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Background and aims: Acute Kidney Injury (AKI) is the most frequent complication after respiratory failure in COVID-19 patients. AKI increases mortality risk, length of hospital stay and healthcare costs with possibile progression toward CKD. Study aims: 1) evaluation of AKI incidence in 1020 COVID-19 hospitalized patients;2) comparison of AKI incidence in COVID-19 vs. pre-pandemic period;3) establishment of out-patient follow-up for monitoring kidney, lung, motor and immune function;4) creation of a biobank for biomarker discovery studies. Methods: AKI incidence was calculated matching laboratory and administrative data of 26214 hospitalized patients in 2018-2019 and in 1020 COVID-19 patients in 2020-2021: KDIGO algorithms were applied for AKI grading. After 12 months from discharge, 232 COVID AKI patients and relative controls matched for age and gender were evaluated for kidney (eGFR, biomarkers of tubular damage NGAL, CCl-14, DKK-3), lung (DLCO, CT scan) and neuro-motor (SPPB, 2-min walking test, post-traumatic stress test-IES) function. Results: Before pandemic, in-hospital AKI incidence was 18% (10% KDIGO 1, 5% KDIGO 2, 3% KDIGO 3): median age of AKI patients was 69. In-hospital mortality was 3.5 % in non-AKI group vs. 15% in AKI group in accordance with KDIGO stages. In COVID patients, AKI incidence increased to 37% (20% KDIGO 1,11% KDIGO 2, 6% KDIGO 3): median age of patients was 54. In-hospital mortality was 31 % in AKI group. After 12 months from hospital discharge, COVID AKI patients showed a persistent reduction of respiratory function (severe DLCO impairment <60%) related to the extent of CT scan abnormalities. AKI patients also presented motor function impairment and a worse posttraumatic stress response. GFR reduction was 1.8 ml/min in non AKI vs. 9.7 ml/min in AKI COVID patients not related to age. Urinary DKK-3 and CCL-14 were also higher in the AKI group. Last, IgG response after SARS-CoV-2 vaccination was significantly lower in the AKI group. Conclusion: AKI incidence was significantly increased during COVID-19 in respect to pre-pandemic period with an association with higher mortality in class 2-3 KDIGO. In the post-COVID follow-up, AKI was associated with lung and neuro-motor function impairment, a defective antibody response and a sudden GFR decline concomitant to the persistence of tubular injury biomarkers. These results suggest the importance of a nephrological and multidisciplinary follow-up of frail patients who developed AKI during hospitalization for COVID-19.
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BACKGROUND AND AIMS: AKI is the most frequent complication after respiratory failure in COVID-19. AKI increases mortality risk, length of hospital stay and healthcare costs, with possible progression towards CKD. Study aims: (1) evaluation of AKI incidence in 1020 COVID-19 hospitalized patients;(2) comparison of AKI incidence in COVID-19 versus pre-pandemic period;(3) establishment of out-patient follow-up for monitoring kidney, lung, motor and immune function;(4) creation of a biobank for biomarker discovery studies. METHOD: AKI incidence was calculated matching laboratory and administrative data of 26 214 hospitalized patients in 2018-2019 and in 1020 COVID-19 patients in 2020-2021: KDIGO algorithms were applied for AKI grading. After 12 months from discharge, 232 COVID AKI patients and relative controls matched for age and gender were evaluated for kidney (eGFR, biomarkers of tubular damage NGAL, CCl- 14, DKK-3), lung (DLCO, CT scan) and neuro-motor (SPPB, 2-min walking test, post-traumatic stress test-IES) function. RESULTS: Before the pandemic, in-hospital AKI incidence was 18% (10% KDIGO 1, 5% KDIGO 2, 3% KDIGO 3): median age of AKI patients was 69. In-hospital mortality was 3.5% in non-AKI group versus 15% in AKI group in accordance with KDIGO stages. In COVID patients, AKI incidence increased to 37% (20% KDIGO 1.11% KDIGO 2, 6% KDIGO 3): median age of patients was 54. In-hospital mortality was 31% in the AKI group;AKI is an independent risk factor for death. After 12 months from hospital discharge, COVID AKI patients showed a persistent reduction of respiratory function (severe DLCO impairment < 60%) related to the extent of CT scan abnormalities. AKI patients also presented the motor function impairment and a worse post-traumatic stress response. GFR reduction was 1.8 mL/min in non-AKI patients versus 9.7 mL/min in AKI COVID patients not related to age. Urinary DKK-3 and CCL-14 were also higher in the AKI group. Last, IgG response after SARS-CoV-2 vaccination was significantly lower in the AKI group. CONCLUSION: AKI incidence was significantly increased during COVID-19 in respect to the pre-pandemic period, with an association with higher mortality in class 2-3 KDIGO. In the post-COVID follow-up, AKI was associated with lung and neuromotor function impairment, a defective antibody response and a sudden GFR decline concomitant to the persistence of tubular injury biomarkers. These results suggest the importance of nephrological and multidisciplinary follow-up of frail patients who developed AKI during hospitalization for COVID-19. (Table Presented).
