INTRODUCTION: Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19. METHODS: We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of invasive mechanical ventilation (IMV) and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded. RESULTS: Of 99 patients studied, 58 developed AKI (58.6%). The risk factors for AKI were older age (OR = 1.07, 95% CI = 1.01-1.13, p = 0.024); obesity (OR = 6.58, 95% CI = 1.8-24.05, p = 0.040); and the need for IMV (OR = 6.18, CI = 1.29-29.58, p = 0.023). The risk factors for mortality were obesity (OR = 5.57, 95% CI = 1.48-20.93, p = 0.011); requirement of vasoactive drugs on admission (OR = 5.35, 95% CI = 1.16-24.61, p = 0.031); and AKI (OR = 8.61, 95% CI = 2.24-33.1, p = 0.002). In-hospital mortality was significantly higher in patients with AKI stage 3 (79.3%) and AKI stage 2 (68.7%) compared with those with AKI stage 1 (25%; p = 0.004). Fifty-three patients underwent the furosemide stress test (FST) to predict progression to AKI stage 3. Of those, 12 progressed to AKI stage 3 (22%). The ROC curve for the FST had an AUC of 0.681 (p = 0.009); a sensitivity of 81.6% and a specificity of 54.5%. CONCLUSIONS: AKI was common in our cohort of patients with severe pneumonia caused by SARS-CoV-2 infection. The risk factors for AKI were older age, obesity and the need for of IMV on admission. The risk factors for mortality were obesity, requirement of vasoactive drugs on admission and AKI. Mortality was more frequent in patients with AKI stages 2-3. The FST had an acceptable predictive capacity to identify patients progressing to AKI stage 3.
INTRODUCTION: Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19. METHODS: We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of invasive mechanical ventilation (IMV) and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded. RESULTS: Of 99 patients studied, 58 developed AKI (58.6%). The risk factors for AKI were older age (OR = 1.07, 95% CI = 1.01-1.13, p = 0.024); obesity (OR = 6.58, 95% CI = 1.8-24.05, p = 0.040); and the need for IMV (OR = 6.18, CI = 1.29-29.58, p = 0.023). The risk factors for mortality were obesity (OR = 5.57, 95% CI = 1.48-20.93, p = 0.011); requirement of vasoactive drugs on admission (OR = 5.35, 95% CI = 1.16-24.61, p = 0.031); and AKI (OR = 8.61, 95% CI = 2.24-33.1, p = 0.002). In-hospital mortality was significantly higher in patients with AKI stage 3 (79.3%) and AKI stage 2 (68.7%) compared with those with AKI stage 1 (25%; p = 0.004). Fifty-three patients underwent the furosemide stress test (FST) to predict progression to AKI stage 3. Of those, 12 progressed to AKI stage 3 (22%). The ROC curve for the FST had an AUC of 0.681 (p = 0.009); a sensitivity of 81.6% and a specificity of 54.5%. CONCLUSIONS: AKI was common in our cohort of patients with severe pneumonia caused by SARS-CoV-2 infection. The risk factors for AKI were older age, obesity and the need for of IMV on admission. The risk factors for mortality were obesity, requirement of vasoactive drugs on admission and AKI. Mortality was more frequent in patients with AKI stages 2-3. The FST had an acceptable predictive capacity to identify patients progressing to AKI stage 3.
Authors: Juan C Ramirez-Sandoval; Jorge E Gaytan-Arocha; Pedro Xolalpa-Chávez; Juan M Mejia-Vilet; Mauricio Arvizu-Hernandez; Eduardo Rivero-Sigarroa; Carlos Torruco-Sotelo; Ricardo Correa-Rotter; Olynka Vega-Vega Journal: Blood Purif Date: 2020-10-26 Impact factor: 2.614
Authors: Elissa Driggin; Mahesh V Madhavan; Behnood Bikdeli; Taylor Chuich; Justin Laracy; Giuseppe Biondi-Zoccai; Tyler S Brown; Caroline Der Nigoghossian; David A Zidar; Jennifer Haythe; Daniel Brodie; Joshua A Beckman; Ajay J Kirtane; Gregg W Stone; Harlan M Krumholz; Sahil A Parikh Journal: J Am Coll Cardiol Date: 2020-03-19 Impact factor: 24.094
Authors: Jonathan S Chávez-Íñiguez; José H Cano-Cervantes; Pablo Maggiani-Aguilera; Natashia Lavelle-Góngora; Josué Marcial-Meza; Estefanía P Camacho-Murillo; Cynthia Moreno-González; Jarumi A Tanaka-Gutiérrez; Ana P Villa Zaragoza; Karla E Rincón-Souza; Sandra Muñoz-López; Olivia Montoya-Montoya; Guillermo Navarro-Blackaller; Aczel Sánchez-Cedillo; Luis E Morales-Buenrostro; Guillermo García-García Journal: PLoS One Date: 2021-11-04 Impact factor: 3.240
Authors: Thomas M Drake; Aya M Riad; Cameron J Fairfield; Conor Egan; Stephen R Knight; Riinu Pius; Hayley E Hardwick; Lisa Norman; Catherine A Shaw; Kenneth A McLean; A A Roger Thompson; Antonia Ho; Olivia V Swann; Michael Sullivan; Felipe Soares; Karl A Holden; Laura Merson; Daniel Plotkin; Louise Sigfrid; Thushan I de Silva; Michelle Girvan; Clare Jackson; Clark D Russell; Jake Dunning; Tom Solomon; Gail Carson; Piero Olliaro; Jonathan S Nguyen-Van-Tam; Lance Turtle; Annemarie B Docherty; Peter Jm Openshaw; J Kenneth Baillie; Ewen M Harrison; Malcolm G Semple Journal: Lancet Date: 2021-07-17 Impact factor: 79.321