SARS-CoV-2 Renal Impairment in Critical Care: An Observational Study of 42 Cases (Kidney COVID)

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to 5% to 16% hospitalization in intensive care units (ICU) and is associated with 23% to 75% of kidney impairments, including acute kidney injury (AKI). The current work aims to precisely characterize the renal impairment associated to SARS-CoV-2 in ICU patients. Forty-two patients consecutively admitted to the ICU of a French university hospital who tested positive for SARS-CoV-2 between 25 March 2020, and 29 April 2020, were included and classified in categories according to their renal function. Complete renal profiles and evolution during ICU stay were fully characterized in 34 patients. Univariate analyses were performed to determine risk factors associated with AKI. In a second step, we conducted a logistic regression model with inverse probability of treatment weighting (IPTW) analyses to assess major comorbidities as predictors of AKI. Thirty-two patients (94.1%) met diagnostic criteria for intrinsic renal injury with a mixed pattern of tubular and glomerular injuries within the first week of ICU admission, which lasted upon discharge. During their ICU stay, 24 patients (57.1%) presented AKI which was associated with increased mortality (p = 0.007), hemodynamic failure (p = 0.022), and more altered clearance at hospital discharge (p = 0.001). AKI occurrence was associated with lower pH (p = 0.024), higher PaCO2 (CO2 partial pressure in the arterial blood) (p = 0.027), PEEP (positive end-expiratory pressure) (p = 0.027), procalcitonin (p = 0.015), and CRP (C-reactive protein) (p = 0.045) on ICU admission. AKI was found to be independently associated with chronic kidney disease (adjusted OR (odd ratio) 5.97 (2.1–19.69), p = 0.00149). Critical SARS-CoV-2 infection is associated with persistent intrinsic renal injury and AKI, which is a risk factor of mortality. Mechanical ventilation settings seem to be a critical factor of kidney impairment.

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SARS-COV2 Renal Impairment in Critical Care: A Retrospective Study of 42 Cases - Kid COVID Study

10.21203/rs.3.rs-64088/v1 ◽

2020 ◽

Author(s):

Antoine-Marie Molina Barragan ◽

Emmanuel Pardo ◽

Pierre Galichon ◽

Nicolas Hantala ◽

Anne-Charlotte Gianinazzi ◽

...

Keyword(s):

Renal Impairment ◽

Renal Injury ◽

Univariate Analysis ◽

Kidney Injury ◽

University Hospital ◽

Icu Admission ◽

Icu Stay ◽

Institutional Review ◽

Patients At Risk ◽

Mixed Pattern

Abstract BackgroundThe new coronavirus (SARS-CoV-2) infection leads to 5% to 16% hospitalization in Intensive Care Units (ICU) and is associated with 23% to 75% of kidney impairments, including acute kidney injury (AKI), as a major prognosis factor. The current work aims to characterize the renal impairment associated to SARS-CoV-2 in ICU patients, to evaluate its risk factors and its relationship with morbidity and mortality. Methods Forty-two patients consecutively admitted to the ICU of a university hospital (Paris, France) who tested positive for SARS-CoV-2 between March 25, 2020 and April 29, 2020 were included and classified in categories according to their renal function. Complete renal profiles and their evolution during ICU stay were fully characterized in 34 patients. Factors associated with AKI were identified through univariate analysis.ResultsThirty-two patients (94,1%) met diagnostic criteria for intrinsic renal injury with a mixed pattern of tubular and glomerular injuries within the first week of ICU admission, that lasted upon discharge. During their ICU stay, 24 patients (57.1%) presented AKI which was associated with increased mortality (p = 0.007), hemodynamic failure (p = 0.022), and more altered clearance at hospital discharge (p = 0.001). AKI occurrence was associated with lower pH (p = 0.024), higher PaCO2 (p = 0.027), PEEP (p = 0.027), procalcitonin (p = 0.015), and CRP (p = 0.045) on ICU admission.ConclusionsCritical SARS-CoV-2 is associated with persistent intrinsic renal injury and AKI, which is a risk factor of mortality. Identifying SARS-CoV-2 patients at risk of AKI will help in modifying clinical practice in ICU. Trial registration In accordance with the French law on biomedical research, this study obtained the approval of an Institutional Review Board (“Comité d’Éthique de la Recherche en Anesthésie-Réanimation” under the reference IRB 00010254 ‐ 2020 ‐ 106). Patients were all informed of the possible use of their data in researches as well as their right and terms of objection. Data were collected and integrated anonymously into a secure database in accordance with the French CNIL MR-004 methodology (registration number 20200803123416).

