Acute Kidney Injury Associated with Coronavirus Disease 2019 in Urban New Orleans

BackgroundAKI is a manifestation of COVID-19 (CoV-AKI). However, there is paucity of data from the United States, particularly from a predominantly black population. We report the phenotype and outcomes of AKI at an academic hospital in New Orleans.MethodsWe conducted an observational study in patients hospitalized at Ochsner Medical Center over a 1-month period with COVID-19 and diagnosis of AKI (KDIGO). We examined the rates of RRT and in-hospital mortality as outcome measures.ResultsAmong 575 admissions (70% black) with COVID-19 [173 (30%) to an intensive care unit (ICU)], we found 161 (28%) cases of AKI (61% ICU and 14% general ward admissions). Patients were predominantly men (62%) and hypertensive (83%). Median body mass index (BMI) was higher among those with AKI (34 versus 31 kg/m2, P<0.0001). AKI over preexisting CKD occurred in 35%. Median follow-up was 25 (1–45) days. The in-hospital mortality rate for the AKI cohort was 50%. Vasopressors and/or mechanical ventilation were required in 105 (65%) of those with AKI. RRT was required in 89 (55%) patients. Those with AKI requiring RRT (AKI-RRT) had higher median BMI (35 versus 33 kg/m2, P=0.05) and younger age (61 versus 68, P=0.0003). Initial values of ferritin, C-reactive protein, procalcitonin, and lactate dehydrogenase were higher among those with AKI; and among them, values were higher for those with AKI-RRT. Ischemic acute tubular injury (ATI) and rhabdomyolysis accounted for 66% and 7% of causes, respectively. In 13%, no obvious cause of AKI was identified aside from COVID-19 diagnosis.ConclusionsCoV-AKI is associated with high rates of RRT and death. Higher BMI and inflammatory marker levels are associated with AKI as well as with AKI-RRT. Hemodynamic instability leading to ischemic ATI is the predominant cause of AKI in this setting.

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Intra-dialytic hypotension following the transition from continuous to intermittent renal replacement therapy

Annals of Intensive Care ◽

10.1186/s13613-021-00885-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

William Beaubien-Souligny ◽

Yifan Yang ◽

Karen E. A. Burns ◽

Jan O. Friedrich ◽

Alejandro Meraz-Muñoz ◽

...

Keyword(s):

Renal Replacement Therapy ◽

Hospital Mortality ◽

Replacement Therapy ◽

Kidney Injury ◽

Hemodynamic Instability ◽

Factors Associated ◽

Definition Of ◽

Vasopressor Use ◽

Cumulative Fluid Balance ◽

Intermittent Renal Replacement Therapy

Abstract Background Transition from continuous renal replacement therapy (CRRT) to intermittent renal replacement therapy (IRRT) can be associated with intra-dialytic hypotension (IDH) although data to inform the definition of IDH, its incidence and clinical implications, are lacking. We aimed to describe the incidence and factors associated with IDH during the first IRRT session following transition from CRRT and its association with hospital mortality. This was a retrospective single-center cohort study in patients with acute kidney injury for whom at least one CRRT-to-IRRT transition occurred while in intensive care. We assessed associations between multiple candidate definitions of IDH and hospital mortality. We then evaluated the factors associated with IDH. Results We evaluated 231 CRRT-to-IRRT transitions in 213 critically ill patients with AKI. Hospital mortality was 43.7% (n = 93). We defined IDH during the first IRRT session as 1) discontinuation of IRRT for hemodynamic instability; 2) any initiation or increase in vasopressor/inotropic agents or 3) a nadir systolic blood pressure of < 90 mmHg. IDH during the first IRRT session occurred in 50.2% of CRRT-to-IRRT transitions and was independently associated with hospital mortality (adjusted odds ratio [OR]: 2.71; CI 1.51–4.84, p < 0.001). Clinical variables at the time of CRRT discontinuation associated with IDH included vasopressor use, higher cumulative fluid balance, and lower urine output. Conclusions IDH events during CRRT-to-IRRT transition occurred in nearly half of patients and were independently associated with hospital mortality. We identified several characteristics that anticipate the development of IDH following the initiation of IRRT.

