ABSTRACT
CONTEXT: The outbreak of coronavirus disease 2019 (CO-VID-19) has rapidly evolved into a global pandemic. Kidney dysfunction is common among patients with COVID-19, and patients who develop acute kidney injury (AKI) have inferior outcomes. There is a growing body of evidence that AKI occurs in a substantial number of patients with COVID-19 and that developing AKI is associated with significantly worse outcomes for COVID-19 patients. The risk for death was amplified when AKI resulted in kidney replacement therapy (KRT). Subject of Review: The Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID) conducted a multicenter retrospective observational study enrolling 3,099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) (J Am Soc Nephrol 2021;32:161-176). A total of 637 of 3,099 patients (20.6%) developed AKI treated with KRT (AKI-KRT) within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Predictors of COVID-19 patients' progress to AKI-KRT were higher BMI, higher stages of CKD, lower ratio of the partial pressure of arterial oxygen over the fraction of inspired oxygen (PaO2:FiO2 ratio) on ICU admission, and greater number of vasopressors received on ICU admission. Second Opinion: Recently, some investigations revealed that the independent predictors of COVID-19 with AKI include older age, Black race, diabetes, hypertension, cardiovascular disease, mechanical ventilation, higher interleukin-6 level, and use of vasopressor medications. It seems that the underlying comorbidities with preexisting vascular endothelial damage and/or the more serious critically ill CO-VID-19 patients can contribute to the development of AKI and even AKI-KRT.
Subject(s)
Acute Kidney Injury/etiology , COVID-19/complications , Endothelium, Vascular/physiopathology , SARS-CoV-2 , Acute Kidney Injury/physiopathology , Acute Kidney Injury/therapy , COVID-19/physiopathology , Humans , Renal Replacement Therapy , Retrospective StudiesABSTRACT
BACKGROUND: Attention should be paid to delirium in coronavirus disease 2019 (COVID-19) patients, especially older people, since advanced age poses increased risk of both delirium and COVID-19-related death. OBJECTIVE: This study aims to summarise the evidence on prevalence, incidence and mortality of delirium in COVID-19 patients. METHODS: We conducted a comprehensive literature search on Pubmed and Embase from inception to 1 December 2020. Three independent reviewers evaluated study eligibility and data extraction, and assessed study quality. Outcomes were analysed as proportions with 95% confidence interval (CI). We also compared mortality differences in COVID-19 patients using odds ratio. RESULTS: In total, we identified 48 studies with 11,553 COVID-19 patients from 13 countries. Pooled prevalence, incidence and mortality rates for delirium in COVID-19 patients were 24.3% (95% CI: 19.4-29.6%), 32.4% (95% CI: 20.8-45.2%) and 44.5% (95% CI: 36.1-53.0%), respectively. For patients aged over 65 years, prevalence, incidence and mortality rates for delirium in COVID-19 patients were 28.2% (95% CI: 23.5-33.1%), 25.2% (95% CI: 16.0-35.6%) and 48.4% (95% CI: 40.6-56.1%), respectively. For patients under 65 years, prevalence, incidence and mortality rates for delirium in COVID-19 patients were 15.7% (95% CI: 9.2-23.6%), 71.4% (95% CI: 58.5-82.7%) and 21.2% (95% CI: 15.4-27.6%), respectively. Overall, COVID-19 patients with delirium suffered higher risk of mortality, compared with those without delirium (OR: 3.2, 95% CI: 2.1-4.8). CONCLUSION: Delirium developed in almost 1 out of 3 COVID-19 patients, and was associated with 3-fold overall mortality. Our findings suggest that first-line healthcare providers should systematically assess delirium and monitor related symptoms among COVID-19 patients.