Severe Acute Kidney Injury in Patients with COVID-19 and Acute Respiratory Distress Syndrome

Chaïbi, Khalil; Dao, Myriam; Pham, Tài; Gumucio-Sanguino, Víctor D.; Paolo, F. A. Di; Pavot, Arthur; Cohen, Yves; Dreyfuss, Didier; Pérez-Fernández, Xosé L.; Gaudry, Stéphane

doi:10.1164/rccm.202005-1524le

Cited by 33 publications

(37 citation statements)

References 9 publications

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“…However, our data demonstrate that patients are more at risk of developing renal impairment with COVID-19 infection which translates to a higher mortality rate. The high mortality rates observed in our study cohort of patients with AKI and COVID-19 infection is similar to other studies [23]. However, unlike other reports, we also investigated patients with pre-existing renal pathologies and included those patients with a previous, viable renal transplant and those with CKD.…”

Section: Discussionsupporting

confidence: 69%

Renal impairment and its impact on clinical outcomes in patients who are critically ill with COVID‐19: a multicentre observational study

et al. 2020

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Summary Renal impairment is common in patients who are critically ill with coronavirus disease‐19 (COVID‐19). We examined the association between acute and chronic kidney disease with clinical outcomes in 372 patients with coronavirus disease‐19 admitted to four regional intensive care units between 10 March 2020 and 31 July 2020. A total of 216 (58%) patients presented with COVID‐19 and renal impairment. Acute kidney injury and/or chronic kidney disease was associated with greater in‐hospital mortality compared with patients with preserved renal function (107/216 patients (50%) (95%CI 44–57) vs. 32/156 (21%) (95%CI 15–28), respectively; p < 0.001, relative risk 2.4 (95%CI 1.7–3.4)). Mortality was greatest in patients with renal transplants (6/7 patients (86%) (95%CI 47–100)). Mortality rates increased in patients with worsening renal injury according to the Kidney Disease: Improving Global Outcomes classification: stage 0 mortality 33/157 patients (21%) (95%CI 15–28) vs. stages 1–3 mortality 91/186 patients (49%) (95%CI 42–56); p < 0.001, relative risk 2.3 (95%CI 1.7–3.3). Survivors were less likely to require renal replacement therapy compared with non‐survivors (57/233 patients (24%) vs. 64/139 patients (46%), respectively; p < 0.001, relative risk 1.9 (95%CI 1.4–2.5)). One‐fifth of survivors who required renal replacement therapy acutely in intensive care continued to require renal support following discharge. Our data demonstrate that renal impairment in patients admitted to intensive care with COVID‐19 is common and is associated with a high mortality and requirement for on‐going renal support after discharge from critical care. Our findings have important implications for future pandemic planning in this patient cohort.

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Section: Discussionsupporting

confidence: 69%

Renal impairment and its impact on clinical outcomes in patients who are critically ill with COVID‐19: a multicentre observational study

et al. 2020

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“…Thus, we hypothesize that these patients suffered from a fulminant form of COVID-19 with rapid and massive lung injury and early systemic spread. RRT rate, a more patient-centered outcome, was similar across the phenotypes, suggesting that other factors may be involved ( 13 , 32 ). In addition to this striking and specific phenotype, we identified two closer phenotypes (phenotype 1 and 2) with less differences in terms of clinical characteristics.…”

Section: Discussionmentioning

confidence: 88%

Identifying Clinical Phenotypes in Moderate to Severe Acute Respiratory Distress Syndrome Related to COVID-19: The COVADIS Study

Lascarrou

Gaultier²,

Soumagne

et al. 2021

Front. Med.