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PREDICTORS OF IN-HOSPITAL MORTALITY IN PATIENTS WITH SNAKE BITE IN POPULATION OF KARACHI, PAKISTAN

Gomal Journal of Medical Sciences ◽

10.46903/gjms/17.04.1861 ◽

2019 ◽

Vol 17 (4) ◽

pp. 107-111

Author(s):

Harish Kumar ◽

Adnan Bashir ◽

Khadijah Abid ◽

Nabeel Naeem Baig

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Medical Center ◽

Kidney Injury ◽

Hazard Ratio ◽

Snake Bite ◽

Rank Test ◽

Cross Sectional ◽

Early Management ◽

Risk Of Death

Background: Snake bite remains major public health problems worldwide. The objective of this study was to determine predictors of in-hospital mortality in patients presenting with snake bite in population of Karachi, Pakistan. Materials & Methods: It was cross-sectional study conducted at Department of General Medicine, Postgraduate Medical Center, Karachi, Pakistan from 11th June 2016 to 10th August 2017. 300 patients with snake bite were selected. Age, gender, acute kidney injury, vomiting and in-hospital mortality were variables. Except age, all variables were nominal and were analyzed by frequency and percentage. Cox-proportional-hazard regression model was applied and hazard ratios were calculated along with 95% confidence intervals (CI) to assess the strength of association between predictors i.e. age, gender, AKI and vomiting and outcome (in-hospital mortality). Kaplan-Meier and time to event plot were used to investigate all patients who were on follow-up for 7 days from admission. Log-rank test was used to identify the predictors of in-hospital mortality for significant independent influence on prognosis at alpha .05. Results: The mean age of the sample was 27.7±14.58 years. Out of a sample of 300 patients, 221 (73.7%) were males and 79 (26.3%) females. The frequency (%) of AKI was 102 (66%), vomiting 122 (40.7%) and of in-hospital mortality 31 (10.3%). The probability of survival at day 7 was 81.8%. Vomiting [hazard ratio 6.86 (95% CI: 2.78-16.93), p=<0.001] and acute kidney injury [hazard ratio 3.85 (95% CI: 1.75-8.45), p=<0.001] were associated with higher risk of death in adjusted analysis. Conclusion: Acute kidney injury and vomiting are strong predictors of mortality among patients with snake bite. These predictors can be helpful for clinicians in assessing prognosis of their patients more accurately and by early management of these factors, mortality & morbidity can be reduced.

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Reduced Mortality Associated with Acute Kidney Injury Requiring Dialysis in the United States

American Journal of Nephrology ◽

10.1159/000445846 ◽

2016 ◽

Vol 43 (4) ◽

pp. 261-270 ◽

Cited By ~ 10

Author(s):

Jeremiah R. Brown ◽

Michael E. Rezaee ◽

William M. Hisey ◽

Kevin C. Cox ◽

Michael E. Matheny ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Incidence Rate ◽

