AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19

BackgroundAKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT).MethodsWe conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. We used multivariable logistic regression to identify patient-and hospital-level risk factors for AKI-RRT and to examine risk factors for 28-day mortality among such patients.ResultsA total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Patient-level risk factors for AKI-RRT included CKD, men, non-White race, hypertension, diabetes mellitus, higher body mass index, higher d-dimer, and greater severity of hypoxemia on ICU admission. Predictors of 28-day mortality in patients with AKI-RRT were older age, severe oliguria, and admission to a hospital with fewer ICU beds or one with greater regional density of COVID-19. At the end of a median follow-up of 17 days (range, 1–123 days), 403 of the 637 patients (63.3%) with AKI-RRT had died, 216 (33.9%) were discharged, and 18 (2.8%) remained hospitalized. Of the 216 patients discharged, 73 (33.8%) remained RRT dependent at discharge, and 39 (18.1%) remained RRT dependent 60 days after ICU admission.ConclusionsAKI-RRT is common among critically ill patients with COVID-19 and is associated with a hospital mortality rate of >60%. Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission.

Download Full-text

In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study

BMJ ◽

10.1136/bmj.m3513 ◽

2020 ◽

pp. m3513 ◽

Cited By ~ 3

Author(s):

Salim S Hayek ◽

Samantha K Brenner ◽

Tariq U Azam ◽

Husam R Shadid ◽

Elizabeth Anderson ◽

...

Keyword(s):

Cardiac Arrest ◽

Intensive Care ◽

Cardiopulmonary Resuscitation ◽

Hospital Discharge ◽

Critically Ill ◽

Critically Ill Patients ◽

Multicenter Cohort Study ◽

Critically Ill Adults ◽

Ill Adults ◽

Hospital Cardiac Arrest

Abstract Objectives To estimate the incidence, risk factors, and outcomes associated with in-hospital cardiac arrest and cardiopulmonary resuscitation in critically ill adults with coronavirus disease 2019 (covid-19). Design Multicenter cohort study. Setting Intensive care units at 68 geographically diverse hospitals across the United States. Participants Critically ill adults (age ≥18 years) with laboratory confirmed covid-19. Main outcome measures In-hospital cardiac arrest within 14 days of admission to an intensive care unit and in-hospital mortality. Results Among 5019 critically ill patients with covid-19, 14.0% (701/5019) had in-hospital cardiac arrest, 57.1% (400/701) of whom received cardiopulmonary resuscitation. Patients who had in-hospital cardiac arrest were older (mean age 63 (standard deviation 14) v 60 (15) years), had more comorbidities, and were more likely to be admitted to a hospital with a smaller number of intensive care unit beds compared with those who did not have in-hospital cardiac arrest. Patients who received cardiopulmonary resuscitation were younger than those who did not (mean age 61 (standard deviation 14) v 67 (14) years). The most common rhythms at the time of cardiopulmonary resuscitation were pulseless electrical activity (49.8%, 199/400) and asystole (23.8%, 95/400). 48 of the 400 patients (12.0%) who received cardiopulmonary resuscitation survived to hospital discharge, and only 7.0% (28/400) survived to hospital discharge with normal or mildly impaired neurological status. Survival to hospital discharge differed by age, with 21.2% (11/52) of patients younger than 45 years surviving compared with 2.9% (1/34) of those aged 80 or older. Conclusions Cardiac arrest is common in critically ill patients with covid-19 and is associated with poor survival, particularly among older patients.

Download Full-text

Analysis of the impact of secondary prophylaxis on Clostridioides difficile recurrence in critically ill adults

SAGE Open Medicine ◽

10.1177/2050312120930898 ◽

2020 ◽

Vol 8 ◽

pp. 205031212093089

Author(s):

Kathryn A Connor ◽

Kelly M Conn

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Low Dose ◽

Secondary Prophylaxis ◽

Infection Prophylaxis ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Critically Ill Adults ◽