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Objectives: Different phenotypes have been identified in acute respiratory distress syndrome (ARDS). Existence of several phenotypes in coronavirus disease (COVID-19) related acute respiratory distress syndrome is unknown. We sought to identify different phenotypes of patients with moderate to severe ARDS related to COVID-19.Methods: We conducted an observational study of 416 COVID-19 patients with moderate to severe ARDS at 21 intensive care units in Belgium and France. The primary outcome was day-28 ventilatory free days. Secondary outcomes were mortality on day 28, acute kidney injury, acute cardiac injury, pulmonary embolism, and deep venous thrombosis. Multiple factor analysis and hierarchical classification on principal components were performed to distinguish different clinical phenotypes.Results: We identified three different phenotypes in 150, 176, and 90 patients, respectively. Phenotype 3 was characterized by short evolution, severe hypoxemia, and old comorbid patients. Phenotype 1 was mainly characterized by the absence of comorbidities, relatively high compliance, and long duration of symptoms, whereas phenotype 2 was characterized female sex, and the presence of mild comorbidities such as uncomplicated diabetes or chronic hypertension. The compliance in phenotype 2 was lower than that in phenotype 1, with higher plateau and driving pressure. Phenotype 3 was associated with higher mortality compared to phenotypes 1 and 2.Conclusions: In COVID-19 patients with moderate to severe ARDS, we identified three clinical phenotypes. One of these included older people with comorbidities who had a fulminant course of disease with poor prognosis. Requirement of different treatments and ventilatory strategies for each phenotype needs further investigation.

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“…Even though a better understanding of the pathophysiologic mechanisms of COVID-19-associated AKI is needed, there is increasing evidence that AKI is prevalent in critically ill patients with SARS-CoV-2 infection and it is closely associated with the severity of COVID-19 [11,12,81,82]. Moreover, clinical data have suggested that AKI represents poor prognosis and is associated with high mortality of patients with SARS-CoV-2 in ICU settings, especially in those with underlying comorbidities and requiring renal replacement therapy [3,9].…”

Section: Coronavirus and Acute Kidney Injurymentioning

confidence: 99%

“…It should be noted that, in spite of strong evidence of increasing kidney dysfunction caused by COVID-19 and of AKI being closely associated with the severity and prognosis of COVID-19 patients, the actual AKI incidence, in particular in ICUs, remains uncertain and may have been underestimated due to different causes, including the design of the studies, the lack of clear operational AKI definitions, the reported AKI stages, and the timeline of AKI onset incidences [4,5,8,81,82].…”

Section: Coronavirus and Acute Kidney Injurymentioning

confidence: 99%

Mechanistic Aspects and Therapeutic Potential of Quercetin against COVID-19-Associated Acute Kidney Injury

Diniz¹,

Souza

Duarte

et al. 2020

Molecules

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The inflammatory mediator and oxidant agent storm caused by the SARS-CoV-2 infection has been strongly associated with the failure of vital organs observed in critically ill patients with coronavirus disease 2019 (COVID-19) and the death of thousands of infected people around the world. Acute kidney injury (AKI) is a common renal disorder characterized by a sudden and sustained decrease in renal function with a critical influence on poor prognosis and lethal clinical outcomes of various etiologies, including some viral infection diseases. It is known that oxidative stress and inflammation play key roles in the pathogenesis and development of AKI. Quercetin is a natural substance that has multiple pharmacological properties, such as anti-inflammatory action, and is used as a dietary supplement. There is evidence of the anti-coronavirus activities of this compound, including against the target SARS-CoV-2 3CLpro. The ability to inhibit coronavirus and its inflammatory processes is strongly desired in a new drug for the treatment of COVID-19. Therefore, in this review, the dual effect of quercetin is discussed from a mechanistic perspective in relation to AKI kidney injury and its nephroprotective potential to SARS-CoV-2 patients.

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Severe Acute Kidney Injury in Patients with COVID-19 and Acute Respiratory Distress Syndrome

Cited by 33 publications

References 9 publications

Renal impairment and its impact on clinical outcomes in patients who are critically ill with COVID‐19: a multicentre observational study

Renal impairment and its impact on clinical outcomes in patients who are critically ill with COVID‐19: a multicentre observational study

Identifying Clinical Phenotypes in Moderate to Severe Acute Respiratory Distress Syndrome Related to COVID-19: The COVADIS Study

Mechanistic Aspects and Therapeutic Potential of Quercetin against COVID-19-Associated Acute Kidney Injury

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