| Autor: |
Larsson AO; Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, 751 85 Uppsala, Sweden., Hultström M; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden.; Department of Medical Cell Biology, Integrative Physiology, Uppsala University, 751 23 Uppsala, Sweden.; Department of Epidemiology, McGill University, Montréal, QC H3A 0G4, Canada.; Lady Davis Institute of Medical Research, Jewish General Hospital, Montréal, QC H3T 1E2, Canada., Frithiof R; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden., Nyman U; Department of Translational Medicine, Division of Medical Radiology, Lund University, 221 85 Malmö, Sweden., Lipcsey M; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden.; Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden., Eriksson MB; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden.; NOVA Medical School, New University of Lisbon, 1099-085 Lisbon, Portugal. |
| Abstrakt: |
COVID-19 is a systemic disease, frequently affecting kidney function. Dexamethasone is standard treatment in severe COVID-19 cases, and is considered to increase plasma levels of cystatin C. However, this has not been studied in COVID-19. Glomerular filtration rate (GFR) is a clinically important indicator of renal function, but often estimated using equations (eGFR) based on filtered metabolites. This study focuses on sources of bias for eGFRs (mL/min) using a creatinine-based equation (eGFR LMR ) and a cystatin C-based equation (eGFR CAPA ) in intensive-care-treated patients with COVID-19. This study was performed on 351 patients aged 18 years old or above with severe COVID-19 infections, admitted to the intensive care unit (ICU) in Uppsala University Hospital, a tertiary care hospital in Uppsala, Sweden, between 14 March 2020 and 10 March 2021. Dexamethasone treatment (6 mg for up to 10 days) was introduced 22 June 2020 (n = 232). Values are presented as medians (IQR). eGFR CAPA in dexamethasone-treated patients was 69 (37), and 74 (46) in patients not given dexamethasone ( p = 0.01). eGFR LMR was not affected by dexamethasone. eGFR LMR in females was 94 (20), and 75 (38) in males ( p = 0.00001). Age and maximal CRP correlated negatively to eGFR CAPA and eGFR LMR , whereas both eGFR equations correlated positively to BMI. In ICU patients with COVID-19, dexamethasone treatment was associated with reduced eGFR CAPA . This finding may be explained by corticosteroid-induced increases in plasma cystatin C. This observation is important from a clinical perspective since adequate interpretation of laboratory results is crucial. |
