Acute Kidney Injury Due to COVID-19 in Intensive Care Unit: An Analysis From a Latin-American Center

Abstract

Introduction: The kidney may be affected by coronavirus (COVID-19) in the setting of acute kidney injury (AKI). Data about AKI in intensive care unit (ICU) patients in Latin America are scarce. We aimed to evaluate the risk of AKI, dialysis (HD), and death in ICU COVID-19 patients in a Brazilian center.Methods: Analysis from medical records of COVID-19 patients in a Brazilian center.Results: A total of 95 patients were analyzed. There was male predominance (64.2%), median age: 64.9 years, and previous history of hypertension and diabetes in 51.6 and 27.4%, respectively. AKI was diagnosed in 54 (56.8%) patients, and 32 (59.2%) of them required HD. Mortality rate was 17.9%. AKI patients when compared with no-AKI were more frequently hypertensive/diabetic and more often needed organ support therapies. Workups depicted more anemia, lymphopenia, and higher levels of inflammatory markers and higher mortality. Comparing patients who had undergone death to survivors, they were older, more frequently diabetic, and had worse SAPS3 and SOFA scores and need for organ support therapies, AKI, and HD. Multinomial logistic regression revealed that hypertension (p = 0.018) and mechanical ventilation (p = 0.002) were associated with AKI; hypertension (p = 0.002), mechanical ventilation (p = 0.008), and use of vasopressor (p = 0.027) to HD patients; and age >65 years (p = 0.03) and AKI (p = 0.04) were risk factors for death.Conclusions: AKI was a common complication of ICU COVID-19 patients, and it was more frequent in patients with hypertension and need of organ support therapies. As well as age >65 years, AKI was an independent risk factor for death.

Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia

“…Gutiérrez-Abejón et al reported a doubling of the mortality rate in patients with COVID-19 and AKI [ 34 ]. Other studies have also demonstrated that AKI is associated with an increased risk of death [ 35 , 36 ]. Patients with a high creatinine level and a low GFR at admission to the ICU had worse outcomes in our study.…”

Association of vasopressors with mortality in critically ill patients with COVID-19: A systematic review and meta-analysis

“…The studies originated from multiple countries, with 13 of coming from institutions located in the USA [20,21,23,[32][33][34][35]38,42,43,45,48,51]. Nineteen studies included only patients admitted in the ICU [20,22,24,25,27,[30][31][32][35][36][37][38][39][43][44][45][46][47]52], five studies included patients admitted in a COVID-19-dedicated HDU [28,29,33,34,42], eight studies included patients who were admitted in both HDU and ICU [21,23,26,40,41,48,49,51], and one study included Emergency Department patients who were later admitted either in the HDU of ICU [50]. Thirty studies included data about patients who received vs. patients who did not receive vasopressors…”

“…Twenty-one out of the 33 included studies provided data on hospital mortality in patients who received vs. patients who did not receive vasopressors, resulting in a total population of 7900 individuals [25,27,[31][32][33][34][35][36][37][39][40][41][42][43][44][45][46][47][48]50,52]. Due to high heterogeneity (I 2 : 94%, PQ<0.001), the random-effects model was implemented.…”

Association of vasopressors with mortality in critically ill patients with COVID-19: a systematic review and meta-analysis

“…All the 34 included studies were observational in their design [ 21 – 54 ]. Twenty studies included only patients admitted to the ICU [ 21 , 23 , 25 , 26 , 28 , 31 – 33 , 36 – 40 , 44 – 48 , 53 , 54 ], five studies included patients admitted to a COVID-19-dedicated HDU [ 29 , 30 , 34 , 35 , 43 ], eight studies included patients who were admitted to both HDU and ICU [ 22 , 24 , 27 , 41 , 42 , 49 , 50 , 52 ], and one study included Emergency Department patients who were later admitted either to ICU [ 51 ]. Thirty-one studies included data about patients who received vs. patients who did not receive vasopressors [ 21 – 38 , 40 – 49 , 51 , 53 , 54 ] and were included in review.…”