Characteristics and outcomes of hospitalized COVID-19 patients with acute kidney injury: The Makati Medical Center experience

Introduction@#Since the breakout of COVID-19 in December 2019, the virus has already affected and taken millions of lives over the past year. There is still much to learn about this disease. It has been postulated that the human kidney is a potential pathway for COVID-19 due to the presence of the ACE2 receptors found in the surfaces of kidney cells. Some studies that demonstrated acute tubular necrosis and lymphocyte infiltration among post mortem COVID-19 patients, concluding that the virus could directly damage the kidney, increasing the risk of the development of Acute Kidney Injury (AKI) among patients with COVID-19. This study investigated the incidence and severity of AKI among hospitalized COVID-19 patients and the association of the degree of AKI with regards to the severity and outcomes of COVID-19 patients.@*Methods@#This was a single-center cross-sectional study retrospective chart review of COVID-19 patients who developed AKI. Descriptive statistics were used to summarize the general and clinical characteristics of the patients. Frequency and proportion were used for categorical variables. Shapiro-Wilk test was used to determine the normality distribution of continuous variables. Continuous quantitative data that met the normality assumption was described using mean and standard deviation, while those that did not were described using median and range. Continuous variables which are normally distributed were compared using the One-way ANOVA, while those variables that are not normally distributed were compared using the Kruskal-Wallis H test. For categorical variables, the Chi-square test was used to compare the outcomes. If the expected percentages in the cells are less than 5%, Fisher's Exact Test was used instead.@*Results@#A total of 1441 COVID-19 in-patients from March 1, 2020 to March 1, 2021 were reviewed, 59 of whom were excluded. Among the adults with COVID-19 who developed AKI, 60% were in stage I, 10% in stage II, and 30% in stage III. The incidence of AKI among COVID-19 in-patients at Makati Medical Center was 13.10% (95% CI 11.36% - 14.99%). Among the 181 patients, 79 (43.65%, 95% CI 36.30 - 51.20) had died. The mortality rate is 22.02% for Stage I, 50% for Stage II, and 85.19% for Stage III. The median length of hospital stay was 12 days, ranging from 1 day up to 181 days. Full renal recovery on discharge was observed only in one-third of the patients. It was observed in 44.95% of those in Stage I, 27.78% of those in Stage II, and 5.56% of those in Stage III.@*Conclusion@#The study demonstrated that the incidence of AKI in hospitalized COVID-19 patients was 13.1% (95% CI 11.36% - 14.99%), which was lower than previously reported. This could be attributed to the longer study period wherein, to date, we have a better understanding of the disease and had already established a standard of care for treatment for the disease attributing to the decreased incidence of AKI among COVID-19 patients than what was initially reported. The development of AKI has a direct correlation with the degree of infection. Among patients who developed AKI, 20% required renal replacement therapy. Overall development of AKI increases the risk of mortality among hospitalized COVID-19 patients. The stage of AKI has a direct correlation with regards to mortality and has an indirect relationship with regards to renal recovery.

Time to blood culture positivity as a predictor of clinical outcome among septic patients

@#<p style="text-align: justify;"><strong>Introduction:</strong> In the setting of Sepsis, Blood Culture is one of the important diagnostic tools in aiding a clinician to determine the offending pathogen. Following the Sepsis Bundle, Blood Culture is obtained at two sites before initiation of antibiotics. However, blood Cultures are one of the expensive tests wherein some clinicians find it unnecessary and costly. This study would provide more information regarding positive blood cultures among septic patients as a prognostic tool regarding the time to positivity. Reporting Time to Positivity would aid clinicians in the severity of the infection and could be used as a clinical predictor of mortality. This study investigated the optimal cutoff point of the time to positivity to predict mortality and the association between time to positivity of blood cultures with mortality among septic patients.</p><p style="text-align: justify;"><strong>Methods:</strong> This was a single-center cross-sectional study with a retrospective chart review of septic patients with positive blood cultures. The optimal cutoff point of time to positivity was determined and associated with mortality.</p><p style="text-align: justify;"><strong>Results:</strong> 405 adult in-patients with sepsis in Makati Medical Center from April 1, 2017, to April 30, 2018, were reviewed. The suggested optimal cutoff TTP is ?19.1 hours, with sensitivity 79.78%, specificity 28.48%, accuracy 39.75%, Youden's index 8.26%. The overall mortality rate is 21.98%. The mortality rate was higher in the TTP < 19.1 group at 23.91% compared to the >19.1 hours group. Predictors associated with mortality are age, liver comorbidity, genitourinary source of infection, and short TTP.</p><p style="text-align: justify;"><strong>Conclusion:</strong> A short TTP was associated with higher mortality rates. TTP can be clinically used to predict poorer outcomes. Therefore, patients with a short TTP should be monitored more closely, and appropriate antibiotics should have been initiated.</p>