Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single centre cohort study.
APACHE
Acute Kidney Injury
/ epidemiology
COVID-19
/ complications
Cohort Studies
Critical Illness
Female
Hospital Mortality
Humans
Incidence
Intensive Care Units
Male
Middle Aged
Organ Dysfunction Scores
Recovery of Function
Renal Replacement Therapy
/ statistics & numerical data
Respiration, Artificial
/ adverse effects
Risk Factors
Water-Electrolyte Balance
Acute kidney injury
COVID-19
Intensive care
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
15 03 2021
15 03 2021
Historique:
received:
11
09
2020
accepted:
08
03
2021
entrez:
16
3
2021
pubmed:
17
3
2021
medline:
25
3
2021
Statut:
epublish
Résumé
Acute kidney injury (AKI) is a common manifestation among patients critically ill with SARS-CoV-2 infection (Coronavirus 2019) and is associated with significant morbidity and mortality. The pathophysiology of renal failure in this context is not fully understood, but likely to be multifactorial. The intensive care unit outcomes of patients following COVID-19 acute critical illness with associated AKI have not been fully explored. We conducted a cohort study to investigate the risk factors for acute kidney injury in patients admitted to and intensive care unit with COVID-19, its incidence and associated outcomes. We reviewed the medical records of all patients admitted to our adult intensive care unit suffering from SARS-CoV-2 infection from 14th March 2020 until 12th May 2020. Acute kidney injury was defined using the Kidney Disease Improving Global Outcome (KDIGO) criteria. The outcome analysis was assessed up to date as 3rd of September 2020. A total of 81 patients admitted during this period. All patients had acute hypoxic respiratory failure and needed either noninvasive or invasive mechanical ventilatory support. Thirty-six patients (44%) had evidence of AKI (Stage I-33%, Stage II-22%, Renal Replacement Therapy (RRT)-44%). All patients with AKI stage III had RRT. Age, diabetes mellitus, immunosuppression, lymphopenia, high D-Dimer levels, increased APACHE II and SOFA scores, invasive mechanical ventilation and use of inotropic or vasopressor support were significantly associated with AKI. The peak AKI was at day 4 and mean duration of RRT was 12.5 days. The mortality was 25% for the AKI group compared to 6.7% in those without AKI. Among those received RRT and survived their illness, the renal function recovery is complete and back to baseline in all patients. Acute kidney injury and renal replacement therapy is common in critically ill patients presenting with COVID-19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay. Recovery of renal function was complete in all survived patients.
Sections du résumé
BACKGROUND
Acute kidney injury (AKI) is a common manifestation among patients critically ill with SARS-CoV-2 infection (Coronavirus 2019) and is associated with significant morbidity and mortality. The pathophysiology of renal failure in this context is not fully understood, but likely to be multifactorial. The intensive care unit outcomes of patients following COVID-19 acute critical illness with associated AKI have not been fully explored. We conducted a cohort study to investigate the risk factors for acute kidney injury in patients admitted to and intensive care unit with COVID-19, its incidence and associated outcomes.
METHODS
We reviewed the medical records of all patients admitted to our adult intensive care unit suffering from SARS-CoV-2 infection from 14th March 2020 until 12th May 2020. Acute kidney injury was defined using the Kidney Disease Improving Global Outcome (KDIGO) criteria. The outcome analysis was assessed up to date as 3rd of September 2020.
RESULTS
A total of 81 patients admitted during this period. All patients had acute hypoxic respiratory failure and needed either noninvasive or invasive mechanical ventilatory support. Thirty-six patients (44%) had evidence of AKI (Stage I-33%, Stage II-22%, Renal Replacement Therapy (RRT)-44%). All patients with AKI stage III had RRT. Age, diabetes mellitus, immunosuppression, lymphopenia, high D-Dimer levels, increased APACHE II and SOFA scores, invasive mechanical ventilation and use of inotropic or vasopressor support were significantly associated with AKI. The peak AKI was at day 4 and mean duration of RRT was 12.5 days. The mortality was 25% for the AKI group compared to 6.7% in those without AKI. Among those received RRT and survived their illness, the renal function recovery is complete and back to baseline in all patients.
CONCLUSION
Acute kidney injury and renal replacement therapy is common in critically ill patients presenting with COVID-19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay. Recovery of renal function was complete in all survived patients.
Identifiants
pubmed: 33722189
doi: 10.1186/s12882-021-02296-z
pii: 10.1186/s12882-021-02296-z
pmc: PMC7957445
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
92Investigateurs
Sanjay Gupta
(S)
Julian Nixon
(J)
Michael P W Grocott
(MPW)
Denny Z H Levett
(DZH)
Michael Stewart
(M)
Ahilanadan Dushianthan
(A)
David Sparkes
(D)
Robert Chambers
(R)
Kathleen Nolan
(K)
Suzie Tanser
(S)
Jonathan Fennell
(J)
Max Jonas
(M)
Michael Celinski
(M)
Dominic Richardson
(D)
Rebecca Cusack
(R)
Benjamin Skinner
(B)
Timothy Nicholson-Robert
(T)
Mai Wakatsuki
(M)
Carin Dear
(C)
Ben Thomas
(B)
Francois Wessels
(F)
Tom Wilkinson
(T)
Anna Freeman
(A)
Hannah Burke
(H)
Ahilanadan Dushianthan
(A)
Michael Celinski
(M)
James Batchelor
(J)
Saul Faust
(S)
Gareth Thomas
(G)
Christopher Kipps
(C)
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