Ill Adults ◽

Infection Recurrence

Introduction: Clostridioides (formerly Clostridium) difficile infection recurrence in patients re-exposed to antibiotics for treatment of a non- Clostridioides difficile infection is high at approximately 33%. Low-dose per os vancomycin (e.g. 125 mg q12 h) or metronidazole (e.g. 500 mg intravenous/per osq8 h) may help prevent recurrences, but study of secondary prophylaxis in critically ill patients is needed. Objectives: To determine whether critically ill adults receiving low-dose per os vancomycin for secondary Clostridioides difficile infection prophylaxis have fewer recurrences of Clostridioides difficile infection in 90 days compared with patients receiving metronidazole for secondary Clostridioides difficile infection prophylaxis or control (no secondary prophylaxis). Methods: This was a retrospective, two-center, observational study in a large academic medical center and affiliated community hospital. Included patients had a history of Clostridioides difficile infection within 1 year of receiving antibiotics for clinical care. We compared patients receiving secondary prophylaxis with vancomycin or metronidazole and control patients; in addition, an unplanned fourth group (vancomycin/metronidazole combination) was identified and analyzed. The primary outcome was Clostridioides difficile infection recurrence within 90 days of a course of broad-spectrum antibiotic therapy. Fisher’s exact, analysis of variance, and Kruskal–Wallis tests were used to compare Clostridioides difficile infection recurrence with prophylaxis group and additional contributing factors. Results: Eighty-two patients were included: 38 control (46.3%), 20 metronidazole (24.4%), 17 vancomycin (20.7%), and 7 combination (8.5%). Ten of 82 patients (12.2%) had at least one Clostridioides difficile infection recurrence; 8/38 patients in the control group (21.1%), 1/7 patients in the combination group (14.3%), 1/17 patients in the per os vancomycin group (5.9%), and 0/20 in the metronidazole group (0%; p = 0.073). As a post hoc secondary analysis, the three prophylaxis groups were coalesced into one group and compared with control (4.5% vs 21%; p = 0.039). Additional factors (e.g. age, obesity, immunosuppression, acid suppression) were not significantly associated with Clostridioides difficile infection recurrence or with prophylaxis group. Conclusion: There was no difference in Clostridioides difficile infection recurrence between prophylaxis groups, however, given the low recurrence rate, prospective evaluation with a larger sample of critically ill patients is necessary.

Download Full-text

Stress ulcer prophylaxis with proton pump inhibitors or histamine 2 receptor antagonists in critically ill adults - a meta-analysis of randomized controlled trials with trial sequential analysis

BMC Gastroenterology ◽

10.1186/s12876-019-1105-y ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Xiaoyang Zhou ◽

Hanyuan Fang ◽

Jianfei Xu ◽

Peifu Chen ◽

Xujun Hu ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Sequential Analysis ◽

Stress Ulcer ◽

Meta Analysis ◽

Trial Sequential Analysis ◽

Gi Bleeding ◽

Ulcer Prophylaxis ◽

Critically Ill Adults ◽

Ill Adults

Abstract Background Proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) have been widely used as stress ulcer prophylaxis (SUP) in critically ill patients, however, its efficacy and safety remain unclear. This study aimed to assess the effect of SUP on clinical outcomes in critically ill adults. Methods Literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane database of clinical trials for randomized controlled trials (RCTs) that investigated SUP, with PPI or H2RA, versus placebo or no prophylaxis in critically ill patients from database inception through 1 June 2019. Study selection, data extraction and quality assessment were performed in duplicate. The primary outcomes were clinically important gastrointestinal (GI) bleeding and overt GI bleeding. Conventional meta-analysis with random-effects model and trial sequential analysis (TSA) were performed. Results Twenty-nine RCTs were identified, of which four RCTs were judged as low risk of bias. Overall, SUP could reduce the incident of clinically important GI bleeding [relative risk (RR) = 0.58; 95% confidence intervals (CI): 0.42–0.81] and overt GI bleeding (RR = 0.48; 95% CI: 0.36–0.63), these results were confirmed by the sub-analysis of trials with low risk of bias, TSA indicated a firm evidence on its beneficial effects on the overt GI bleeding (TSA-adjusted CI: 0.31–0.75), but lack of sufficient evidence on the clinically important GI bleeding (TSA-adjusted CI: 0.23–1.51). Among patients who received enteral nutrition (EN), SUP was associated with a decreased risk of clinically important GI bleeding (RR = 0.61; 95% CI: 0.44–0.85; TSA-adjusted CI: 0.16–2.38) and overt GI bleeding (RR = 0.64; 95% CI: 0.42–0.96; TSA-adjusted CI: 0.12–3.35), but these benefits disappeared after adjustment with TSA. Among patients who did not receive EN, SUP had only benefits in reducing the risk of overt GI bleeding (RR = 0.37; 95% CI: 0.25–0.55; TSA-adjusted CI: 0.22–0.63), but not the clinically important GI bleeding (RR = 0.27; 95% CI: 0.04–2.09). Conclusions SUP has benefits on the overt GI bleeding in critically ill patients who did not receive EN, however, its benefits on clinically important GI bleeding still needs more evidence to confirm.

