scholarly journals Acute Kidney Injury in Critical Care COVID-19 Patients on Invasive Mechanical Ventilation: The Potential Preventive Role of Dexamethasone

2022 ◽  
Author(s):  
Olynka Vega Vega
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Critical Care ◽  
Lower Incidence ◽  
Cox Regression ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Dexamethasone Treatment ◽  
Cox Regression Analysis ◽  
Severe Stage

Abstract Background. A high incidence of acute kidney injury (AKI) has been reported in COVID-19 patients in critical care units and those undergoing invasive mechanical ventilation (IMV). The introduction of dexamethasone as treatment for severe COVID-19 has improved mortality, but its effects in other organs remain under study. Methods. In this prospective observational cohort study, we evaluated the incidence of AKI in critically ill COVID-19 patients undergoing mechanical ventilation, and the association of dexamethasone treatment with the incidence, severity, and outcomes of AKI. The association between dexamethasone treatment and AKI was evaluated by multivariate logistic regression. The association of the combination of dexamethasone treatment and AKI on mortality was evaluated by Cox-regression analysis. Results. We included 552 patients. AKI was diagnosed in 311 (56%), of which 196 (63%) corresponded to severe (stage 2 or 3) AKI, and 46 (14.8%) received renal replacement therapy (RRT). Two hundred and sixty-seven (48%) patients were treated with dexamethasone. This treatment was associated to lower incidence of AKI (OR 0.34, 95%CI 0.22-0.52, p<0.001) after adjusting for age, body mass index, laboratory parameters, SOFA score, and vasopressor use. Dexamethasone treatment significantly reduced mortality in patients with severe AKI (HR 0.63, 95%CI 0.41-0.96, p=0.032). Conclusions. The incidence of AKI is high in COVID-19 patients under IMV. Dexamethasone treatment is associated with a lower incidence of AKI and a lower mortality in the group with severe AKI.

scholarly journals Acute kidney injury in patients with severe COVID-19 in Mexico

2020 ◽  
Author(s):  
GUSTAVO CASAS ◽  
MARIA-ISABEL LEON ◽  
MAURICIO GONZALEZ-NAVARRO ◽  
CLAUDIA ALVARADO DE LA BARRERA ◽  
Santiago Avila-Rios ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Systemic Disease ◽  
Invasive Mechanical Ventilation ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Vasoactive Drugs ◽  
D Dimer

Introduction: Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19. Methods: We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of mechanical ventilation and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded. Results: Of 99 patients studied, 58 developed AKI (58.6%). The group with AKI had higher body mass index (p=0.0003) and frequency of obesity (p=0.001); a higher requirement of invasive mechanical ventilation (p=0.008) and vasoactive drugs (p=0.004); greater levels of serum creatinine (p<0.001) and D-dimer on admission (p<0.001); and lower lymphocyte counts (p=0.001) than the non-AKI group. The multivariate analysis indicated that risk factors for AKI were obesity (adjusted hazard ratio (HR)=2.71, 95% confidence interval (CI)=1.33-5.51, p=0.005); higher serum creatinine (HR=1.44, CI=1.02-2.02, p=0.035) and D-dimer levels on admission (HR=1.14, CI=1.06-1.23, p<0.001). In-hospital mortality was higher in the AKI group than in the non-AKI group (65.5% vs. 14.6%; p=0.001). Conclusions: AKI was common in our cohort of patients with severe COVID-19 and it was associated with mortality. The risk factors for AKI were obesity, elevated creatinine levels and higher D-dimer levels on admission. Key words: Acute kidney injury; AKI; acute renal failure; COVID-19; SARS-CoV-2.

scholarly journals Duration of Acute Kidney Injury and in-hospital Mortality in Elder Patients With Severe COVID-19: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Yue Cai ◽  
Qinglin Li ◽  
Shanshan Guo ◽  
Yanyan Chen ◽  
Fang Wang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Cox Regression ◽  
Kidney Injury ◽  
Final Analysis ◽  
Prognostic Impact ◽  
Cox Regression Analysis ◽  
Elder Patients ◽  
Kaplan Meier ◽  
Transient Aki

