ABSTRACT
BACKGROUND: Acute kidney injury (AKI) is a recognised complication of coronavirus disease 2019 (COVID-19), yet the reported incidence varies widely and the associated risk factors are poorly understood. METHODS: Data was collected on all adult patients who returned a positive COVID-19 swab while hospitalised at a large UK teaching hospital between 1st March 2020 and 3rd June 2020. Patients were stratified into community- and hospital-acquired AKI based on the timing of AKI onset. RESULTS: Out of the 448 eligible patients with COVID-19, 118 (26.3 %) recorded an AKI during their admission. Significant independent risk factors for community-acquired AKI were chronic kidney disease (CKD), diabetes, clinical frailty score and admission C-reactive protein (CRP), systolic blood pressure and respiratory rate. Similar risk factors were significant for hospital-acquired AKI including CKD and trough systolic blood pressure, peak heart rate, peak CRP and trough lymphocytes during admission. In addition, invasive mechanical ventilation was the most significant risk factor for hospital-acquired AKI (adjusted odds ratio 9.1, p < 0.0001) while atrial fibrillation conferred a protective effect (adjusted odds ratio 0.29, p < 0.0209). Mortality was significantly higher for patients who had an AKI compared to those who didn't have an AKI (54.3 % vs. 29.4 % respectively, p < 0.0001). On Cox regression, hospital-acquired AKI was significantly associated with mortality (adjusted hazard ratio 4.64, p < 0.0001) while community-acquired AKI was not. CONCLUSIONS: AKI occurred in over a quarter of our hospitalised COVID-19 patients. Community- and hospital-acquired AKI have many shared risk factors which appear to converge on a pre-renal mechanism of injury. Hospital- but not community acquired AKI was a significant risk factor for death.
Subject(s)
Acute Kidney Injury/etiology , COVID-19/complications , Hospitalization , Acute Kidney Injury/epidemiology , Age Factors , Aged , COVID-19/mortality , Female , Humans , Incidence , Kaplan-Meier Estimate , Male , Middle Aged , Retrospective Studies , Risk Factors , United Kingdom/epidemiologyABSTRACT
274 Figure 1Venous thromboembolic (VTE) events over time and proportional hospital acquired thrombosis rates(HAT)[Figure omitted. See PDF]We did not find increased rates of clinically significant VTE events in hospitalised patients with COVID-19. Our findings raise questions regarding the merits of unvalidated risk assessment tools and increased thromboprophylaxis dosing strategies in COVID-19 patients.
ABSTRACT
A short-cut review of the literature was carried out to examine the potential utility of prone positioning in awake patients with hypoxaemic respiratory failure. Four papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that there is no evidence that regular prone positioning in the awake patient with hypoxaemic respiratory failure impacts on clinically relevant outcomes. Further research is required to evaluate the safety and effectiveness of this intervention, compared with routine mobilisation strategies.