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Introduction La défaillance rénale est la deuxième atteinte la plus fréquente après le syndrome de détresse respiratoire aiguë (SDRA), chez les patients en réanimation suite au COVID-19, et est fortement associée à la mortalité. Description L’objectif de cette étude multicentrique était d’analyser l’impact des traitements spécifiques du COVID-19 et du SDRA sur le risque d’IRA sévère chez les patients en réanimation pour COVID-19 sévère. Méthodes Dans cette étude de cohorte, les données de patients consécutifs hospitalisés dans 6 unités de réanimation pour COVID-19 étaient collectées rétrospectivement. L’incidence et la sévérité de l’IRA étaient monitorées durant tout le séjour en réanimation. Les patients majeurs hospitalisés en réanimation pour SDRA secondaire à un COVID-19 sévère nécessitant la ventilation mécanique était inclus. Résultats Au total, 164 patients ont été inclus dans l’analyse finale, 97 (59,1 %) présentaient une IRA, dont 39 (23,8 %) une IRA sévère KDIGO 3 et 21 (12,8 %) nécessitant une épuration extrarénale (EER). En analyse univariée, l’IRA sévère était associée à l’exposition aux inhibiteurs de l’enzyme de conversion de l’angiotensine (IEC) (p=0,016), à l’HTA (p=0,029), au score de gravité APACHE-II (p=0,004) et à la mortalité à j28 (p=0,008), j60 (p<0,001) et j90 (p<0,001). En analyse multivariée, les facteurs associés à l’apparition d’une IRA sévère étaient : l’exposition aux IEC (OR : 4,238 (1,307–13,736), p=0,016), le score APACHE-II (sans l’âge) (OR : 1,138 (1,044–1,241), p=0,003) et le monoxyde d’azote (NO) inhalé (OR : 5,694 (1,953–16,606), p=0,001). Les facteurs protecteurs étaient le décubitus ventral (OR : 0,234 (0,057–0,967), p=0,045) et la dexaméthasone (OR : 0,194 (0,053–0,713), p=0,014) (Figure 1). Conclusion La dexaméthasone est associée à une prévention du risque d’IRA sévère et d’EER, et le NO inhalé est associé à un risque d’IRA sévère et d’EER chez les patients en réanimation suite à un COVID-19. Le NO inhalé doit être utilisé avec précaution au cours du SDRA du au COVID-19.
ABSTRACT
BACKGROUND AND AIMS: Kidney failure is the second most frequent condition after acute respiratory distress syndrome (ARDS) in critically ill patients with severe COVID-19 and is strongly associated with mortality. The aim of this multicentric study was to assess the impact of the specific treatments of COVID-19 and ARDS on the risk of severe acute kidney injury (AKI) in critically ill COVID patients. METHOD: Data from a prospectively collected database of consecutive patients hospitalized in six ICUs for COVID-19 was retrospectively analysed. The incidence and severity of AKI were monitored during the entire ICU stay. Patients older than 18 years hospitalized in for COVID-19-related ARDS requiring mechanical ventilation were included. RESULTS: A total of 164 patients were included in the final analysis, 97 (59.1%) displayed AKI, of which 39 had severe stage 3 AKI and 21 (12.8%) requiring renal replacement therapy (RRT). In univariate analysis, severe AKI was associated with ACEI exposure (P = .016), high blood pressure (P = .029), APACHE-II score (P = .004) and mortality at D28 (P = .008), D60 (P < .001) and D90 (P < .001). In multivariate analysis, the factors associated with the onset of stage 3 AKI were: exposure to CEI [OR: 4.238 (1.307-13.736);P = .016], APACHE II score (without age) [OR: 1.138 (1.044-1.241);P = .003] and iNO [OR: 5.694 (1.953-16.606);P = .001], protective factors were prone positioning [OR: 0.234 (0.057-0.967);P = .045] and dexamethasone [OR: 0.194 (0.053-0.713);P = .014]. CONCLUSION: Dexamethasone seems to prevent the risk of severe AKI and RRT, and iNO seems associated with severe AKI and RRT in critically ill patients with COVID-19. iNO must be used with caution in COVID-19 related ARDS.
ABSTRACT
OBJECTIVES: The main objective was to evaluate the precision of the Modified Lung Ultrasound (MLUS score) for predicting the need for respiratory support in the first 48 hours in patients with dyspnea due to the coronavirus disease 2019 (COVID-19). The secondary objectives were 1) to compare the MLUS and National Early Warning Score 2 (NEWS2), as well as the combination of both scores, as predictors of severity according to the World Health Organization (WHO) Ordinal Scale for Clinical Improvement;and 2) to compare severity assessed by ultrasound scoring to severity assessed by lung computed tomography (CT). MATERIAL AND METHODS: Multicenter prospective observational cohort study conducted from March 30 to April 30, 2020, in 2 university hospitals. Adult patients with dyspnea due to COVID-19 were included. An initial lung ultrasound was performed, and the results of MLUS, NEW2, and lung CT evaluations were recorded. Patients were classified by risk according to the WHO scale at 48 hours, as follows: low risk (score less than 5) or high risk (score of 5 or more). RESULTS: A total of 100 patients were included: 35 (35%) were classified as low risk and 65 (65%) as high risk. The correlation between the MLUS and WHO assessments was positive and very high (Spearman rank correlation ? = 0.832;P .001). The area under the receiver operating characteristic curves of the MLUS, NEW2 and combined ultrasound scores, in relation to prediction of risk classification were, respectively, 0.96 (0.93-0.99), 0.89 (0.82-0.95) and 0.98 (0.96-1.0). The MLUS and lung CT assessments were correlated. CONCLUSION: An early lung ultrasound score can predict clinical severity in patients with dyspnea due to COVID-19.