1. Acute Kidney Injury and Renal Replacement Therapy in Critically Ill COVID-19 Patients: Risk Factors and Outcomes: A Single-Center Experience in Brazil
- Author
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Marcelino de Souza Durão, Julio Cesar Martins Monte, Leonardo José Rolim Ferraz, Marcelo Costa Batista, Virgilio Gonçalves Pereira, Marisa Petrucelli Doher, Bento Fortunato Cardoso dos Santos, Oscar Fernando Pavão dos Santos, Thais Nemoto Matsui, Patricia Faria Scherer, Ary Serpa Neto, Bruno C. Silva, Adriano Luiz Ammirati, Fabiana D Carneiro, Rinaldo Bellomo, Fabricio Rodrigues Torres de Carvalho, Thiago Domingos Corrêa, Bruna Gomes Barbeiro, and Intensive Care Medicine
- Subjects
Male ,Continuous renal replacement therapy ,medicine.medical_treatment ,030232 urology & nephrology ,Comorbidity ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,law.invention ,0302 clinical medicine ,Risk Factors ,law ,Severe acute respiratory syndrome coronavirus 2 ,Medicine ,Hospital Mortality ,Aged, 80 and over ,Respiratory Distress Syndrome ,Acute kidney injury ,Hematology ,General Medicine ,Middle Aged ,Intensive care unit ,female genital diseases and pregnancy complications ,Renal Replacement Therapy ,Intensive Care Units ,C-Reactive Protein ,Treatment Outcome ,Nephrology ,Creatinine ,Female ,Brazil ,Research Article ,medicine.medical_specialty ,Critical Illness ,Multiple Organ Failure ,03 medical and health sciences ,Internal medicine ,Humans ,Renal replacement therapy ,Renal Insufficiency, Chronic ,Risk factor ,Dialysis ,Aged ,Retrospective Studies ,SARS-CoV-2 ,business.industry ,COVID-19 ,Retrospective cohort study ,medicine.disease ,Respiration, Artificial ,business ,Multiple organ dysfunction syndrome - Abstract
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.
- Published
- 2020
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