Abstract Background Patients with severe coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality. This study evaluated the prognostic impact of AKI duration on in-hospital mortality in elder patients.Methods We performed a retrospective study of 126 patients with confirmed COVID-19 with severe or critical disease who treated in the ICU from February 4, 2020, to April 16, 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes serum creatinine (Scr) criteria. AKI patients were divided into transient AKI and persistent AKI groups based on whether Scr level returned to baseline within 48 h post-AKI.Results In total, 107 patients were included in the final analysis. The mean age was 70 (64–78) years, and 69 (64.5%) patients were men. AKI occurred in 48 (44.9%) during their ICU stay. Of these, 11 (22.9%) had transient AKI, 37 (77.9%) had persistent AKI. In-hospital mortality was 18.6% (n =11) for patients without AKI, 72.7% (n=8) for patients with transient AKI, and 86.5% (n=32) for patients with persistent AKI (P<0.001). Kaplan–Meier curve analysis revealed that patients with both transient AKI and persistent AKI had significantly higher death rates than those without AKI (log-rank P<0.001). Multivariate Cox regression analysis revealed that transient and persistent AKI were an important risk factor for in-hospital mortality in older patients with severe COVID-19 even after adjustment for variables (hazard ratio [HR]=2.582; 95% CI: 1.025–6.505; P=0.044; and HR=6.974; 95% CI: 3.334–14.588; P<0.001).Conclusions AKI duration is a useful parameter to predict of worse clinical outcomes in elder patients with COVID-19 in the ICU. Among AKI patients, those persistent AKI have a lower in-hospital survival rate than those transient AKI, emphasizing the importance of identifying an appropriate treatment window for early intervention.

scholarly journals Incidence, Risk Factors and Mortality Outcome in Patients with Acute Kidney Injury in COVID-19: A Single-Center Observational Study

2020 ◽  
Author(s):  
Alfano Gaetano ◽  
Ferrari Annachiara ◽  
Fontana Francesco ◽  
Mori Giacomo ◽  
Magistroni Riccardo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cox Regression ◽  
Case Fatality ◽  
Kidney Injury ◽  
Serum Levels ◽  
University Hospital ◽  
Hospital Death ◽  
Cox Regression Analysis ◽  
Incidence Risk

AbstractBackgroundAcute kidney injury (AKI) is a recently recognized complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate the incidence, risk factors and case-fatality rate of AKI in patients with documented COVID-19.MethodsWe reviewed the health medical records of 307 consecutive patients hospitalized for symptoms of COVID-19 at the University Hospital of Modena, Italy.ResultsAKI was diagnosed in 69 out of 307 (22.4%) patients. The stages of AKI were stage 1 in 57.9%, stage 2 in 24.6% and stage 3 in 17.3%. Hemodialysis was performed in 7.2% of the subjects. AKI patients had a mean age of 74.7±9.9 years and higher serum levels of the main marker of inflammation and organ involvement (lung, liver, hearth and liver) than non-AKI patients. AKI events were more frequent in subjects with severe lung comprise. Two peaks of AKI events coincided with in-hospital admission and death of the patients. Kidney injury was associate with a higher rate of urinary abnormalities including proteinuria (0.448±0.85 vs 0.18±0.29; P=<0.0001) and hematuria (P=0.032) compared to non-AKI patients. At the end of follow-up, 65.2% of the patients did not recover their renal function after AKI. Risk factors for kidney injury were age, male sex, CKD and non-renal SOFA. Adjusted Cox regression analysis revealed that AKI was independently associated with in-hospital death (hazard ratio [HR]=3.74; CI 95%, 1.34-10.46) compared to non-AKI patients. Groups of patients with AKI stage 2-3 and failure to recover kidney function were associated with the highest risk of in-hospital mortality. Lastly, long-hospitalization was positively associated with a decrease of serum creatinine, likely due to muscle depletion occurred with prolonged bed rest.ConclusionsAKI was a dire consequence of patients with COVID-19. Identification of patients at high-risk for AKI and prevention of kidney injury by avoiding dehydration and nephrotoxic agents is imperative in this vulnerable cohort of patients.

scholarly journals Clinical and laboratory markers of the new coronavirus disease SARS-CoV-2 COVID-19 in hospitalized patients

