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Федеральный дистанционный консультативный центр анестезиологии и реаниматологии на базе Первого МГМУ им. И.М. Сеченова

Acute kidney injury (AKI) is associated with increased mortality in most critical settings. However, it is unclear whether its mild form (i.e. AKI stage 1) is associated with increased mortality also in non-critical settings. Here we conducted an international study in patients hospitalized with SARS-CoV-2 infection aiming 1. to estimate the incidence of AKI at each stage and its impact on mortality 2. to identify AKI risk factors at admission (susceptibility) and during hospitalization (exposures) and factors contributing to AKI-associated mortality. We included 939 patients from medical departments in Moscow (Russia) and Padua (Italy). In-hospital AKI onset was identified in 140 (14.9%) patients, mainly with stage 1 (65%). Mortality was remarkably higher in patients with AKI compared to those without AKI (55 [39.3%] vs. 34 [4.3%], respectively). Such association remained significant after adjustment for other clinical conditions at admission (relative risk [RR] 5.6; CI 3.5- 8.8) or restricting to AKI stage 1 (RR 3.2; CI 1.8–5.5) or to subjects with AKI onset preceding deterioration of clinical conditions. After hospital admission, worsening of hypoxic damage, inflammation, hyperglycemia, and coagulopathy were identified as hospital-acquired risk factors predicting AKI onset. Following AKI onset, the AKI-associated worsening of respiratory function was identified as the main contributor to AKI-induced increase in mortality risk. In conclusion, AKI is a common complication of Sars-CoV2 infection in non-intensive care settings where it markedly increases mortality risk also at stage 1. The identification of hospital-acquired risk factors and exposures might help prevention of AKI onset and of its complications.

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Цель. Изучение летальности и факторов риска смерти больных с COVID-19, госпитализированных для респираторной поддержки в отделения реанимации и интенсивной терапии (ОРИТ) лечебных учреждений Российской Федерации. Материал и методы. Ретроспективное исследование было выполнено в Федеральном дистанционном консультативном центре анестезиологии и реаниматологии для взрослых пациентов с COVID-19 на базе Первого МГМУ им. И.М. Сеченова. В исследование включали всех пациентов с известными исходами (смерть от любых причин или выздоровление) SARS-CoV-2 пневмонии, осложнившейся острым респираторным дистресс синдромом (ОРДС), которые были проконсультированы с 16 марта по 3 мая 2020 г. Факторы риска смерти анализировали с помощью многофакторной регрессионной модели Кокса. Результаты. В исследование были включены 1522 пациента, 864 (56,8%) мужчины и 658 (43,2%) женщин. Медиана возраста-62 года. 922 (60,6%) больных находились в ОРИТ стационаров Москвы и Московской области, 600 (39,4%)-лечебных учреждений в 70 регионах Российской Федерации. У 995 (65,4%) больных диагноз SARS-CoV-2 инфекции был подтвержден с помощью ПЦР. Умерли 995 (65,4%) пациентов, выжили 527 (34,6%). Основными причинами смерти были ОРДС (93,2%), сер

In a recent article, Ma et al. suggested that patients with cancer will be more susceptible to severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection and complications, although data on COVID-19 and malignancies remain limited. 1 In a small study, Liang et al. noted that patients with cancer were more likely to experience severe sequelae of SARS-CoV-2 infection, such as intensive care admission, invasive ventilation or death. 2 However, Wang and Zhang argued that the most important morbidity factor is exposure to an infection source, whereas worse outcomes from SARS-CoV-2 infection could be associated (at least partly) with older age of patients with cancer. 3 Xia and colleagues also concluded that current evidence is insufficient to confirm an association between cancer and COVID-19. 4 These issues have important implications for management of patients with malignancies during pandemics of COVID-19 that continues to evolve in many countries including Russia.

Correspondenceearly promise in retrospective studies also failed in a phase III trial in critically ill COVID-19 patients on mechanical ventilation. 12 These trials raise doubts about benefit of IL-6 blockade in COVID-19.In summary, neither earlier TCZ administration in nonintubated ICU patients with severe COVID-19 associated pneumonia nor late infusion after initiation of mechanical ventilation did reduce mortality. Unfortunately, our findings are in line with the preliminary results of phase III trials of IL-6 inhibitors in patients with severe COVID-19 pneumonia. We agree with Ramiro et al 2 that initial immunosuppressive treatment, if considered necessary in these patients, should involve widely available and inexpensive glucocorticoids, whereas IL-6 inhibitors, as chloroquine/hydroxychloroquine, 13 may be preserved for patients with rheumatic diseases in whom these medications have established efficacy.