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Protein carbonyl concentration as a biomarker for development and mortality in sepsis-induced acute kidney injury

Bioscience Reports ◽

10.1042/bsr20171238 ◽

2018 ◽

Vol 38 (1) ◽

Cited By ~ 6

Author(s):

Nara Aline Costa ◽

Ana Lúcia Gut ◽

Paula Schmidt Azevedo ◽

Suzana Erico Tanni ◽

Natália Baraldi Cunha ◽

...

Keyword(s):

Septic Shock ◽

Prospective Observational Study ◽

Kidney Injury ◽

Protein Carbonyl ◽

Apache Ii Score ◽

Roc Curve Analysis ◽

Logistic Regression Models ◽

Icu Admission ◽

Icu Stay ◽

The Mean

The objective of the present study was to evaluate protein carbonyl concentration as a predictor of AKI development in patients with septic shock and of renal replacement therapy (RRT) and mortality in patients with SAKI. This was a prospective observational study of 175 consecutive patients over the age of 18 years with septic shock upon Intensive Care Unit (ICU) admission. After exclusion of 46 patients (27 due to AKI at ICU admission), a total of 129 patients were enrolled in the study. Demographic information and blood samples were taken within the first 24 h of the patient’s admission to determine serum protein carbonyl concentrations. Among the patients who developed SAKI, the development of AKI was evaluated, along with mortality and need for RRT. The mean age of the patients was 63.3 ± 15.7 years, 47% were male and 51.2% developed SAKI during ICU stay. In addition, protein carbonyl concentration was shown to be associated with SAKI. Among 66 patients with SAKI, 77% died during the ICU stay. Protein carbonyl concentration was not associated with RRT in patients with SAKI. However, the ROC curve analysis revealed that higher levels of protein carbonyl were associated with mortality in these patients. In logistic regression models, protein carbonyl level was associated with SAKI development (OR: 1.416; 95% CI: 1.247–1.609; P<0.001) and mortality when adjusted by age, gender, and APACHE II score (OR: 1.357; 95% CI: 1.147–1.605; P<0.001). In conclusion, protein carbonyl concentration is predictive of AKI development and mortality in patients with SAKI, with excellent reliability.

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Colistin Use Patterns and Toxicity in Critically Ill Patients in Pauls Stradiņš Clinical University Hospital

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.2478/prolas-2018-0024 ◽

2018 ◽

Vol 72 (4) ◽

pp. 201-206 ◽

Cited By ~ 1

Author(s):

Aleksandra Aitullina ◽

Angelika Krūmiņa ◽

Vinita Cauce ◽

Santa Purviņa

Keyword(s):

Renal Impairment ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

University Hospital ◽

Gram Negative Bacteria ◽

Acinetobacter Baumanii ◽

Use Patterns ◽

Renal Replacement Therapies ◽

Median Cumulative Dose

Abstract Colistin is used systemically in critically ill patients for treatment of infections caused by multi-drug resistant (MDR) Gram-negative bacteria, e.g., Acinetobacter baumanii. It is potentially nephro- and neurotoxic. It is recommended to decrease the dose of colistin in case of renal impairment or renal replacement therapies (RRT) but clear recommendations are not available yet. The aim of this retrospective study was to determine colistin use patterns in critically ill patients in Pauls Stradiņš University Hospital. Forty patients were included in this study. The most common indications for colistin were pneumonia associated with mechanical ventilation or sepsis caused by MDR A. baumanii. Median duration of colistin therapy was 11.5 (IQR 7.0; 17.0) days and median cumulative dose was 91.5 (43.0; 150.0) million units (MU). The usual regimen was 9 MU as loading dose and 3 MU three times daily as maintenance dose, but in case of renal impairment and RRT colistin regimens varied a lot between the patients. In 21% (7 from 33) of cases, acute kidney injury (AKI) was observed during colistin therapy (serum creatinine increases more than twice from baseline). All these AKI cases occurred in patients with previously normal renal function and none of the patients in this group needed RRT.