2021 ◽  
Vol 26 (4) ◽  
pp. 48-55
Author(s):  
L.R. Shostakovych-Koretskaya  ◽  
T.V. Kireyeva ◽  
O.P. Shevchenko-Makarenko ◽  
M.O. Turchin ◽  
V.I. Chumak ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cox Regression ◽  
Survival Curve ◽  
Invasive Mechanical Ventilation ◽  
International Normalized Ratio ◽  
Hospitalized Patients ◽  
Response To Therapy ◽  
Blood Oxygen Saturation ◽  
Cox Regression Analysis ◽  
D Dimer

The prognostic predictors of an unfavorable course of coronavirus disease (COVID-19) and its complications with manifestations of pneumonia and the need for oxygen support and connection to the invasive mechanical ventilation were studied. Clinical and laboratory associations in hospitalized patients with COVID-19 were evaluated, the possible predictors of connection to the invasive mechanical ventilator in 37 patients were identified. Patients were hospitalized on day 6.65±3.32 of the disease, blood oxygen saturation (SpO2) depended on the severity of the disease and response to therapy. Positive significant correlations between the level of growth stimulating factor (ST2) and D-Dimer, creatine phosphokinase MB fraction (CPK-MB) and D-dimmer, CPK-MB and ST2 were revealed, as well as of ferritin and D-Dimer with ST2. There were no significant associations with troponin. C-reactive protein (CRP) probably correlated with CPK-MB and ferritin. The International Normalized Ratio (INR) indicator had significant correlations with D-dimmer, ST2 and CPK-MB. Cox regression analysis showed that the survival curve has a stepwised nature and the highest risk of deterioration, which requires mechanical ventilation, was noted on the 6th day of illness (95.0% CI = 0.9-1.0, with an average SpO2 level =87.3%). ROC analysis showed the presence of a possible relationship between D-Dimer, ST2 protein, CPK-MB and the risk of developing a critical condition requiring mechanical ventilation in patients. The study showed that COVID-19 disease has a phase nature, when after the first phase of the disease, the pulmonary phase and hypercytokinemia progress in some patients with the development of hypoxia, a decrease in SpO2. Therefore, the identification of markers of disease progression is essential for predicting the course and possible prevention of the development of acute respiratory distress syndrome with the use of invasive mechanical ventilation.

scholarly journals Colistin-Induced Acute Kidney Injury and the Effect on Survival in Patients with Multidrug-Resistant Gram-Negative Infections: Significance of Drug Doses Adjusted to Ideal Body Weight

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Nittha Arrayasillapatorn ◽  
Palinee Promsen ◽  
Kittrawee Kritmetapak ◽  
Siriluck Anunnatsiri ◽  
Wijittra Chotmongkol ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Body Weight ◽  
Total Dose ◽  
Cox Regression ◽  
Kidney Injury ◽  
Ideal Body Weight ◽  
Multidrug Resistant ◽  
Gram Negative ◽  
Cox Regression Analysis ◽  
Ideal Body

Background. Colistin is a lifesaving treatment for multidrug-resistant Gram-negative bacterial (MDR-GNB) infections along with its well-known nephrotoxicity. The controversy of colistin-induced acute kidney injury (AKI) on mortality is noted. This study aimed to determine the risk factors and impact of AKI on the survival and significance of colistin dosage. Methods. A retrospective cohort study was performed in adult patients who received intravenous colistin for MDR-GNB treatment between June 2015 and June 2017. Factors influencing colistin-induced AKI and survival were evaluated by Cox regression analysis. Cut-off levels of the colistin dose per ideal body weight (IBW) that significantly affected clinical outcomes were assessed with linearity trends and receiver operating characteristic analyses. Results. AKI occurred in 68.5% of 412 enrolled patients with an incidence rate of 10.6 per 100 patients-days and a median time was 6 (3–13) days. Stages I–III of AKI were 38.3, 24.5, and 37.2%. Factors associated with colistin-induced AKI were advanced age, high serum bilirubin, AKI presented before colistin administration, increased daily colistin doses per IBW, and concomitant use of nephrotoxic drugs. Colistin-induced AKI was related to mortality (HR 1.74, 95% CI 1.06–2.86, p = 0.028 ). In the non-AKI before colistin usage subgroup, the total dose and total dose/IBW were >1,500–2,000 mg and 30–35 mg/kg to benefit mortality reduction but were <2,500–3,000 mg and 45–50 mg/kg for risk reduction of AKI. A daily colistin dose/IBW >4.5 mg/kg/day also increased the risk of AKI. In the AKI developed before colistin subgroup, the cut-off values of total colistin dose >1250–1350 mg and total dose/IBW >23.5–24 mg/kg demonstrated significant risks of AKI. Conclusion. The incidence of AKI after colistin administration was high and impacted mortality. Prevention and early correction of these related factors are mandatory. Careful use of colistin was also both beneficial in mortality and AKI reductions.