Hospital Admissions ◽

Population Attributable Risk ◽

Kidney Injury ◽

The United States ◽

Attributable Risk ◽

Discharge Data ◽

The Us

Background: Dialysis-requiring acute kidney injury (AKI-D) is a documented complication of hospitalization and procedures. Temporal incidence of AKI-D and related hospital mortality in the US population has not been recently characterized. We describe the epidemiology of AKI-D as well as associated in-hospital mortality in the US. Methods: Retrospective cohort of a national discharge data (n = 86,949,550) from the Healthcare Cost and Utilization Project's National Inpatient Sample, 2001-2011 of patients' hospitalization with AKI-D. Primary outcomes were AKI-D and in-hospital mortality. We determined the annual incidence rate of AKI-D in the US from 2001 to 2011. We estimated ORs for AKI-D and in-hospital mortality for each successive year compared to 2001 using multiple logistic regression models, adjusted for patient and hospital characteristics, and stratified the analyses by sex and age. We also calculated population-attributable risk of in-hospital mortality associated with AKI-D. Results: The adjusted odds of AKI-D increased by a factor of 1.03 (95% CI 1.02-1.04) each year. The number of AKI-D-related (19,886-34,195) in-hospital deaths increased almost 2-fold, although in-hospital mortality associated with AKI-D (28.0-19.7%) declined significantly from 2001 to 2011. Over the same period, the adjusted odds of mortality for AKI-D patients were 0.60 (95% CI 0.56-0.67). Population-attributable risk of mortality associated with AKI-D increased (2.1-4.2%) over the study period. Conclusions: The incidence rate of AKI-D has increased considerably in the US since 2001. However, in-hospital mortality associated with AKI-D hospital admissions has decreased significantly.

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P6460The significance of syncope as a presenting symptom in patients with intermediate risk pulmonary embolism

European Heart Journal ◽

10.1093/eurheartj/ehz746.1052 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S S Natanzon ◽

R Beigel ◽

F Chernomordik ◽

I Mazin ◽

R Herscovici ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Mortality ◽

Medical Center ◽

Statistical Significance ◽

Hemodynamic Instability ◽

Inotropic Support ◽

Intermediate Risk ◽

Escalation Therapy ◽

Significant Difference ◽

Secondary Outcomes

Abstract Background Intermediate risk pulmonary emboli patients are a challenging group with high risk of recurrent VTE, hemodynamic instability and mortality. A gap of knowledge has emerged regarding predictors of clinical deterioration. The prognostic role of syncope presentation is debatable. We thought to investigate the ability of syncope to predict in-hospital complications and the need of escalation therapy among intermediate risk PE patients admitted to the ICCU. Methods Consecutive cohort of all patients hospitalized with a diagnosis of PE, classified as intermediate risk and admitted to the intensive cardiac care unit at the Sheba medical center between the years 2008–2016. Primary outcome: MACE consisting of either one of or a combination of: mechanical ventilation, hemodynamic instability and need for inotropic support, Secondary reperfusion and in-hospital mortality. Secondary outcomes: Each of the individual components including major bleeding and renal failure Results 213 intermediate risk PE patients were analyzed. 40 patients (19%) presented with syncope. Syncope patients had significant higher RV/LV ratio upon computed tomography (1.7±0.6 vs. 1.4±0.4, p=0.011). The presence of either moderate or severe RV dysfunction was more prevalent, without statistical significance (57.5% vs. 41%, p=0.076). Syncope patients had higher prevalence of escalation therapy (28.9% vs 9.4%, p=0.003), as well as in the following individual secondary endpoints: mechanical ventilation (10% vs 1.8%, p=0.026), hemodynamic instability (17.9% vs 2.9%, p=0.02), bleeding rates (15% vs 2.4%, p=0.004), and increased need of inotropic support (10% vs 0.6%, p=0.005). There was no significant difference in the need for reperfusion therapy, both surgical (5% vs. 0.6%, p=0.093) and non- surgical (7.5% vs 6.4%, p=0.732), and in-hospital mortality (2.5% vs 0%, p=0.190). Secondary Outcomes Conclusion The presence of syncope as a presenting symptom is associated with more complicated in-hospital clinical course. These patients warrant more aggressive monitoring and assessment for the need of escalation therapy.