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ESBL-colonization at ICU admission: impact on subsequent infection, carbapenem-consumption, and outcome

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.5 ◽

2019 ◽

Vol 40 (4) ◽

pp. 408-413 ◽

Cited By ~ 7

Author(s):

Aurélien Emmanuel Martinez ◽

Andreas Widmer ◽

Reno Frei ◽

Hans Pargger ◽

Daniel Tuchscherer ◽

...

Keyword(s):

Rectal Swab ◽

Length Of Hospital Stay ◽

University Hospital ◽

Subsequent Infection ◽

Icu Admission ◽

Icu Stay ◽

Hazard Ratios ◽

Increased Risk ◽

Screening Strategies ◽

The University

AbstractObjective:To determine whether colonization with extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE) predicts the risk for subsequent infection and impacts carbapenem-consumption and outcome in intensive care unit (ICU) patients.Design:Prospective cohort study.Setting:The 2 ICUs in the University Hospital Basel in Switzerland.Patients:All patients admitted to the 2 ICUs providing mechanical ventilation and an expected ICU stay >48 hours.Methods:Patients were routinely screened for ESBL-PE carriage by rectal swab on admission. Competing risk regression analyses were applied to calculate hazard ratios (HRs) for infection with ESBL-PE and mortality. Length of hospital stay, length of ICU stay, and duration of carbapenem exposure were compared using the Mann-Whitney U test.Results:Among 302 patients, 24 (8.0%) were colonized with ESBL-PE on ICU admission. Infections with ESBL-PE occurred in 4 patients, of whom 3 (75%) were identified as ESBL-PE colonized on admission. ESBL-PE colonization on admission was associated with subsequent ESBL-PE infection (hazard ratio [HR], 25.52; 95% confidence interval [CI], 2.40–271.41; P = .007) and exposure to carbapenems (HR, 2.42; 95% CI, 1.01–5.79; P = .047), whereas duration of carbapenem exposure did not differ in relation to ESBL-PE colonization (median, 7 days [IQR, 3–8 days] vs median, 6 days [IQR 3–9 days]; P = 0.983). Patients colonized with ESBL-PE were not at increased risk for death overall (HR, 1.00; 95% CI, 0.44–2.30; P = .993) or death attributable to infection (HR, 1.20; 95% CI, 0.28–5.11; P = .808).Conclusions:Screening strategies for detection of ESBL-PE colonization on ICU admission may allow the identification of patients at highest risk for ESBL-PE infection and the correct allocation of empiric carbapenem treatment.

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Incidence and predictors of delirium on the intensive care unit in patients with acute kidney injury, insight from a retrospective registry

Scientific Reports ◽

10.1038/s41598-021-96839-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Markus Jäckel ◽

Nico Aicher ◽

Jonathan Rilinger ◽

Xavier Bemtgen ◽

Eugen Widmeier ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Kidney Injury ◽

Stage I ◽

Stage Ii ◽

University Hospital ◽

Psychiatric Disease ◽

Daily Routine ◽

Icu Stay

AbstractAcute kidney injury (AKI) and delirium are common complications on the intensive care unit (ICU). Few is known about the association of AKI and delirium, as well as about incidence and predictors of delirium in patients with AKI. In this retrospective study, all patients with AKI, as defined by the KDIGO (kidney disease improving global outcome) guideline, treated for more than 24 h on the ICU in an university hospital in 2019 were included and analyzed. Delirium was defined by a NuDesc (Nursing Delirium screening scale) ≥ 2, which is evaluated three times a day in every patient on our ICU as part of daily routine. A total of 383/919 (41.7%) patients developed an AKI during the ICU stay. Delirium was detected in 230/383 (60.1%) patients with AKI. Independent predictors of delirium were: age, psychiatric disease, alcohol abuse, mechanical ventilation, severe shock, and AKI stage II/III (all p < 0.05). The primary cause of illness had no influence on the onset of delirium. Among patients with AKI, the duration of the ICU stay correlated with higher stages of AKI and the presence of delirium (stage I/no delirium: median 1.9 (interquartile range (25th–75th) 1.3–2.9) days; stage II/III/no delirium: 2.6 (1.6–5.5) days; stage I/delirium: 4.1 (2.5–14.3) days; stage II/III/delirium: 6.8 (3.5–11.9) days; all p < 0.01). Delirium, defined as NuDesc ≥ 2 is frequent in patients with AKI on an ICU and independently predicted by higher stages of AKI.

