Acute Kidney Injury and Renal Replacement Therapy in Critically Ill COVID-19 Patients: Risk Factors and Outcomes: A Single-Center Experience in Brazil.

Autor: Doher MP; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil., Torres de Carvalho FR; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil., Scherer PF; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil., Matsui TN; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil., Ammirati AL; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil., Caldin da Silva B; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil., Barbeiro BG; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil., Carneiro FD; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil., Corrêa TD; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil., Ferraz LJR; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil., Dos Santos BFC; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil., Pereira VG; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil., Batista MC; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.; Nephrology Division, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, São Paulo, Brazil., Monte JCM; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil., Santos OFP; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.; Nephrology Division, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, São Paulo, Brazil., Bellomo R; Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, New South Wales, Australia., Serpa Neto A; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil., Durão MS; Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil, marcelino@einstein.br.; Nephrology Division, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, São Paulo, Brazil, marcelino@einstein.br.; Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil, marcelino@einstein.br.
Jazyk: angličtina
Zdroj: Blood purification [Blood Purif] 2021; Vol. 50 (4-5), pp. 520-530. Date of Electronic Publication: 2020 Dec 18.
DOI: 10.1159/000513425
Abstrakt: Background: Critically ill patients with COVID-19 may develop multiple organ dysfunction syndrome, including acute kidney injury (AKI). We report the incidence, risk factors, associations, and outcomes of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients.
Methods: We performed a retrospective cohort study of adult patients with COVID-19 diagnosis admitted to the intensive care unit (ICU) between March 2020 and May 2020. Multivariable logistic regression analysis was applied to identify risk factors for the development of AKI and use of RRT. The primary outcome was 60-day mortality after ICU admission.
Results: 101 (50.2%) patients developed AKI (72% on the first day of invasive mechanical ventilation [IMV]), and thirty-four (17%) required RRT. Risk factors for AKI included higher baseline Cr (OR 2.50 [1.33-4.69], p = 0.005), diuretic use (OR 4.14 [1.27-13.49], p = 0.019), and IMV (OR 7.60 [1.37-42.05], p = 0.020). A higher C-reactive protein level was an additional risk factor for RRT (OR 2.12 [1.16-4.33], p = 0.023). Overall 60-day mortality was 14.4% {23.8% (n = 24) in the AKI group versus 5% (n = 5) in the non-AKI group (HR 2.79 [1.04-7.49], p = 0.040); and 35.3% (n = 12) in the RRT group versus 10.2% (n = 17) in the non-RRT group, respectively (HR 2.21 [1.01-4.85], p = 0.047)}.
Conclusions: AKI was common among critically ill COVID-19 patients and occurred early in association with IMV. One in 6 AKI patients received RRT and 1 in 3 patients treated with RRT died in hospital. These findings provide important prognostic information for clinicians caring for these patients.
(© 2020 S. Karger AG, Basel.)
Databáze: MEDLINE
Externí odkaz: