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Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes

Background: Critically ill patients with COVID-19 are prone to develop severe acute kidney injury (AKI), defined as KDIGO (Kidney Disease Improving Global Outcomes) stages 2 or 3. However, data are limited in these patients. We aimed to report the incidence, risk factors, and prognostic impact of se...

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Autores principales: Ghosn, Muriel, Attallah, Nizar, Badr, Mohamed, Abdallah, Khaled, De Oliveira, Bruno, Nadeem, Ashraf, Varghese, Yeldho, Munde, Dnyaseshwar, Salam, Shameen, Abduljawad, Baraa, Saleh, Khaled, Elkambergy, Hussam, Wahla, Ali, Taha, Ahmed, Dibu, Jamil, Bayrlee, Ahmed, Hamed, Fadi, Rahman, Nadeem, Mallat, Jihad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998509/
https://www.ncbi.nlm.nih.gov/pubmed/33804100
http://dx.doi.org/10.3390/jcm10061217
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author Ghosn, Muriel
Attallah, Nizar
Badr, Mohamed
Abdallah, Khaled
De Oliveira, Bruno
Nadeem, Ashraf
Varghese, Yeldho
Munde, Dnyaseshwar
Salam, Shameen
Abduljawad, Baraa
Saleh, Khaled
Elkambergy, Hussam
Wahla, Ali
Taha, Ahmed
Dibu, Jamil
Bayrlee, Ahmed
Hamed, Fadi
Rahman, Nadeem
Mallat, Jihad
author_facet Ghosn, Muriel
Attallah, Nizar
Badr, Mohamed
Abdallah, Khaled
De Oliveira, Bruno
Nadeem, Ashraf
Varghese, Yeldho
Munde, Dnyaseshwar
Salam, Shameen
Abduljawad, Baraa
Saleh, Khaled
Elkambergy, Hussam
Wahla, Ali
Taha, Ahmed
Dibu, Jamil
Bayrlee, Ahmed
Hamed, Fadi
Rahman, Nadeem
Mallat, Jihad
author_sort Ghosn, Muriel
collection PubMed
description Background: Critically ill patients with COVID-19 are prone to develop severe acute kidney injury (AKI), defined as KDIGO (Kidney Disease Improving Global Outcomes) stages 2 or 3. However, data are limited in these patients. We aimed to report the incidence, risk factors, and prognostic impact of severe AKI in critically ill patients with COVID-19 admitted to the intensive care unit (ICU) for acute respiratory failure. Methods: A retrospective monocenter study including adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection admitted to the ICU for acute respiratory failure. The primary outcome was to identify the incidence and risk factors associated with severe AKI (KDIGO stages 2 or 3). Results: Overall, 110 COVID-19 patients were admitted. Among them, 77 (70%) required invasive mechanical ventilation (IMV), 66 (60%) received vasopressor support, and 9 (8.2%) needed extracorporeal membrane oxygenation (ECMO). Severe AKI occurred in 50 patients (45.4%). In multivariable logistic regression analysis, severe AKI was independently associated with age (odds ratio (OR) = 1.08 (95% CI (confidence interval): 1.03–1.14), p = 0.003), IMV (OR = 33.44 (95% CI: 2.20–507.77), p = 0.011), creatinine level on admission (OR = 1.04 (95% CI: 1.008–1.065), p = 0.012), and ECMO (OR = 11.42 (95% CI: 1.95–66.70), p = 0.007). Inflammatory (interleukin-6, C-reactive protein, and ferritin) or thrombotic (D-dimer and fibrinogen) markers were not associated with severe AKI after adjustment for potential confounders. Severe AKI was independently associated with hospital mortality (OR = 29.73 (95% CI: 4.10–215.77), p = 0.001) and longer hospital length of stay (subhazard ratio = 0.26 (95% CI: 0.14–0.51), p < 0.001). At the time of hospital discharge, 74.1% of patients with severe AKI who were discharged alive from the hospital recovered normal or baseline renal function. Conclusion: Severe AKI was common in critically ill patients with COVID-19 and was not associated with inflammatory or thrombotic markers. Severe AKI was an independent risk factor of hospital mortality and hospital length of stay, and it should be rapidly recognized during SARS-CoV-2 infection.