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Ultrasound for Non-invasive Assessment and Monitoring of Quadriceps Muscle Thickness in Critically Ill Patients With Acute Kidney Injury

Frontiers in Nutrition ◽

10.3389/fnut.2021.622823 ◽

2021 ◽

Vol 8 ◽

Author(s):

Alice Sabatino ◽

Umberto Maggiore ◽

Giuseppe Regolisti ◽

Giovanni Maria Rossi ◽

Francesca Di Mario ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Muscle Wasting ◽

Kidney Injury ◽

Muscle Thickness ◽

Quadriceps Muscle ◽

Apache Ii Score ◽

Icu Admission ◽

Icu Stay

Background and aims: Critically ill patients with acute kidney injury (AKI) undergo major muscle wasting in the first few days of ICU stay. An important concern in this clinical setting is the lack of adequate tools for routine bedside evaluation of the skeletal muscle mass, both for the determination of nutritional status at admission, and for monitoring. In this regard, the present study aims to ascertain if ultrasound (US) is able to detect changes in quadriceps muscle thickness of critically ill patients with acute kidney injury (AKI) over short periods of time.Methods: This is a prospective observational study with a follow-up at 5 days. All adult patients with AKI hospitalized at the Renal ICU of the Parma University Hospital over 12 months, with a hospital stay before ICU admission no longer than 72 h, and with a planned ICU stay of at least 5 days, were eligible for the study. An experienced investigator assessed quadriceps rectus femoris and vastus intermedius thickness (QRFT and QVIT) at baseline and after 5 days of ICU stay.Results: We enrolled 30 patients with 74 ± 11 years of age and APACHE II score of 22 ± 5. Muscle thickness decreased by 15 ± 13% within the first 5 days of ICU stay (P < 0.001 for all sites as compared to ICU admission). Patients with more severe muscle loss had lower probability of being discharged home (OR: 0.04, 95%CI: 0.00–0.74; P = 0.031).Conclusions: In critically ill patients with AKI, bedside muscle US identifies patients with accelerated muscle wasting.

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Automated left atrial strain analysis for predicting atrial fibrillation in severe COVID-19 pneumonia: a prospective study

Annals of Intensive Care ◽

10.1186/s13613-021-00955-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Christophe Beyls ◽

Alexis Hermida ◽

Yohann Bohbot ◽

Nicolas Martin ◽

Christophe Viart ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Cumulative Risk ◽