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Hospitalization for complications due to systemic therapy in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7078 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 7078-7078

Author(s):

Muni Rubens ◽

Venkataraghavan Ramamoorthy ◽

Anshul Saxena ◽

Emir Veledar ◽

Peter McGranaghan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Systemic Therapy ◽

Kidney Injury ◽

Unknown Origin ◽

The United States ◽

Urgent Care ◽

Coordinated Care ◽

Hospitalization Rates ◽

Management Of Complications

7078 Background: Management of complications of systemic therapy for cancer involves significant healthcare burden for both patients and healthcare system. Aim of this study is to estimate trends as well as burden associated with these hospitalizations, using a nationally representative data. Methods: National Inpatient Sample data during 2005-2016 was used to identify complications of systemic therapy using ICD-9 and ICD-10 external cause of injury codes. Primary outcome was hospitalization rate while secondary outcomes were cost and in-hospital mortality related to these complications. Results: There were 443,222,223 hospitalizations recorded during the study period, of which 2,419,722 were due to complications of systemic therapy. The average annual percentage change of these hospitalizations was 8.1%, compared to -0.5% for general hospitalizations. The 3 most common causes for hospitalization were anemia (12.8%), neutropenia (10.8%), and sepsis (7.8%). During the study period, hospitalization rates had highest relative increases for sepsis (1.9 fold) and acute kidney injury (1.6 fold) and highest relative decrease for dehydration (0.21 fold) and fever of unknown origin (0.35 fold). Complications responsible for highest costs per hospitalization were sepsis ($16,834), acute kidney injury ($13,172), and pneumonia ($13,040). Leading causes of in-hospital mortality associated with systemic therapy were sepsis (15.8%), pneumonia (7.6%), and acute kidney injury (7.0%). Conclusions: During 2005-2016, hospitalization rates for systemic therapy complications increased by an annual rate of 8.1%, with anemia, neutropenia, and sepsis as the most common complications requiring hospitalization. Initiatives such as rule OP-35 by the Centers for Medicare and Medicaid Service, improving access and providing coordinated care, early identification and management of symptoms, and expanding urgent care access could decrease these hospitalizations and the burden on healthcare. [Table: see text]

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Hospital Mortality in the United States following Acute Kidney Injury

BioMed Research International ◽

10.1155/2016/4278579 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 18

Author(s):

Jeremiah R. Brown ◽

Michael E. Rezaee ◽

Emily J. Marshall ◽

Michael E. Matheny

Keyword(s):

United States ◽

Acute Kidney Injury ◽

Hospital Mortality ◽

Hospital Admission ◽

Kidney Injury ◽

The United States ◽

The World ◽

Hospital Deaths ◽

Related Mortality ◽

Temporal Incidence

Acute kidney injury (AKI) is a common reason for hospital admission and complication of many inpatient procedures. The temporal incidence of AKI and the association of AKI admissions with in-hospital mortality are a growing problem in the world today. In this review, we discuss the epidemiology of AKI and its association with in-hospital mortality in the United States. AKI has been growing at a rate of 14% per year since 2001. However, the in-hospital mortality associated with AKI has been on the decline starting with 21.9% in 2001 to 9.1 in 2011, even though the number of AKI-related in-hospital deaths increased almost twofold from 147,943 to 285,768 deaths. We discuss the importance of the 71% reduction in AKI-related mortality among hospitalized patients in the United States and draw on the discussion of whether or not this is a phenomenon of hospital billing (coding) or improvements to the management of AKI.

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Incidence Trends and Predictors of In-Hospital Mortality in Drowning in Children and Adolescents in the United States: A National Inpatient Database Analysis

Clinical Pediatrics ◽

10.1177/0009922819886871 ◽

2019 ◽

Vol 59 (2) ◽

pp. 134-141

Author(s):

Krishna Kishore Umapathi ◽

Aravind Thavamani ◽

Harshitha Dhanpalreddy ◽

Jasmine Khatana ◽

Aparna Roy

Keyword(s):

