Outcomes of critically ill patients with acute kidney injury in COVID-19 infection: an observational study

Bezerra, Rodrigo; Teles, Flávio; Mendonca, Polyana Bezerra; Damte, Tedla; Likaka, Andrew; Ferrer‐Miranda, Edyniesky; Albuquerque, Jones; Filho, José Luiz de Lima

doi:10.1080/0886022x.2021.1933530

Cited by 28 publications

(28 citation statements)

References 26 publications

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“…the results presented here may not represent Brazilian ICUs or those in the Southern Hemisphere. In fact, a recent Brazilian study conducted in public hospitals with limited resources showed a mortality rate of 93% for patients with COVID-19 and severe AKI [35].…”

Section: Plos Onementioning

confidence: 99%

COVID-19-associated acute kidney injury patients treated with renal replacement therapy in the intensive care unit: A multicenter study in São Paulo, Brazil

et al. 2022

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Introduction Multicenter studies involving patients with acute kidney injury (AKI) associated with the disease caused by the new coronavirus (COVID-19) and treated with renal replacement therapy (RRT) in developing countries are scarce. The objectives of this study were to evaluate the demographic profile, clinical picture, risk factors for mortality, and outcomes of critically ill patients with AKI requiring dialysis (AKI-RRT) and with COVID-19 in the megalopolis of São Paulo, Brazil. Methods This multicenter, retrospective, observational study was conducted in the intensive care units of 13 public and private hospitals in the metropolitan region of the municipality of São Paulo. Patients hospitalized in an intensive care unit, aged ≥ 18 years, and treated with RRT due to COVID-19-associated AKI were included. Results The study group consisted of 375 patients (age 64.1 years, 68.8% male). Most (62.1%) had two or more comorbidities: 68.8%, arterial hypertension; 45.3%, diabetes; 36.3%, anemia; 30.9%, obesity; 18.7%, chronic kidney disease; 15.7%, coronary artery disease; 10.4%, heart failure; and 8.5%, chronic obstructive pulmonary disease. Death occurred in 72.5% of the study population (272 patients). Among the 103 survivors, 22.3% (23 patients) were discharged on RRT. In a multiple regression analysis, the independent factors associated with death were the number of organ dysfunctions at admission and RRT efficiency. Conclusion AKI-RRT associated with COVID-19 occurred in patients with an elevated burden of comorbidities and was associated with high mortality (72.5%). The number of organ dysfunctions during hospitalization and RRT efficiency were independent factors associated with mortality. A meaningful portion of survivors was discharged while dependent on RRT (22.3%).

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Section: Plos Onementioning

confidence: 99%

COVID-19-associated acute kidney injury patients treated with renal replacement therapy in the intensive care unit: A multicenter study in São Paulo, Brazil

et al. 2022

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“…The studies originated from multiple countries, with 13 of coming from institutions located in the USA [20,21,23,[32][33][34][35]38,42,43,45,48,51]. Nineteen studies included only patients admitted in the ICU [20,22,24,25,27,[30][31][32][35][36][37][38][39][43][44][45][46][47]52], five studies included patients admitted in a COVID-19-dedicated HDU [28,29,33,34,42], eight studies included patients who were admitted in both HDU and ICU [21,23,26,40,41,48,49,51], and one study included Emergency Department patients who were later admitted either in the HDU of ICU [50]. Thirty studies included data about patients who received vs. patients who did not receive vasopressors…”

Section: Study Characteristicsmentioning

confidence: 99%

Association of vasopressors with mortality in critically ill patients with COVID-19: A systematic review and meta-analysis

Mermiri

Mavrovounis

Laou

et al. 2022

Preprint

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Purpose: The effect of vasopressors on mortality of critically ill patients with COVID-19 has not been studied extensively. Methods: A systematic search of PubMed, Scopus, and clinicaltrials.gov was conducted for relevant articles until January 2022. Eligibility criteria were randomized controlled and non-randomized trials. The primary outcome was all-cause mortality at 28 days or 30 days. The quality of studies was assessed using the MINORS tool. Paired meta-analysis was used to estimate the pooled risk ratios along with their 95% Confidence Interval. Results: In total, 33 studies were included. Twenty-one studies with a total population of 7900 individuals provided data on mortality. Patients who received vasopressors were statistically significantly more likely to die compared to those who did not receive vasopressor therapy [RR (95%CI): 4.26 (3.15, 5.76); p<0.001]. This result remained statistically significant regardless of the in-hospital setting. In-hospital and 30-day mortality were statistically significantly higher in patients who received vasopressors [RR (95%CI): 4.60 (2.47, 8.55); p<0.001 and RR (95%CI): 2.97 (1.72, 5.14); p<0.001, respectively]. Four studies provided data on specific vasopressors; the highest mortality rate was observed in patients treated with vasopressin or epinephrine, while patients receiving angiotensin-II as a sole or second-line vasopressor agent had the lowest mortality rate. Also, analysis of 10 studies with a total population of 3519 individuals revealed that patients who received vasopressors were statistically significantly more likely to experience acute kidney injury [RR (95%CI): 3.17 (2.21, 4.54); p<0.001]. Conclusion: Vasopressors have detrimental effect on survival of critically ill patients with COVID-19.

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“…There is evidence of an association between COVID-19 mortality and impaired renal function 17 . Creatinine is a reliable marker for renal function.…”

Section: Resultsmentioning

confidence: 99%

The ratio of serum LL-37 levels to blood leucocyte count correlates with COVID-19 severity

Keutmann

Hermes

Meinberger

et al. 2022

Sci Rep

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Beneficial effects of vitamin D on COVID-19 progression have been discussed in several studies. Vitamin D stimulates the expression of the antimicrobial peptide LL-37, and evidence shows that LL-37 can antagonize SARS-CoV-2. Therefore, we investigated the association between LL-37 and vitamin D serum levels and the severity of COVID-19. To this end, 78 COVID-19 patients were divided into 5 groups according to disease severity. We determined serum levels of LL-37, vitamin D, and routine laboratory parameters. We demonstrated a correlation of CRP, IL-6, PCT, leukocyte count, and LDH with the severity of COVID-19. Our study did not demonstrate a direct relationship between serum levels of LL-37 and vitamin D and the severity of COVID-19. LL-37 is produced by granulocytes and released at the site of inflammation. Therefore, the analysis of LL-37 in broncho-alvelolar lavage rather than in patient serum seems critical. However, since LL-37 is produced by granulocytes, we determined serum LL-37 levels as a function of leukocyte count. The LL-37/leukocyte count ratio correlates highly significantly inversely proportional with COVID-19 severity. Our results indicate that the LL-37/leukocyte count ratio could be used to assess the risk of COVID-19 progression as early as hospital admission.

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Outcomes of critically ill patients with acute kidney injury in COVID-19 infection: an observational study

Cited by 28 publications

References 26 publications

COVID-19-associated acute kidney injury patients treated with renal replacement therapy in the intensive care unit: A multicenter study in São Paulo, Brazil

COVID-19-associated acute kidney injury patients treated with renal replacement therapy in the intensive care unit: A multicenter study in São Paulo, Brazil

Association of vasopressors with mortality in critically ill patients with COVID-19: A systematic review and meta-analysis

The ratio of serum LL-37 levels to blood leucocyte count correlates with COVID-19 severity

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