Strain Analysis ◽

University Hospital ◽

World Health ◽

Left Atrial Strain ◽

Icu Admission ◽

Icu Stay ◽

Saps Ii Score

Abstract Background Atrial fibrillation (AF) is the most documented arrhythmia in COVID-19 pneumonia. Left atrial (LA) strain (LAS) analysis, a marker of LA contractility, have been associated with the development of AF in several clinical situations. We aimed to assess the diagnostic ability of LA strain parameters to predict AF in patients with severe hypoxemic COVID-19 pneumonia. We conducted a prospective single center study in Amiens University Hospital intensive care unit (ICU) (France). Adult patients with severe or critical COVID-19 pneumonia according to the World Health Organization definition and in sinus rhythm were included. Transthoracic echocardiography was performed within 48 h of ICU admission. LA strain analysis was performed by an automated software. The following LA strain parameters were recorded: LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd) and LA strain during contraction phase (LASct). The primary endpoint was the occurrence of AF during ICU stay. Results From March 2020 to February of 2021, 79 patients were included. Sixteen patients (20%) developed AF in ICU. Patients of the AF group were significantly older with a higher SAPS II score than those without AF. LAScd and LASr were significantly more impaired in the AF group compared to the other group (− 8.1 [− 6.3; − 10.9] vs. − 17.2 [− 5.0; − 10.2] %; P < 0.001 and 20.2 [12.3;27.3] % vs. 30.5 [23.8;36.2] %; P = 0.002, respectively), while LASct did not significantly differ between groups (p = 0.31). In a multivariate model, LAScd and SOFA cv were significantly associated with the occurrence of AF. A LAScd cutoff value of − 11% had a sensitivity of 76% and a specificity of 75% to identify patients with AF. The 30-day cumulative risk of AF was 42 ± 9% with LAScd > − 11% and 8 ± 4% with LAScd ≤ − 11% (log rank test P value < 0.0001). Conclusion For patients with severe COVID-19 pneumonia, development of AF during ICU stay is common (20%). LAS parameters seem useful in predicting AF within the first 48 h of ICU admission. Trial registration: NCT04354558.

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Renal Impairment in Young Patients with Unilateral Ureteral Lithiasis Obstruction: What Factors can be Responsible?

Revista de Chimie ◽

10.37358/rc.18.2.6110 ◽

2018 ◽

Vol 69 (2) ◽

pp. 375-378

Author(s):

Catalin Pricop ◽

Ileana Adela Vacaroiu ◽

Daniela Radulescu ◽

Daniel Andone ◽

Dragos Puia

Keyword(s):

Renal Impairment ◽

Serum Creatinine ◽

Young Patients ◽

Kidney Injury ◽

Contralateral Kidney ◽

Reactive Protein ◽

Ureteral Lithiasis ◽

Unilateral Hydronephrosis ◽

Duration Of Hospitalization ◽

History Of

In the literature, occurrence of acute kidney injury (AKI) in young patients with unilateral ureteral lithiasic obstruction and without previous renal impairment is not very often reported, and the underlined pathophysiological mechanisms are poorly known; according to some studies, it is a false kidney failure, the increase in serum creatinine being due to absorbtion of obstructed urine in the affected kidney. We have conducted a retro and prospective study in order to identify the possible risk factors that can cause renal function impairment in young patients (18-40 years) with unilateral ureteral lithiasis obstruction and a normal contralateral kidney. Results. From 402 patients included in the study, 20.64% (83 cases) presented with serum creatinine ] 1.3 mg/dL. In patients with renal impairment, prevalence of male gender and history of NSAIDS use before admission were significantly higher than in non-AKI group. Serum urea/creatinine ratio, and estimated glomerular filtration rate (MDRD formula) were significantly higher, and respectively lower in AKI group. We found no significant differences between the two groups regarding age, prevalence of urinary tract infection after relief of obstruction, C-reactive protein value, and the duration of hospitalization. Conclusions. AKI in young patients with unilateral ureteral lithiasis obstruction and normal contralateral kidney is not quite a rare finding in our region. NSAIDs use can influence development of AKI, and should be used cautiously even in young patients with renal colic. In our opinion, the presence of AKI in patients with unilateral hydronephrosis demands urgent endourological intervention. Choosing conservative therapy in these patients, especially treatment with NSAIDS may aggravate the renal dysfunction.

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AT1 and AT2 receptors modulate renal tubular cell necroptosis in angiotensin II-infused renal injury mice

Scientific Reports ◽

10.1038/s41598-019-55550-8 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 4

Author(s):

Yongjun Zhu ◽

Hongwang Cui ◽

Jie Lv ◽

Haiqin Liang ◽

Yanping Zheng ◽

...