scholarly journals Impact of acute kidney injury on in-hospital outcomes in Chinese patients with community acquired pneumonia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dawei Chen ◽  
Hongbo Yuan ◽  
Changchun Cao ◽  
Zhihe Liu ◽  
Linglin Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Community Acquired Pneumonia ◽  
Chinese Patients ◽  
Vasoactive Drugs ◽  
Hospital Outcomes ◽  
Independent Risk Factors

Abstract Background Acute kidney injury (AKI) is a frequent complication of community acquired pneumonia (CAP). However, the impact of AKI on in-hospital outcomes of patients with CAP in the Chinese population remains unclear. Methods Patients diagnosed with CAP were evaluated in this retrospective observational study. Multiple Cox regression models were employed to identify the association between AKI and in-hospital mortality and 30-day mortality, respectively. Results A total of 4213 patients were recruited; 950 (22.5%) patients were diagnosed with AKI. Independent risk factors for AKI were age, male gender, hypertension, cardiac dysfunction, diabetes, chronic kidney disease, acute respiratory failure, use of diuretics, use of vasoactive drugs, and CURB-65. Cox proportional hazards regression revealed AKI, use of angiotensin receptor blocker, hypertension, CURB-65, acute respiratory failure, and use of vasoactive drugs to be independent risk factors for both in-hospital and 30-day mortality. Compared to patients without AKI, those suffering AKI were found to have 1.31-fold (HR 1.31, 95% CI, 1.04–1.66; P = 0.023) and 1.29-fold (HR 1.29, 95% CI, 1.02–1.62; P = 0.033) increased in-hospital and 30-day mortality risks, respectively. In addition, patients with AKI were likely to require admission to intensive care unit (ICU) (42.9% versus 11.4%; P < 0.001), mechanical ventilation (33.8% versus 9.3%; P < 0.001), invasive mechanical ventilation (25.9% versus 5.8%; P < 0.001), non-invasive mechanical ventilation (25.4% versus 7.1%; P < 0.001), and experienced a longer duration of hospital stay (14 days versus 10 days; P < 0.001) than those without AKI. However, no significant difference in ICU stay (11 days versus 10 days; P = 0.099) and duration of mechanical ventilation (8 days versus 8 days; P = 0.369) between AKI and non-AKI groups was found. Conclusion AKI was common in Chinese patients with CAP. Patients with CAP who developed AKI had worse in-hospital outcomes.

scholarly journals Elevated serum iron level is a predictor of prognosis in severe patients with acute kidney injury

2020 ◽  
Author(s):  
Jie Shu ◽  
Yufeng HU ◽  
Xueshu Yu ◽  
Jiaxiu Chen ◽  
Wenwei Xu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Intensive Care ◽  
Serum Iron ◽  
Cox Regression ◽  
Elevated Serum ◽  
Kidney Injury ◽  
Iron Level ◽  
Serum Iron Level ◽  
Cox Regression Analysis

Abstract Background: Accumulation of iron is associated with oxidative stress (OS), inflammation and regulated cell death. The above three reactions contribute to the development of acute kidney injury (AKI). Here we aimed to investigate the association between the serum iron level and prognosis in severe patients with AKI.Methods: A total of 483 patients with AKI defined by Kidney Disease: Improving Global Guidelines (KIDGO) were included in this retrospective study. The data was extracted from the single-center Medical Information Mart for Intensive Care Ⅲ (MIMIC-Ⅲ) database. The max serum iron concentration measured after Intensive Care Unit (ICU) admission was defined as the serum iron in the study and divided into three groups (Low group, Middle group, High group). We plotted boxplots and Kaplan–Meier curves and used cox regression analysis to analyze data.Results: In univariable Cox regression analysis, serum iron levels were significantly correlated to the prognosis of AKI patients. After adjusting for confounding variables, higher serum iron level was remained to associate with the increase in 90-day mortality in the multivariable Cox regression analysis. Moreover, the risk of 90-day mortality stepwise increased as the groups of serum iron levels increased in AKI patients.Conclusions: From our study, we investigated that high serum iron level was associated with the increased mortality in severe patients with AKI. Serum iron levels on admission can be a predictor for predicting the prognosis of AKI patients.

