ABSTRACT
Background: Acute kidney injury (AKI) is a common complication of COVID-19 ARDS and is associated with greater risk of mortality (1)). In addition to the direct tubular injury mediated by the virus, indirect mechanisms play a role in AKI development. Positive pressure ventilation, by increasing intrathoracic pressure, leads to a decreased venous return to the heart and to a reduced cardiac output (2). In addition, elevated central venous pressure (CVP) may result in elevated tubular hydrostatic pressure in the encapsulated kidney, which reduces glomerular filtration rate and oxygen delivery (3). We hypothesized that elevated intrathoracic pressure, determined by positive pressure ventilation is associated with an increased risk of AKI. The aim of the study is to assess the association between hemodynamics and ventilatory parameters set during mechanical ventilation and AKI in patients with COVID-19 ARDS. Method(s): This is single center retrospective observational study performed at Papa Giovanni XXIII Hospital Bergamo (Italy). Consecutive patients were enrolled with a diagnosis of COVID-19 and ARDS managed with invasive mechanical ventilation. If patients developed AKI (defined according to KDIGO definition) within 14 days of ICU stay were included in "AKI group", otherwise were classified in "non-AKI group". Demographic characteristics, lab tests and hemodynamic [mean arterial pressure (MAP) and central venous pressure (CVP), fluid balance] and ventilatory parameters [positive end-expiratory pressure (PEEP), plateau pressure (PPlat)] were compared between group using Mann Whitney test. Data are presented as median and 95% CI. Only data registered until the day of the AKI occurrence, in patients in AKI group, or until the day corresponding to the median days between ICU admission and the AKI occurrence calculated before for patients in non-AKI group, were considered for the statistical analysis. Result(s): Among the 140 patients included in the analysis, AKI occurred in 70 (48%) patients and 27 (19%) required continuous renal replacement therapy (CRRT). Table 1 shows comparison between the two groups. Patients in AKI group were older, had higher prevalence of obesity, hypertension and diabetes, had lower MAP and received a greater amount of fluid and furosemide compared to patients in non-AKI group (p<0.05). Only a trend toward a greater CVP was observed in patients with AKI, without reaching a significant difference. Both PEEP and Pplat were set higher in patients with AKI, while the severity of lung disease, measured by PaO2/FiO2 were not different between the two groups. Conclusion(s): In our cohort, higher pressure ventilation was associated with an increased risk of AKI.
ABSTRACT
Background and aim: Italy was the first European country to face the outbreak of COVID-19. The aim of this study was to show its impact on the activity of a tertiary care Endoscopy Unit with more than 18,000 procedures/year. Materials and methods: This is a single-center study performed at Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy. Our Institution was converted to COVID-19 Hospital from January to April 2020 and only emergency and oncologic procedures were maintained to preserve both patients’ and operators’ health. Data about outpatients visits and endoscopic examinations performed from January to April 2020 were compared to those of the same period of the previous year. Results: A dramatic drop of all activities was shown. All outpatient visits decreased of 45,89% (1100 vs 2033), including -39.5% (227 vs 375) of Inflammatory Bowel Disease and -28.6% (30 vs 42) of biliopancreatic visits. All endoscopic examinations diminished of 74.1% (562 vs 2173). In detail, colonoscopies were reduced of 78.8% (266 vs 1256), including -85.5% (29 vs 200) of screening procedures, EGDS of 70.4% (241 vs 814), EUS of 44.8% (32 vs 58) and ERCP of 48.9% (23 vs 45). Overall, -64.6% of Gastro-Intestinal (GI) cancers were detected (17 vs 48). A reduction of 77.8% and 80% were obtained in terms of advanced adenomas (i.e., high grade dysplasia and villous histology) and adenocarcinomas detected during colonoscopy (22 vs 100 and 6 vs 30, respectively). These absolute reductions were not compensated by significative increase of relative diagnostic yields which were 3.3% vs 2.3% (17/507 vs 48/2070;Odd Ratio [OR] 0.94), 8.3% vs 7.9% (22/266 vs 100/1256;OR 1.05) and 2.3% vs 2.4% (6/266 vs 30/1256;OR 0.94) for all GI cancers, advanced adenomas, and colorectal cancer in 2020 and 2019, respectively. Although a reduction of 35.3%, a significant improvement was showed comparing diagnostic yield of gastric adenocarcinoma in 2020 and 2019, being 4.6% vs 2.1% (11/241 vs 17/814;OR 0.44), respectively. Conclusions: The COVID-19 outbreak caused a notably decrease of all activities, including colorectal screening colonoscopy. This produced a reduction of the total amount of neoplasia detected compared to the same period of the previous year. The consequences of this delay are still to be shown.
ABSTRACT
Aims Italy was the first European country to experience COVID-19 outbreak. The aim of this study was to show its impacton the activity of a tertiary care Endoscopy Unit with >18,000 procedures/year. Methods This is a single-center study performed at Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy. OurInstitution was converted to COVID-19 Hospital from January to April 2020 and only emergency and oncologic procedureswere maintained to preserve both patients' and operators' health. Data about outpatients visits and endoscopicexaminations performed from January to April 2020 were compared to the same period of 2019. Results A dramatic drop of all activities was shown. In details, overall outpatient visits decreased of-45,89 % (1100 vs2033), including-39.5 % (227 vs 375) of IBD and-28.6 % (30 vs 42) biliopancreatic visits. Endoscopic examinations alsodiminished considerably as shown in table 1. Overall,-64.6 % of gastro-intestinal cancers were detected (17 vs 48). Areduction of-77.8 % and-80 % were obtained in terms of advanced neoplasia (i.e. high-grade dysplasia and villoushistology) and adenocarcinomas detected during colonoscopy between the two years (22 vs 100 and 6 vs 30, respectively).Such absolute reduction was not compensated by an increase of relative diagnostic yield, being 8.3 % vs 7.9 % (22/266 vs100/1256;Odd Ratio [OR] 1.05) and 2.3 % vs 2.4 % (6/266 vs 30/1256;OR 0.94) for advanced neoplasia and colorectalcancer, respectively. Although a reduction of-35.3 %, a significant improvement was showed comparing diagnostic yield ofgastric adenocarcinomas, being 2.1 % vs 4.6 % (17/814 vs 11/241;OR 0.44), respectively. Conclusions COVID-19 caused a notably decrease of all activities, including screening colonoscopy. This produced areduction of the total amount of neoplasia detected during endoscopy compared to the same period of the previous year.The consequences of this delay are still to be shown. (Table Presented).