Keyword(s):

Angiotensin Ii ◽

Renal Injury ◽

Critical Role ◽

Kidney Injury ◽

Renin Angiotensin System ◽

Tubular Cell ◽

Tubular Damage ◽

Renal Tubular Cell ◽

Ang Ii ◽

Renal Tubular

AbstractAbnormal renin-angiotensin system (RAS) activation plays a critical role in the initiation and progression of chronic kidney disease (CKD) by directly mediating renal tubular cell apoptosis. Our previous study showed that necroptosis may play a more important role than apoptosis in mediating renal tubular cell loss in chronic renal injury rats, but the mechanism involved remains unknown. Here, we investigate whether blocking the angiotensin II type 1 receptor (AT1R) and/or angiotensin II type 2 receptor (AT2R) beneficially alleviates renal tubular cell necroptosis and chronic kidney injury. In an angiotensin II (Ang II)-induced renal injury mouse model, we found that blocking AT1R and AT2R effectively mitigates Ang II-induced increases in necroptotic tubular epithelial cell percentages, necroptosis-related RIP3 and MLKL protein expression, serum creatinine and blood urea nitrogen levels, and tubular damage scores. Furthermore, inhibition of AT1R and AT2R diminishes Ang II-induced necroptosis in HK-2 cells and the AT2 agonist CGP42112A increases the percentage of necroptotic HK-2 cells. In addition, the current study also demonstrates that Losartan and PD123319 effectively mitigated the Ang II-induced increases in Fas and FasL signaling molecule expression. Importantly, disruption of FasL significantly suppressed Ang II-induced increases in necroptotic HK-2 cell percentages, and necroptosis-related proteins. These results suggest that Fas and FasL, as subsequent signaling molecules of AT1R and AT2R, might involve in Ang II-induced necroptosis. Taken together, our results suggest that Ang II-induced necroptosis of renal tubular cell might be involved both AT1R and AT2R and the subsequent expression of Fas, FasL signaling. Thus, AT1R and AT2R might function as critical mediators.

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Effectiveness of a vancomycin dosing protocol guided by area under the concentration-time curve to minimal inhibitory concentration (AUC/MIC) with multidisciplinary team support to improve hospital-wide adherence to a vancomycin dosing protocol: A pilot study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.296 ◽

2021 ◽

pp. 1-6

Author(s):

Panipak Katawethiwong ◽

Anucha Apisarnthanarak ◽

Kittiya Jantarathaneewat ◽

David J. Weber ◽

David K. Warren ◽

...

Keyword(s):

Mortality Rate ◽

Multidisciplinary Team ◽

Kidney Injury ◽

University Hospital ◽

Routine Practice ◽

Post Intervention ◽

Coagulase Negative Staphylococci ◽

Time Curve ◽

Concentration Time ◽

Quasi Experimental

Abstract Background: Limited data are available on the implementation of an area under the concentration-time curve (AUC)–based dosing protocol with multidisciplinary team (MT) support to improve adherence with vancomycin dosing protocol. Objective: To evaluate the effectiveness of an AUC-based dosing protocol with MT support intervention with adherence to a hospital-wide vancomycin dosing protocol at Thammasat University Hospital. Method: We conducted a quasi-experimental study in patients who were prescribed intravenous vancomycin. The study was divided into 2 periods; (1) the preintervention period when the vancomycin dosing protocol was already applied in routine practice and (2) the post-intervention period when the implementation of an AUC-based dosing protocol with MT support was added to the existing vancomycin dosing protocol. The primary outcome was the rate of adherence, and the secondary outcomes included acute kidney injury events, vancomycin-related adverse events, and 30-day mortality rate. Results: In total, 240 patients were enrolled. The most common infections were skin and soft-tissue infections (24.6%) and bacteremia (24.6%). The most common pathogens were coagulase-negative staphylococci (19.6%) and Enterococcus spp (15.4%). Adherence with the vancomycin dosing protocol was significantly higher in the postintervention period (90.8% vs 55%; P ≤ .001). By multivariate analysis, an AUC-based dosing protocol with MT support was the sole predictor for adherence with the vancomycin dosing protocol (adjusted odds ratio, 10.31; 95% confidence interval, 4.54–23.45; P ≤ .001). The 30-day mortality rate was significantly lower during the postintervention period (8.3% vs 20%; P = .015). Conclusions: AUC-based dosing protocol with MT support significantly improved adherence with vancomycin dosing protocol and was associated with a lower 30-day mortality rate.

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