scholarly journals Impact of Acute Kidney Injury on Survival in Patients With Chronic Hepatitis C

2020 ◽  
Author(s):  
Hankyu Jeon ◽  
Jae Heon Kim ◽  
Sang Soo Lee ◽  
Hee Jin Kim ◽  
Ra Ri Cha ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Cox Regression ◽  
Kidney Injury ◽  
Hcv Infection ◽  
Decompensated Cirrhosis ◽  
Cox Regression Analysis ◽  
Overall Mortality

Abstract Background: Acute kidney injury (AKI) is expected to occur commonly in patients with chronic hepatitis C. In addition, AKI may affect the survival of patients with chronic hepatitis C. However, few studies are available on this topic. We aimed to evaluate the incidence of AKI in patients with chronic hepatitis C and investigate the factors related to overall mortality. Methods: Between January 2005 and December 2018, 1252 patients with chronic hepatitis C virus (HCV) infection were retrospectively enrolled at two centers. Of them, 1008, 123, and 121 patients had chronic hepatitis (CH), compensated cirrhosis (Com-LC), and decompensated cirrhosis (Decom-LC) or hepatocellular carcinoma (HCC) at entry, respectively. Results: Over a mean follow-up period of 5.2 years, 285 patients developed AKI, with an incidence rate of 4.35 per 100 person-years. The incidence of AKI increased gradually with progression of chronic hepatitis C: CH (3.32 per 100 person-years), Com-LC (5.86 per 100 person-years), and Decom-LC or HCC (17.28 per 100 person-years). Patients without AKI showed a better survival rate than patients with AKI (P < 0.001). In multivariate Cox regression analysis, AKI (hazard ratio, 6.66; 95% confidence interval, 4.26–10.41) remained an independent risk factor for overall mortality. Conclusion: AKI is common in patients with chronic HCV infection and is associated with significant overall mortality. Therefore, clinicians should carefully monitor the occurrence of AKI, which is an important predictor of mortality in patients with chronic hepatitis C.

scholarly journals Clinical characteristics of 34 COVID-19 patients admitted to ICU in Hangzhou, China

2020 ◽  
Author(s):  
Yi Zheng ◽  
Lijun Sun ◽  
Mi Xu ◽  
Jian Pan ◽  
Yuntao Zhang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Clinical Characteristics ◽  
Acute Liver Injury ◽  
Invasive Mechanical Ventilation ◽  
Cardiac Injury ◽  
Kidney Injury ◽  
Progressive Decrease ◽  
Complications Rate

AbstractIntroductionThe purpose of the study was to summarize the clinical and laboratory characteristics of the coronavirus disease 2019 patients admitted to intensive care unit.MethodsWe tracked the data until March 5, 2020. The cases in our cohort were divided into cases only received noninvasive ventilation (NIV) and cases required invasive mechanical ventilation (IMV). The characteristics between the two groups were compared.Results34 cases were included in the study. The complications rate (including, acute liver injury, acute cardiac injury and acute kidney injury) were higher in IMV cases. Lymphocytopenia and neutrophilia occurred in most cases in both groups on the admission day, however, lymphocyte levels dropped progressively and more severe lymphopenia occurred in IMV group. Increased amounts of plasma IL-6 and IL-10 were found in both groups on the admission day, the progressive decrease of which occurred in NIV cases rather than IMV cases, and the levels were higher in IMV cases during hospitalization.ConclusionsLymphocytopenia, neutrophilia, and increase of IL-6 and IL-10 occurred in SARS-CoV-2 infected patients in ICU, however, the dynamics of those were significantly different in IMV cases and NIV cases during hospitalization.

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