COVID-19-associated coagulopathy and acute kidney injury in critically ill patients.

Autor: Silva BCD; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Cordioli RL; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Santos BFCD; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Guerra JCC; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Rodrigues RDR; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Souza GM; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Ashihara C; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Midega TD; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Campos NS; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Carneiro BV; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Campos FND; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Guimarães HP; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Matos GFJ; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Aranda VF; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Ferraz LJR; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Corrêa TD; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Jazyk: angličtina
Zdroj: Einstein (Sao Paulo, Brazil) [Einstein (Sao Paulo)] 2023 Sep 15; Vol. 21, pp. eAO0119. Date of Electronic Publication: 2023 Sep 15 (Print Publication: 2023).
DOI: 10.31744/einstein_journal/2023AO0119
Abstrakt: Objective: The incidence of thrombotic events and acute kidney injury is high in critically ill patients with COVID-19. We aimed to evaluate and compare the coagulation profiles of patients with COVID-19 developing acute kidney injury versus those who did not, during their intensive care unit stay.
Methods: Conventional coagulation and platelet function tests, fibrinolysis, endogenous inhibitors of coagulation tests, and rotational thromboelastometry were conducted on days 0, 1, 3, 7, and 14 following intensive care unit admission.
Results: Out of 30 patients included, 13 (43.4%) met the criteria for acute kidney injury. Comparing both groups, patients with acute kidney injury were older: 73 (60-84) versus 54 (47-64) years, p=0.027, and had a lower baseline glomerular filtration rate: 70 (51-81) versus 93 (83-106) mL/min/1.73m2, p=0.004. On day 1, D-dimer and fibrinogen levels were elevated but similar between groups: 1780 (1319-5517) versus 1794 (726-2324) ng/mL, p=0.145 and 608 (550-700) versus 642 (469-722) g/dL, p=0.95, respectively. Rotational thromboelastometry data were also similar between groups. However, antithrombin activity and protein C levels were lower in patients who developed acute kidney injury: 82 (75-92) versus 98 (90-116), p=0.028 and 70 (52-82) versus 88 (78-101) µ/mL, p=0.038, respectively. Mean protein C levels were lower in the group with acute kidney injury across multiple time points during their stay in the intensive care unit.
Conclusion: Critically ill patients experiencing acute kidney injury exhibited lower endogenous anticoagulant levels. Further studies are needed to understand the role of natural anticoagulants in the pathophysiology of acute kidney injury within this population.
Databáze: MEDLINE
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