Download Full-text

Delirium Assessment Tools for Use in Critically Ill Adults: A Psychometric Analysis and Systematic Review

Critical Care Nurse ◽

10.4037/ccn2018633 ◽

2018 ◽

Vol 38 (1) ◽

pp. 38-49 ◽

Cited By ~ 24

Author(s):

Céline Gélinas ◽

Mélanie Bérubé ◽

Annie Chevrier ◽

Brenda T. Pun ◽

E. Wesley Ely ◽

...

Keyword(s):

Psychometric Properties ◽

Critically Ill ◽

Critically Ill Patients ◽

Assessment Tools ◽

Cognitive Test ◽

Delirium Assessment ◽

Nursing Delirium Screening Scale ◽

Detection Score ◽

Critically Ill Adults ◽

Ill Adults

BACKGROUNDDelirium is highly prevalent in critically ill patients. Its detection with valid tools is crucial.OBJECTIVETo analyze the development and psychometric properties of delirium assessment tools for critically ill adults.METHODSDatabases were searched to identify relevant studies. Inclusion criteria were English language, publication before January 2015, 30 or more patients, and patient population of critically ill adults (>18 years old). Search terms were delirium, scales, critically ill patients, adult, validity, and reliability. Thirty-six manuscripts were identified, encompassing 5 delirium assessment tools (Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), Cognitive Test for Delirium, Delirium Detection Score, Intensive Care Delirium Screening Checklist (ICDSC), and Nursing Delirium Screening Scale). Two independent reviewers analyzed the psychometric properties of these tools by using a standardized scoring system (range, 0–20) to assess the tool development process, reliability, validity, feasibility, and implementation of each tool.RESULTSPsychometric properties were very good for the CAM-ICU (19.6) and the ICDSC (19.2), moderate for the Nursing Delirium Screening Scale (13.6), low for the Delirium Detection Score (11.2), and very low for the Cognitive Test for Delirium (8.2).CONCLUSIONSThe results indicate that the CAM-ICU and the ICDSC are the most valid and reliable delirium assessment tools for critically ill adults. Additional studies are needed to further validate these tools in critically ill patients with neurological disorders and those at various levels of sedation or consciousness.

Download Full-text

Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study

Annals of Intensive Care ◽

10.1186/s13613-019-0495-x ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 25

Author(s):

Ignacio Martin-Loeches ◽

Maria Consuelo Guia ◽

Maria Sole Vallecoccia ◽

David Suarez ◽

Mercedes Ibarz ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Very Elderly ◽

Multicenter Cohort Study ◽

Multicenter Cohort

Download Full-text

Risk Factors for and Prediction of Hypoxemia during Tracheal Intubation of Critically Ill Adults

Annals of the American Thoracic Society ◽

10.1513/annalsats.201802-118oc ◽

2018 ◽

Vol 15 (11) ◽

pp. 1320-1327 ◽

Cited By ~ 11

Author(s):

Andrew C. McKown ◽

Jonathan D. Casey ◽

Derek W. Russell ◽

Aaron M. Joffe ◽

David R. Janz ◽

...

Keyword(s):

Risk Factors ◽

Tracheal Intubation ◽

Critically Ill ◽

Critically Ill Adults ◽

Ill Adults

Download Full-text

The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study

10.21203/rs.3.rs-50431/v1 ◽

2020 ◽

Author(s):

Ling Sang ◽

Sibei Chen ◽

Xia Zheng ◽

Weijie Guan ◽

Zhihui Zhang ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Retrospective Study ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Right Heart Failure ◽

Right Heart ◽

Icu Admission ◽

Incidence Risk

Abstract Background: Since the clinical correlates, prognosis and determinants of AKI in patients with Covid-19 remain largely unclear, we perform a retrospective study to evaluate the incidence, risk factors and prognosis of AKI in severe and critically ill patients with Covid-19.Methods: We reviewed medical records of all adult patients (>18 years) with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. The clinical data, including patient demographics, clinical symptoms and signs, laboratory findings, treatment [including respiratory supports, use of medications and continuous renal replacement therapy (CRRT)] and clinical outcomes, were extracted from the electronic records, and we access the incidence of AKI and the use of CRRT, risk factors for AKI, the outcomes of renal diseases, and the impact of AKI on the clinical outcomes.Results: Among 210 subjects, 131 were males (62.4%). The median age was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) patients were classified as stage 1, 2 and 3, respectively. 54 cases (58.7%) received CRRT. Age, sepsis, Nephrotoxic drug, IMV and elevated baseline Scr were associated with AKI occurrence. The renal recover during hospitalization among 16 AKI patients (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure and higher P/F ratio. Of 210 patients, 93 patients deceased within 28 days of ICU admission. AKI stage 3, critical disease, greater age and minimum P/F <150mmHg independently associated with it.Conclusions: Among patients with Covid-19, the incidence of AKI was high. age , sepsis, nephrotoxic drug, IMV and baseline Scr were strongly associated with the development of AKI. Time from admission to AKI diagnosis, right heart failure and P/F ratio were independently associated with the potential of renal recovery. Finally, AKI KIDGO stage 3 independently predicted the risk of death within 28 days of ICU admission.