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This study is the first step towards a broader research intent: developing and optimising a Personal Comfort System for tertiary sector working environments. The entire industrial sector, and in particular offices, have seen changes in working habits, with a large increase in smart working to prevent COVID infection. The chance to partialise the HVAC system and maintains the rooms in an under-conditioned state is the obligatory way towards reducing energy waste, providing each workstation with an independent system that guarantees the operator's comfort conditions. The first step of the analysis was conducted simulating a general scenario and adopting conservative assumptions in order to predict the potential energy savings and the required PCS power. BES and CFD were coupled, using the outputs of the dynamic energy simulations in its most energy demanding timestep as input for the fluid dynamics analysis. The results showed energy savings between 15 and 20%, which is likely an underestimation of the potential savings due to very conservative assumptions and looking at the data from the few field analyses available in literature. Moreover, the operators' localised thermal comfort conditions improved, moving from a slightly cold to a neutral situation. Despite the conservative hypothesis, the results are promising, showing several opportunities for further analysis and improvement, as well as possible ways for its optimisation. © 2021 IEEE
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BACKGROUND AND AIMS: In 2020, SARS-CoV-2 pandemic had a devastating impact on individuals and on national health systems worldwide. Although being primarily a lung disease, COVID-19-associated systemic inflammation and activation of coagulation/complement cascades lead to multiple organ dysfunction including Acute Kidney Injury (AKI). Our aim is to evaluate AKI prevalence and mortality in hospitalized patients during COVID-19 pandemic in a 500-bed University Hospital. METHOD: Observational study on 945 COVID-19 patients (March-May 2020). Data collection from Board Hospital Discharge and serum creatinine (Lab database). AKI stratification in accordance to KDIGO criteria and evaluation of outcome in the different subgroups. The same methodology was adopted to assess AKI prevalence and outcome in 2018-2019. RESULTS: 351/945 (37.14%) of all hospital admissions for COVID-19 showed AKI further sub-classified as follows: 173 (18.3%) stage 1, 112 (11.9%) stage 2 and 66 (6.9%) stage 3: the control NO AKI group was 594/945 (62.86%). COVID-associated AKI prevalence was higher than that observed in 2018 (total AKI 17.9%, stage 1 10.7%, stage 2 4.5%, stage 3 2.7%) and 2019 (total AKI 17.2%, stage 1 10.1%, stage 2 4.5%, stage 3 2.6%). During COVID-19 pandemic, in-hospital mortality was 27% for NO AKI group, 28% for total AKI group, further subdivided 24% for stage 1, 45% for stage 2 and 42% for stage 3 group, respectively. Mortality was different from that observed during 2018 (NO AKI 3.77%, total AKI 15.2%, stage 1 9.69%, stage 2 17.24%, stage 3 18.9%) and 2019 (NO AKI 3.56%, total AKI 18.35%, stage 1 10.6%, stage 2 20.1%, stage 3 24.3%). In COVID-19 patients, mean age of NO AKI group was 64.6 ys vs. 71.7 ys of total AKI group divided in 71.6 ys for stage 1, 74.3 ys for stage 2 and 67.9 ys for stage 3, respectively. Mean eGFR at admission was 74.2 ml/min for NO AKI group, 61.3 ml/ min for total AKI group divided in 64.3 ml/min for stage 1, 57.8 ml/min for stage 2 and 52.5 ml/min for stage 3. Mean serum creatinine at admission was 1.17 mg/dl in NO AKI group, 1.43 mg/dl for total AKI group divided in1.22 mg/dl for stage 1, 1.4 mg/dl for stage 2 and 2.25 mg/dl for