Renal Involvement in Patients with COVID-19 Pneumonia and Outcomes After Stem Cell Nebulization

Abstract

BackgroundThe COVID-19 pandemic presented an unprecedented challenge to identify effective drugs for prevention and treatment.ObjectiveTo characterize acute renal injury (AKI) in patients with COVID-19 and their relation with clinical outcomes within the framework of the SENTAD COVID clinical trial at the Abu Dhabi Stem Cells Center.MethodsAbu Dhabi Stem Cell Center (ADSCC) proposed a prospective clinical trial nebulization treatment with autologous stem cells (Non-Hematopoietic Peripheral Blood Stem Cells (NHPBSC)), at Abu Dhabi hospitals.Participants20 treated patients were compared with 23 not treated patients. Both groups received COVID 19 standard treatment.OutcomesAfter the results were collected, this study was created to determine the impact of the disease on the renal function and the efficacy of the therapy on patient’s outcomes.ResultsOne third of the critical patients studied suffered kidney failure. Patients in the treated group showed a favorable tendency to improve in contrast to those in the control group. Less patients from group A suffered from sepsis in comparison with the group B (25% vs 65%), HR=0.38, (95% Confidence Interval: 0.16 – 0.86), *p=0.0212. These results suggested a NNT=2.5. An improvement in lymphocyte count, CRP, and shorter hospital stay after treatment was evidenced, which led to less superinfection and sepsis in the treated group.ConclusionsThe proposed anti-inflammatory effect of the stem cells, offers a great promise for managing the illness, emerging as a crucial adjuvant tool in promoting healing and early recovery in severe COVID-19 infections and other supportive treatments.ARTICLE SUMMARYOur study had several strengths and limitation: It was a randomized trial.The treatment showed a positive result, providing evidence that this intervention is effective in routine practice.We found fewer complications related to prolonged hospital stay in the treated group.The is the small number of participants.It was carried out in 4 different hospitals, each with different criteria for the selection of the initial empirical antimicrobials, which can cause multiple resistant germs.

Stem cell nebulization therapy for COVID-19 infection: radiological and clinical outcomes

“…The fact that the range in hospital stay after the intervention was much shorter in group A than in group B, given the homogeneity of the treated group thanks to the therapy, and the statistical dispersion of the control group data, although the median was not significant between the groups, may explain why there were fewer radiological controls in the treated group since shorter hospital stay is a protective factor against additional complications and nosocomial infections [7,30,31]. Following international recommendations, public hospitals in Abu Dhabi performed most of the radiographic control with CXR [30] due to infection control issues related to transporting patients to CT rooms for SARS-CoV-2 cases.…”

“…Mesenchymal stem cells (MSCs) have immunomodulatory effects that can neutralize the intensified immune response and repair damaged and injured cells and tissues in the context of acute respiratory distress syndrome (ARDS). MSCs secrete multiple factors involved in the regeneration and modulation of tissue damage, such as epidermal growth factor (EGF), platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF) and insulin-like growth factor, and lung injury in vivo [7].…”

“…Previously, within the framework of this clinical trial, we examined the frequency of acute kidney injury (ARI) in patients with SARS-CoV-2 and its relationship with clinical outcomes, finding it in approximately one-third of critically ill patients [7]. In addition, those who received the treatment showed a tendency to improve in terms of hospital stay and the evolution of biomarkers (amelioration of lymphopenia [8,18,25], neutrophillymphocyte ratio [26][27][28][29], and C-reactive protein (CRP)) compared to those in the control group.…”

“…Among the paraclinical findings, a normal or decreased total WBC count and lymphopenia are found, and elevated liver enzymes, LDH, and Creactive protein are negative prognostic factors. In critically ill patients, the value of D-dimer increases, which is associated with a multi-organ imbalance [6][7][8].…”