Download Full-text

Early Versus Late Use of Dexamethasone in Critically Ill Patients With COVID-19: A Multicenter, Cohort Study

10.21203/rs.3.rs-349677/v5 ◽

2021 ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Al Juhani ◽

Ghazwa B. Korayem ◽

Khalid Eljaaly ◽

Alaa Alhubaishi ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Critically Ill ◽

Critically Ill Patients ◽

Positive Outcomes ◽

Multicenter Cohort Study ◽

Mechanically Ventilated ◽

Icu Admission ◽

Early Use ◽

Late Group

Abstract Rationale: It is unclear whether the timing of dexamethasone initiation is associated with positive outcomes. Objectives: To evaluate the appropriate timing of systemic dexamethasone initiation in critically ill patients with COVID-19. Methods: A multicenter, non-interventional cohort study including adults with COVID-19 patients admitted to intensive care units (ICUs) received systemic dexamethasone between March 2020 and January 2021. Patients were divided into two groups based on the timing for dexamethasone use (early vs. late). Early use is defined as the new initiation of dexamethasone within 24 hours of ICU admission. Propensity score matching was used based on the patient’s SOFA score, MV within 24 hours of ICU admission, proning status, and tocilizumab use during ICU stay. Results: A total of 480 patients were included in the study; dexamethasone was initiated early within 24 hours of ICU admission in 367 patients. Among 202 patients matched using propensity score, 101 had received dexamethasone after 24 hours of ICU admission (1:1 ratio). The 30-day mortality (OR [95%CI]: 1.82[1.04, 3.19], P=0.04) and in-hospital mortality (OR [95%CI]: 1.80[1.03, 3.15], P=0.04) were higher in the late group. Among the non-mechanically ventilated patients, late use of dexamethasone was associated with higher odds of developing respiratory failure that required MV (OR [95%CI]: 3.8 [1.41, 10.3], P=0.008). Conclusion: Early use of dexamethasone within 24 hours of ICU admission in critically ill patients with COVID-19 was associated with mortality benefits. Moreover, dexamethasone's early use might be considered a proactive measure in non-mechanically ventilated critically ill patients with COVID-19, to prevent further complications.

Download Full-text

Association of multiple glycemic parameters at intensive care unit admission with mortality and clinical outcomes in critically ill patients

Scientific Reports ◽

10.1038/s41598-019-55080-3 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 6

Author(s):

Priscila Bellaver ◽

Ariell F. Schaeffer ◽

Diego P. Dullius ◽

Marina V. Viana ◽

Cristiane B. Leitão ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Glycemic Variability ◽

Stress Hyperglycemia ◽

Critically Ill Adults ◽

Ill Adults

AbstractThe aim of the present study was to investigate the association of multiple glycemic parameters at intensive care unit (ICU) admission with outcomes in critically ill patients. Critically ill adults admitted to ICU were included prospectively in the study and followed for 180 days until hospital discharge or death. Patients were assessed for glycemic gap, hypoglycemia, hyperglycemia, glycemic variability, and stress hyperglycemia ratio (SHR). A total of 542 patients were enrolled (30% with preexisting diabetes). Patients with glycemic gap >80 mg/dL had increased need for renal replacement therapy (RRT; 37.7% vs. 23.7%, p = 0.025) and shock incidence (54.7% vs. 37.4%, p = 0.014). Hypoglycemia was associated with increased mortality (54.8% vs. 35.8%, p = 0.004), need for RRT (45.1% vs. 22.3%, p < 0.001), mechanical ventilation (MV; 72.6% vs. 57.5%, p = 0.024), and shock incidence (62.9% vs. 35.8%, p < 0.001). Hyperglycemia increased mortality (44.3% vs. 34.9%, p = 0.031). Glycemic variability >40 mg/dL was associated with increased need for RRT (28.3% vs. 14.4%, p = 0.002) and shock incidence (41.4% vs.31.2%, p = 0.039). In this mixed sample of critically ill subjects, including patients with and without preexisting diabetes, glycemic gap, glycemic variability, and SHR were associated with worse outcomes, but not with mortality. Hypoglycemia and hyperglycemia were independently associated with increased mortality.

Download Full-text