stage 3. Among evaluated comorbidities, only diabetes (p=0,048) and cognitive impairment (p=0,001) were associated with a significant increased risk for AKI development. ICU admission rate was 5% for NO AKI group and 18% for total AKI group divided in 14% for stage 1, 22% for stage 2 and 44% for stage 3. Mean length of hospital stay for NO AKI group was 7.22 days vs 15.08 days for total AKI group divided in 13.67 for stage 1, 15.83 for stage 2 and 21.82 for stage 3. Of note, all different therapies administered to COVID-19 patients did not correlate with AKI incidence. Mean eGFR at discharge was 76 ml/min for NO AKI group vs 66 ml/min for total AKI group divided in 68.7 ml/min for stage 1, 59.3 ml/min for stage 2 and 59.3 ml/min for stage 3. Mean serum creatinine at discharge was 1.14 mg/dl for NO AKI group vs 1.45 mg/dl for total AKI group divided in 1.28 mg/dl for stage 1, 1.58 mg/dl for stage 2 and 2.05 mg/dl for stage 3. CONCLUSION: COVID-19 pandemic is associated with an increased AKI prevalence in hospitalized patients (2-fold increase in all KDIGO stages). AKI associated with an increased risk of mortality: of note, AKI stage2-3 had a strong impact on mortality in comparison to NO AKI group (OR 2.59 and 2.11, respectively). The presence of eGFR >60 ml/min and serum creatinine < 1.2 mg/dl at admission were associated with a lower risk of AKI development: reduced eGFR levels were observed at discharge particularly in AKI stage 2-3. The length of hospital stay and risk of ICU admission depended on AKI incidence and severity. COVID-19 lead to an increased burden for Nephrologists due to increased AKI prevalence: a nephrological follow-up is needed to avoid progression from AKI to chronic kidney disease (CKD).
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Introduction: The ongoing SARS-COV-2 pandemic hit world’s population since the first trimester of 2020. Since the beginning health care workers have been at higher risk of morbidity because of in-hospital infections. Moreover, health care workers can contribute to the spread of infection. The aim of the study was to monitor the spread and outcomes among health care workers in Nephrology-Dialysis units in Piedmont and Valle d’Aosta Regions, North-West Italy. Methods: A web platform accessible by Dialysis coordinators across the first and second wave of pandemic is still being used to collect and regularly update demographic and clinical data of health care workers. We present preliminary results on risk estimates and measures of association. Results: An overall of 163 cases has been monitored since March 2020. The cumulative incidence is 13,5% compared to 3,3% of the general population. A slightly higher cumulative incidence has been observed among Nurses 14%, while among Doctors it is 12%. A higher incidence rate among operators is observed in the second wave of infection compared to the first (9,5% and 4%, respectively). During Autumn 2020 Italian Government did not opt for a strict lockdown in high risk Regions such as Piedmont and Valle d’Aosta. Nonetheless, strict protocols for in-hospital treatments ensured that cumulative incidence grew at a slower rate than the rest of the population (incidence rate ratio of 3,3 for health care workers compared to 5,9 for the rest of the population). Conclusions: The study of an overall population of 163 showed a higher susceptibility to SARS-COV-2 infection for health care workers compared to the general population. We observed increased risks of infection in the second wave of pandemic compared to the first wave, suggesting that despite strict protocols to manage dialysis patients infection risks for health care workers could increase without strict general lockdowns. No conflict of interest