Hospital Mortality ◽

Health Care Cost ◽

Invasive Mechanical Ventilation ◽

Kidney Injury ◽

The United States ◽

Database Analysis ◽

Mortality Trends ◽

Incidence Trends ◽

Incidence And Mortality ◽

Inpatient Database

We sought to examine incidence and mortality trends of drowning-related hospitalizations in children aged <20 years and to study the presence of risk factors associated with in-hospital mortality. Retrospective analysis of the 2003-2016 Health Care Cost and Utilization Project National Inpatient Sample and Kids’ Inpatient Database was performed. The estimated annual incidence rate of drowning hospitalizations declined 31.5% from 2.73 to 1.87 per 100 000 population. Most drowning-related hospitalizations were seen in <5-year-old children (66.4%) and in males (65.3%), Caucasians (41.7%), and public insurance (46%). In-hospital mortality declined 46% from an estimated 290 deaths in 2003 to 156 deaths in 2016. On multivariate analysis, age <5 years, Caucasian ethnicity, uninsured status, pool/bathtub or undetermined location, arrhythmia (adjusted odds ratio [aOR] = 1.3, P = .001), acute kidney injury (aOR = 3.4, P < .001), cerebral edema (aOR = 2.8, P < .001), cardiopulmonary resuscitation (aOR = 12.1, P < .001), and invasive mechanical ventilation (aOR = 28.4, P < .001) were found to be independent predictors of mortality.

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Neutrophil-to-Lymphocyte Ratio on Admission Predicts In-hospital Mortality in Patients with COVID-19

10.21203/rs.3.rs-49294/v1 ◽

2020 ◽

Author(s):

Jin Hu ◽

Jun Zhou ◽

Fang Dong ◽

Jie Tan ◽

Shuntao Wang ◽

...

Keyword(s):

Hospital Mortality ◽

Kidney Injury ◽

Predictive Performance ◽

Neutrophil To Lymphocyte Ratio ◽

Positive Trend ◽

Inpatient Mortality ◽

Multivariate Regression Model ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Novel Coronavirus

Abstract Background: A novel coronavirus caused an outbreak of acute infectious pneumonia are spreading over the globe. However, studies predicting prognosis are limited. We predicted outcomes of patients with coronavirus disease 2019 (COVID-19) using the neutrophil-to-lymphocyte ratio (NLR) on admission.Methods: We retrospectively analyzed the characteristics of COVID-19 patients diagnosed from February 6 to March 1. The outcomes, including the occurrence of in-hospital mortality, acute kidney injury (AKI), and endotracheal intubation (ETI), were recorded. The relationships of neutrophils, lymphocytes, C-reactive protein, lactate dehydrogenase, and NLR with outcomes were assessed using multivariate regression model. P-values for trends across quartiles of NLR was examined.Results: A total of 182 patients were included. 37 (20.3%) patients died during the hospitalization, 41 (22.5%) developed AKI, and 36 (19.8%) received ETI. The NLR had a superior predictive performance than others. Using an NLR cutoff of 11.4, the area under the curves (AUC) were 0.766 for in-hospital mortality, 0.755 for AKI, and 0.733 for ETI. In multivariate analysis, NLR >11.4 was further identified as an independent prognostic factor. Following stratification with quartiles of NLR, a positive trend between the increasing quartiles of NLR and the three outcomes were observed (p-values for trends across quartiles were 0.043, <0.001, and 0.041, respectively). The multivariate adjusted odds ratio (OR) in the highest quartile vs. the lowest quartile were 5.738 for mortality, 25.307 for AKI, and 5.136 for ETI.Conclusions: Increasing NLR obtained on admission is a powerful predictor for inpatient mortality, AKI, and ETI in COVID-19 patients.

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Characteristics, Outcomes and 60-Day Hospital Mortality of ICU Patients with COVID-19 and Acute Kidney Injury

Kidney360 ◽

10.34067/kid.0004282020 ◽

2020 ◽

Vol 1 (12) ◽

pp. 1339-1344 ◽

Cited By ~ 1

Author(s):

