Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort

Lumlertgul, Nuttha; Baker, Eleanor; Pearson, Emma; Dalrymple, Kathryn V.; Pan, Jacqueline; Jheeta, Anup; Weerapolchai, Kittisak; Wang, Yanzhong; Leach, Richard; Barrett, Nicholas; Ostermann, Marlies

doi:10.1186/s13613-022-01094-6

Cited by 5 publications

(1 citation statement)

References 57 publications

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“…We observed a higher rate of patients with non-renal recovery ≥7 days in our cohort. We cannot exclude that these discrepancies were partly due to differences in the definition of renal recovery: we used normalization of SCr while Lumlertgul et al used SCr < 1.5 times baseline value, a more sensitive definition [ 48 ]. Additionally, our study shows that patients who made a rapid renal recovery had a better prognosis since AKD was associated with increased mortality at 90 days and mortality was strongly associated with initial AKI stage.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Outcome of Early-Onset Acute Kidney Injury and Recovery in Critically Ill COVID-19 Patients: A Retrospective Analysis

et al. 2023

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Background: The clinical significance of early-onset acute kidney injury (EO-AKI) and recovery in severe COVID-19 intensive care unit (ICU) patients is poorly documented. Objective: The aim of the study was to assess the epidemiology and outcome of EO-AKI and recovery in ICU patients admitted for SARS-CoV-2 pneumonia. Design: This was a retrospective single-centre study. Setting: The study was carried out at the medical ICU of the university hospital of Clermont-Ferrand, France. Patients: All consecutive adult patients aged ≥18 years admitted between 20 March 2020 and 31 August 2021 for SARS-CoV-2 pneumonia were enrolled. Patients with chronic kidney disease, referred from another ICU, and with an ICU length of stay (LOS) ≤72 h were excluded. Interventions: EO-AKI was defined on the basis of serum creatinine levels according to the Kidney Disease Improving Global Outcomes criteria, developing ≤7 days. Depending on renal recovery, defined by the normalization of serum creatinine levels, EO-AKI was transient (recovery within 48 h), persistent (recovery between 3 and 7 days) or AKD (no recovery within 7 days after EO-AKI onset). Measurements: Uni- and multivariate analyses were performed to determine factors associated with EO-AKI and EO-AKI recovery. Main Results: EO-AKI occurred in 84/266 (31.5%) study patients, of whom 42 (50%), 17 (20.2%) and 25 (29.7%) had EO-AKI stages 1, 2 and 3, respectively. EO-AKI was classified as transient, persistent and AKD in 40 (47.6%), 15 (17.8%) and 29 (34.6%) patients, respectively. The 90-day mortality was 87/244 (35.6%) and increased with EO-AKI occurrence and severity: no EO-AKI, 38/168 (22.6%); EO-AKI stage 1, 22/39 (56.4%); stage 2, 9/15 (60%); and stage 3, 18/22 (81.8%) (p < 0.01). The 90-day mortality in patients with transient or persistent AKI and AKD was 20/36 (55.6%), 8/14 (57.1%) and 21/26 (80.8%), respectively (p < 0.01). MAKE-90 occurred in 42.6% of all patients. Conclusions: In ICU patients admitted for SARS-CoV-2 pneumonia, the development of EO-AKI and time to recovery beyond day 7 of onset were associated with poor outcome.

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Section: Discussionmentioning

confidence: 99%

Epidemiology and Outcome of Early-Onset Acute Kidney Injury and Recovery in Critically Ill COVID-19 Patients: A Retrospective Analysis

et al. 2023

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The role of imaging in detecting and monitoring COVID-19 complications in the Intensive Care Unit (ICU) setting

Brandi,

Renzulli

2024

APS

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Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most people infected with the virus experience mild to moderate respiratory illness. However, some might become seriously ill and may develop acute respiratory distress syndrome (ARDS), thus requiring non-invasive or invasive mechanical ventilation. Furthermore, COVID-19 disease can involve also other organs and systems, causing several extra-pulmonary manifestations and, thus, negatively influencing the patient’s outcome. Imaging studies play a pivotal role in the monitoring of severely ill patients, especially those admitted to the intensive care unit (ICU), who can develop several potentially life-threatening complications, both from the infection itself and the mechanical supporting system. This widespread utility of imaging modalities calls for a deeper understanding of potential radiologic findings in this disease and the need for multidisciplinary collaboration between radiologists and anesthesiologists to provide actionable guidance to appropriate interventions under such conditions.

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Impact of sex differences on cardiac injury in critically ill patients with COVID-19

Jozwiak,

Doyen,

Denormandie

et al. 2023

Respir Res

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Background COVID-19 infections are associated with accrued inflammatory responses which may result in cardiac injury. Immune response to infection appears different between men and women, suggesting that COVID-19 patients’ outcomes may differ according to biological sex. However, the impact of biological sex on the occurrence of cardiac injury during intensive care unit (ICU) stay in COVID-19 patients remain unclear. Methods In this multicenter and prospective study, we included consecutive patients admitted to ICU for severe COVID-19 pneumonia, during the first two pandemic waves. Biological, electrocardiogram (ECG) and echocardiographic variables were collected on ICU admission. Cardiac injury was defined by increased troponin above 99th percentile of upper norm value and newly diagnosed ECG and/or echocardiographic abnormalities. The primary endpoint was the proportion of patients with cardiac injury during ICU stay according to biological sex. The impact of biological sex on other subsequent clinical outcomes was also evaluated. Results We included 198 patients with a median age of 66 (56–73) years, 147 (74%) patients were men and 51 (26%) were women. Overall, 119 (60%) patients had cardiac injury during ICU stay and the proportion of patients with cardiac injury during ICU stay was not different between men and women (60% vs. 61%, p = 1.00). Patients with cardiac injury during ICU stay showed more cardiovascular risk factors and chronic cardiac disease and had a higher ICU mortality rate. On ICU admission, they had a more marked lymphopenia (0.70 (0.40–0.80) vs. 0.80 (0.50–1.10) × 109/L, p < 0.01) and inflammation (C-Reactive Protein (155 (88–246) vs. 111 (62–192) mg/L, p = 0.03); D-Dimers (1293 (709–2523) vs. 900 (560–1813) µg/L, p = 0.03)). Plasmatic levels of inflammatory biomarkers on ICU admission correlated with SAPS-2 and SOFA scores but not with the different echocardiographic variables. Multivariate analysis confirmed cardiovascular risk factors (OR = 2.31; 95%CI (1.06–5.02), p = 0.03) and chronic cardiac disease (OR = 8.58; 95%CI (1.01–73.17), p = 0.04) were independently associated with the occurrence of cardiac injury during ICU stay, whereas biological sex (OR = 0.88; 95%CI (0.42–1.84), p = 0.73) was not. Biological sex had no impact on the occurrence during ICU stay of other clinical outcomes. Conclusions Most critically ill patients with COVID-19 were men and experienced cardiac injury during ICU stay. Nevertheless, biological sex had no impact on the occurrence of cardiac injury during ICU stay or on other clinical outcomes. Clinical trial registration NCT04335162

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Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort

Cited by 5 publications

References 57 publications

Epidemiology and Outcome of Early-Onset Acute Kidney Injury and Recovery in Critically Ill COVID-19 Patients: A Retrospective Analysis

Epidemiology and Outcome of Early-Onset Acute Kidney Injury and Recovery in Critically Ill COVID-19 Patients: A Retrospective Analysis

The role of imaging in detecting and monitoring COVID-19 complications in the Intensive Care Unit (ICU) setting

Impact of sex differences on cardiac injury in critically ill patients with COVID-19

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