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Risk Factors of AKI in Acute Respiratory Distress Syndrome: A Time-Dependent Competing Risk Analysis on Severe COVID-19 Patients
INTRODUCTION: Acute kidney injury (AKI) is frequently observed in patients with COVID-19 admitted to intensive care units (ICUs). Observational studies suggest that cardiovascular comorbidities and mechanical ventilation (MV) are the most important risk factors for AKI. However, no studies have inve...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9834615/ https://www.ncbi.nlm.nih.gov/pubmed/36643941 http://dx.doi.org/10.1177/20543581221145073 |
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author | Marchiset, Antoine Serazin, Valerie Ben Hadj Salem, Omar Pichereau, Claire Lima Da Silva, Lionel Au, Siu-Ming Barbier, Christophe Loubieres, Yann Hayon, Jan Gross, Julia Outin, Herve Jamme, Matthieu |
author_facet | Marchiset, Antoine Serazin, Valerie Ben Hadj Salem, Omar Pichereau, Claire Lima Da Silva, Lionel Au, Siu-Ming Barbier, Christophe Loubieres, Yann Hayon, Jan Gross, Julia Outin, Herve Jamme, Matthieu |
author_sort | Marchiset, Antoine |
collection | PubMed |
description | INTRODUCTION: Acute kidney injury (AKI) is frequently observed in patients with COVID-19 admitted to intensive care units (ICUs). Observational studies suggest that cardiovascular comorbidities and mechanical ventilation (MV) are the most important risk factors for AKI. However, no studies have investigated the renal impact of longitudinal covariates such as drug treatments, biological variations, and/or MV parameters. METHODS: We performed a monocentric, prospective, longitudinal analysis to identify the dynamic risk factors for AKI in ICU patients with severe COVID-19. RESULTS: Seventy-seven patients were included in our study (median age: 63 [interquartile range, IQR: 53-73] years; 58 (75%) men). Acute kidney injury was detected in 28 (36.3%) patients and occurred at a median time of 3 [IQR: 2-6] days after ICU admission. Multivariate Cox cause-specific time-dependent analysis identified a history of hypertension (cause-specific hazard (CSH) = 2.46 [95% confidence interval, CI: 1.04-5.84]; P = .04), a high hemodynamic Sequential Organ Failure Assessment score (CSH = 1.63 [95% CI: 1.23-2.16]; P < .001), and elevated Paco(2) (CSH = 1.2 [95%CI: 1.04-1.39] per 5 mm Hg increase in Pco(2); P = .02) as independent risk factors for AKI. Concerning the MV parameters, positive end-expiratory pressure (CSH = 1.11 [95% CI: 1.01-1.23] per 1 cm H(2)O increase; P = .04) and the use of neuromuscular blockade (CSH = 2.96 [95% CI: 1.22-7.18]; P = .02) were associated with renal outcome only in univariate analysis but not after adjustment. CONCLUSION: Acute kidney injury is frequent in patients with severe COVID-19 and is associated with a history of hypertension, the presence of hemodynamic failure, and increased Pco(2). Further studies are necessary to evaluate the impact of hypercapnia on increasing the effects of ischemia, particularly in the most at-risk vascular situations. |
format | Online Article Text |
id | pubmed-9834615 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-98346152023-01-13 Risk Factors of AKI in Acute Respiratory Distress Syndrome: A Time-Dependent Competing Risk Analysis on Severe COVID-19 Patients Marchiset, Antoine Serazin, Valerie Ben Hadj Salem, Omar Pichereau, Claire Lima Da Silva, Lionel Au, Siu-Ming Barbier, Christophe Loubieres, Yann Hayon, Jan Gross, Julia Outin, Herve Jamme, Matthieu Can J Kidney Health Dis Original Clinical Research Mixed Method INTRODUCTION: Acute kidney injury (AKI) is frequently observed in patients with COVID-19 admitted to intensive care units (ICUs). Observational studies suggest that cardiovascular comorbidities and mechanical ventilation (MV) are the most important risk factors for AKI. However, no studies have investigated the renal impact of longitudinal covariates such as drug treatments, biological variations, and/or MV parameters. METHODS: We performed a monocentric, prospective, longitudinal analysis to identify the dynamic risk factors for AKI in ICU patients with severe COVID-19. RESULTS: Seventy-seven patients were included in our study (median age: 63 [interquartile range, IQR: 53-73] years; 58 (75%) men). Acute kidney injury was detected in 28 (36.3%) patients and occurred at a median time of 3 [IQR: 2-6] days after ICU admission. Multivariate Cox cause-specific time-dependent analysis identified a history of hypertension (cause-specific hazard (CSH) = 2.46 [95% confidence interval, CI: 1.04-5.84]; P = .04), a high hemodynamic Sequential Organ Failure Assessment score (CSH = 1.63 [95% CI: 1.23-2.16]; P < .001), and elevated Paco(2) (CSH = 1.2 [95%CI: 1.04-1.39] per 5 mm Hg increase in Pco(2); P = .02) as independent risk factors for AKI. Concerning the MV parameters, positive end-expiratory pressure (CSH = 1.11 [95% CI: 1.01-1.23] per 1 cm H(2)O increase; P = .04) and the use of neuromuscular blockade (CSH = 2.96 [95% CI: 1.22-7.18]; P = .02) were associated with renal outcome only in univariate analysis but not after adjustment. CONCLUSION: Acute kidney injury is frequent in patients with severe COVID-19 and is associated with a history of hypertension, the presence of hemodynamic failure, and increased Pco(2). Further studies are necessary to evaluate the impact of hypercapnia on increasing the effects of ischemia, particularly in the most at-risk vascular situations. SAGE Publications 2023-01-10 /pmc/articles/PMC9834615/ /pubmed/36643941 http://dx.doi.org/10.1177/20543581221145073 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Clinical Research Mixed Method Marchiset, Antoine Serazin, Valerie Ben Hadj Salem, Omar Pichereau, Claire Lima Da Silva, Lionel Au, Siu-Ming Barbier, Christophe Loubieres, Yann Hayon, Jan Gross, Julia Outin, Herve Jamme, Matthieu Risk Factors of AKI in Acute Respiratory Distress Syndrome: A Time-Dependent Competing Risk Analysis on Severe COVID-19 Patients |
title | Risk Factors of AKI in Acute Respiratory Distress Syndrome: A
Time-Dependent Competing Risk Analysis on Severe COVID-19
Patients |
title_full | Risk Factors of AKI in Acute Respiratory Distress Syndrome: A
Time-Dependent Competing Risk Analysis on Severe COVID-19
Patients |
title_fullStr | Risk Factors of AKI in Acute Respiratory Distress Syndrome: A
Time-Dependent Competing Risk Analysis on Severe COVID-19
Patients |
title_full_unstemmed | Risk Factors of AKI in Acute Respiratory Distress Syndrome: A
Time-Dependent Competing Risk Analysis on Severe COVID-19
Patients |
title_short | Risk Factors of AKI in Acute Respiratory Distress Syndrome: A
Time-Dependent Competing Risk Analysis on Severe COVID-19
Patients |
title_sort | risk factors of aki in acute respiratory distress syndrome: a
time-dependent competing risk analysis on severe covid-19
patients |
topic | Original Clinical Research Mixed Method |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9834615/ https://www.ncbi.nlm.nih.gov/pubmed/36643941 http://dx.doi.org/10.1177/20543581221145073 |
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