Subject(s)
COVID-19 , Fibrin Fibrinogen Degradation Products/analysis , Hematoma , Heparin , Lung , Pulmonary Embolism , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , COVID-19/blood , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , Computed Tomography Angiography/methods , Hematoma/complications , Hematoma/diagnostic imaging , Hematoma/therapy , Heparin/administration & dosage , Heparin/adverse effects , Humans , Hypoxia/etiology , Hypoxia/therapy , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Patient Care Management/methods , Patient Selection , Pulmonary Embolism/complications , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Pulmonary Embolism/therapy , Risk Adjustment/methods , SARS-CoV-2 , Treatment OutcomeABSTRACT
BACKGROUND: Acute kidney injury (AKI) is frequent in Coronavirus Infection Disease 2019 (COVID-19) patients. Factors associated with AKI in COVID-19 intensive care unit (ICU) patients and their outcomes have not been previously explored. METHODS: Prospective observational study of COVID-19 patients admitted to the ICUs of the Hospital Clínic of Barcelona (Spain), from March 25th to April 21st, 2020, who developed AKI stage 2 or higher (AKIN classification). The primary goal was to describe the characteristics of moderate-severe AKI of COVID-19 patients in an ICU context. As a secondary goal, we aimed to find independent predictors of AKI progression, Renal Replacement Therapy (RRT) requirement and mortality among these patients. RESULTS: During the study period, 52 out of 237 ICU patients, developed AKIN stage 2 or higher and were included in the study. A Sequential Organ Failure Assessment (SOFA) score at AKI diagnosis of 8 or higher was associated with RRT, OR 5.2, p 0.032. At the time of AKI diagnosis, patients had a worse liver profile and higher inflammation markers than at admission. Fifty per cent of the patients presented AKI progression from AKIN 2 to 3 and 28.85% required RRT. The use of corticosteroids in 69.2% of patients was associated with a reduced requirement of RRT, OR 0.13 (CI 95% 0.02-0.89), p 0.037. AKI was associated with high mortality (50%) and a longer hospital stay, median 35 vs 18 days (p 0.024). CONCLUSIONS: The prevalence of moderate/severe AKI in COVID-19 patients admitted to the ICU is high and has a strong correlation with mortality and length of hospital stay.
Subject(s)
Acute Kidney Injury/etiology , COVID-19/complications , Critical Illness , Renal Replacement Therapy/methods , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Aged , COVID-19/epidemiology , Female , Follow-Up Studies , Hospital Mortality/trends , Hospitalization/trends , Humans , Incidence , Intensive Care Units/statistics & numerical data , Male , Pandemics , Prospective Studies , Risk Factors , SARS-CoV-2 , Spain/epidemiologyABSTRACT
Resumen Durante el último año se han publicado múltiples estudios en el campo de la cardiopatía isquémica y de los cuidados críticos cardiovasculares. Hemos seleccionado las publicaciones más destacadas según el criterio de los autores. During the last year, multiple trials in the field of ischemic heart disease and acute cardiac care have been published. We have made a selection of the most relevant ones.