Erin Taub ◽  
Raji R. Annadi ◽  
Minh Hoai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Hospital Death ◽  
Study Cohort ◽  
Icu Admission ◽  
Risk Of Death ◽  
Increased Risk

<b><i>Introduction:</i></b> Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. <b><i>Methods:</i></b> This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, <i>t</i> test, χ<sup>2</sup> test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. <b><i>Results:</i></b> Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28–17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12–18.64), IMV (OR 8.79, 95% CI 2.08–37.00), and death (OR 18.03, 95% CI 2.84–114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19–114.4, <i>p</i> = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44–240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001–0.06). <b><i>Conclusion:</i></b> Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

scholarly journals Epidemiology and short-term outcomes of acute kidney injury among patients in the intensive care unit in Laos: a nationwide multicenter, prospective, and observational study

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Noot Sengthavisouk ◽  
Nuttha Lumlertgul ◽  
Chanmaly Keomany ◽  
Phonepadith Banouvong ◽  
Phetvilay Senavong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Observational Study ◽  
Kidney Injury ◽  
Short Term

scholarly journals P0597TRAINING IS NOT ENOUGH: RESISTANCE TO THE APPLICATION OF THE AGREED CRITERIA (KDIGO) FOR THE DIAGNOSIS OF ACUTE KIDNEY INJURY IN INTENSIVE CARE UNITS IN EGYPT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Samar Abd ElHafeez ◽  
Yasmine Naga ◽  
Graziella D'arrigo ◽  
Giovanni Tripepi ◽  
Carmine Zoccali
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Diagnosis ◽  
Kidney Injury ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Icu Admission ◽  
Kdigo Guidelines ◽  
University Teaching Hospitals

Abstract Background and Aims Acute kidney injury (AKI) is one of the most serious complications of patients admitted to intensive care units (ICUs). It is associated with high short- and long-term mortality and resource utilization. The definition of AKI has been established by the KDIGO guidelines based on changes in serum creatinine, urine output or both. However, in clinical practice physicians may ignore the standard criteria and rely on clinical judgement. We therefore aimed to assess the degree of physicians’ compliance with the KDIGO guidelines in diagnosis of AKI. Method We collected data (demographic, clinical, and biochemical) in a multicenter prospective cohort study from all adults admitted to ICUs (10 surgical and 8 medical) units at Alexandria University Teaching Hospitals from February 1st, 2016 till August 1st, 2016. Alexandria Teaching Hospitals cover four governorates of Northern Egypt and serve approximately 14 million people. Doctors were preliminarily instructed to apply KDIGO criteria for the diagnosis of AKI. Personal and clinical experience data were collected from the treating physicians. We followed patients for thirty days from study entry until discharge, death or study end. Written informed consent was obtained from all participants. AKI was defined and classified based on KDIGO 2012 criteria. In parallel, we registered the actual clinical diagnosis made by the treating physicians. We used frequencies and means for qualitative and quantitative variables as appropriate. Results The study included 532 patients who were on average 46 year old (±18), 41.7% were males, 23.5% with smoking, 23.1% had diabetes, 34.8%, were hypertensive, 11.3 % with pre-existing chronic kidney disease, and 30.1% had cardiovascular diseases. There were 140 physicians responsible for treating the enrolled subjects, with mean age 30 ±3 years, 57% were males, 20% were nephrologists, and the median years of experience was 3 years (inter-quartile range: 2-4years). The AKI incidence was 62.2% according to KDIGO criteria versus 49.9% based on the clinical diagnosis of treating physicians. Among those not reported to have AKI by the treating physicians; 19.1% were in stage 1, 26.4% in stage 2, and 12.9% in stage 3 AKI based on KDIGO. About 24% of patients who had AKI at ICU admission and 15% of those who developed AKI after ICU admission were not appropriately identified as AKI patients according to the physicians. There was a significant association between the physician speciality (nephrology vs other specialties) and the correct AKI diagnosis based on KDIGO criteria (X2=47.06, p&lt;0.001). Conclusion To streamline a correct and timely identification of AKI, treating physicians in ICUs at a large hospital in North Africa, like the Alexandria University Teaching Hospitals in Egypt, need well focused training and knowledge verification post training on KDIGO guidelines for identifying AKI patients. Implementation of electronic alerts could help in proper diagnosis and management.

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