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spelling pubmed-79985092021-03-28 Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes Ghosn, Muriel Attallah, Nizar Badr, Mohamed Abdallah, Khaled De Oliveira, Bruno Nadeem, Ashraf Varghese, Yeldho Munde, Dnyaseshwar Salam, Shameen Abduljawad, Baraa Saleh, Khaled Elkambergy, Hussam Wahla, Ali Taha, Ahmed Dibu, Jamil Bayrlee, Ahmed Hamed, Fadi Rahman, Nadeem Mallat, Jihad J Clin Med Article Background: Critically ill patients with COVID-19 are prone to develop severe acute kidney injury (AKI), defined as KDIGO (Kidney Disease Improving Global Outcomes) stages 2 or 3. However, data are limited in these patients. We aimed to report the incidence, risk factors, and prognostic impact of severe AKI in critically ill patients with COVID-19 admitted to the intensive care unit (ICU) for acute respiratory failure. Methods: A retrospective monocenter study including adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection admitted to the ICU for acute respiratory failure. The primary outcome was to identify the incidence and risk factors associated with severe AKI (KDIGO stages 2 or 3). Results: Overall, 110 COVID-19 patients were admitted. Among them, 77 (70%) required invasive mechanical ventilation (IMV), 66 (60%) received vasopressor support, and 9 (8.2%) needed extracorporeal membrane oxygenation (ECMO). Severe AKI occurred in 50 patients (45.4%). In multivariable logistic regression analysis, severe AKI was independently associated with age (odds ratio (OR) = 1.08 (95% CI (confidence interval): 1.03–1.14), p = 0.003), IMV (OR = 33.44 (95% CI: 2.20–507.77), p = 0.011), creatinine level on admission (OR = 1.04 (95% CI: 1.008–1.065), p = 0.012), and ECMO (OR = 11.42 (95% CI: 1.95–66.70), p = 0.007). Inflammatory (interleukin-6, C-reactive protein, and ferritin) or thrombotic (D-dimer and fibrinogen) markers were not associated with severe AKI after adjustment for potential confounders. Severe AKI was independently associated with hospital mortality (OR = 29.73 (95% CI: 4.10–215.77), p = 0.001) and longer hospital length of stay (subhazard ratio = 0.26 (95% CI: 0.14–0.51), p < 0.001). At the time of hospital discharge, 74.1% of patients with severe AKI who were discharged alive from the hospital recovered normal or baseline renal function. Conclusion: Severe AKI was common in critically ill patients with COVID-19 and was not associated with inflammatory or thrombotic markers. Severe AKI was an independent risk factor of hospital mortality and hospital length of stay, and it should be rapidly recognized during SARS-CoV-2 infection. MDPI 2021-03-15 /pmc/articles/PMC7998509/ /pubmed/33804100 http://dx.doi.org/10.3390/jcm10061217 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ghosn, Muriel
Attallah, Nizar
Badr, Mohamed
Abdallah, Khaled
De Oliveira, Bruno
Nadeem, Ashraf
Varghese, Yeldho
Munde, Dnyaseshwar
Salam, Shameen
Abduljawad, Baraa
Saleh, Khaled
Elkambergy, Hussam
Wahla, Ali
Taha, Ahmed
Dibu, Jamil
Bayrlee, Ahmed
Hamed, Fadi
Rahman, Nadeem
Mallat, Jihad
Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes
title Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes
title_full Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes
title_fullStr Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes
title_full_unstemmed Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes
title_short Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes
title_sort severe acute kidney injury in critically ill patients with covid-19 admitted to icu: incidence, risk factors, and outcomes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998509/
https://www.ncbi.nlm.nih.gov/pubmed/33804100
http://dx.doi.org/10.3390/jcm10061217
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