Jyotsana Thakkar ◽

Sudham Chand ◽

Michael S. Aboodi ◽

Anirudh R. Gone ◽

Emad Alahiri ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Mortality ◽

Medical Center ◽

Invasive Mechanical Ventilation ◽

Kidney Injury ◽

Day Hospital ◽

Icu Admission ◽

High Incidence ◽

Stage 1

BackgroundAKI has been reported in patients with COVID-19 pneumonia and it is associated with higher mortality. The aim of our study is to describe characteristics, outcomes, and 60-day hospital mortality of patients with COVID-19 pneumonia and AKI in the intensive care unit (ICU).MethodsWe conducted a retrospective study in which all adult patients with confirmed COVID-19 who were admitted to ICUs of Montefiore Medical Center and developing AKI were included. The study period ranged from March 10 to April 11, 2020. The 60-day follow-up data through June 11, 2020 were obtained.ResultsOf 300 adults admitted to the ICUs with COVID-19 pneumonia, 224 patients (75%) presented with AKI or developed AKI subsequent to admission. A total of 218 (97%) patients required invasive mechanical ventilation for moderate to severe acute respiratory distress syndrome (ARDS). A total of 113 (50%) patients had AKI on day 1 of ICU admission. The peak AKI stages observed were stage 1 in 49 (22%), stage 2 in 35 (16%), and stage 3 in 140 (63%) patients, respectively. Among patients with AKI, 114 patients (51%) required RRT. The mortality rate of patients requiring RRT was 70%. Of the 34 patients who were survivors, 25 (74%) were able to be weaned off RRT completely before hospital discharge. Nonsurvivors were older and had significantly higher admission and peak creatinine levels, admission hemoglobin, and peak phosphate levels compared with survivors. The 60-day hospital mortality was 67%.ConclusionsCOVID-19 requiring ICU admission is associated with high incidence of severe AKI, necessitating RRT in approximately half of such patients. The majority of patients with COVID-19 and AKI in ICU developed moderate to severe ARDS, requiring invasive mechanical ventilation. Timing or severity of AKI did not affect outcomes. The 60-day hospital mortality is high (67%). Patients with AKI requiring RRT have high mortality, but survivors have good rates of RRT recovery.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_12_31_KID0004282020.mp3

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Evidence for the utility of cfDNA plasma concentrations to predict disease severity in COVID-19

10.1101/2021.04.29.21256291 ◽

2021 ◽

Author(s):

Katharina Hoeter ◽

Elmo Neuberger ◽

Susanne Fischer ◽

Manuel Herbst ◽

Ema Juškevičiūtė ◽

...

Keyword(s):

Disease Severity ◽

Clinical Laboratory ◽

Medical Center ◽

Plasma Concentrations ◽

Kidney Injury ◽

Predictive Biomarker ◽

Neurological Complications ◽

Reactive Protein ◽

Heparin Plasma ◽

The University

AbstractCOVID-19 is a pandemic caused by the highly infective SARS-CoV-2. There is a need for biomarkers not only for overall prognosis but also for predicting the response to treatments and thus for improvements in the clinical management of patients with COVID-19. Circulating cell-free DNA (cfDNA) has emerged as a promising biomarker in the assessment of various disease conditions. The aim of this retrospective and observational pilot study was to examine the potential value of cfDNA plasma concentrations as a correlative biomarker in hospitalized COVID-19 patients. Lithium-Heparin plasma samples were obtained from twenty-one COVID-19 patients during hospitalization in the University Medical Center of Mainz, Germany, and the cfDNA concentrations were determined by quantitative PCR yielding amplicons of long interspersed nuclear elements (LINE-1). cfDNA plasma concentrations of COVID-19 patients ranged between 247.5 and 6346.25 ng/ml and the mean concentrations were 1831 ± 1388 ng/ml (± standard deviation). Correlations were found between cfDNA levels and the occurrence of acute respiratory distress symptom (ARDS), acute kidney injury (AKI), myositis, neurological complications, bacterial superinfection and disease severity as defined by sepsis-related organ failure assessment score (SOFA) score. D-Dimer and C-reactive-protein (CRP), determined by clinical laboratory analysis, showed the highest correlations with cfDNA levels. The results of this observational study suggest that cfDNA plasma concentrations may serve as a predictive biomarker of disease severity in COVID-19. Prospective studies enrolling larger patient cohorts are ongoing to test this hypothesis.

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