ABSTRACT
INTRODUCTION: Hypertriglyceridemia is a known complication of propofol infusion, and higher levels of triglycerides are known to be associated with pancreatitis. Patients with severe COVID-19 pneumonia often require prolonged mechanical ventilatory support and often undergo prolonged sedation with medications such as propofol. In our study we looked to identify safe cut offs for triglyceride levels as well as cumulative dosing of propofol in order to minimize the risk of developing pancreatitis. METHOD(S): Utilizing our COVID-19 database from hospitals in the Steward Health Care Network we conducted a retrospective multi-center review to evaluate the instances of pancreatitis in critically ill patients with COVID-19 pneumonia who received propofol for sedation while intubated. We chart reviewed each patient and collected data regarding the number of days over which propofol was administered, cumulative doses of propofol, peak triglyceride levels, lipase levels, symptoms of pancreatitis and abdominal CT imaging consistent with pancreatitis. For the data analysis we used ROC analysis in conjunction with Youden's index to identify the optimal thresholds for propofol administration parameters and triglyceride levels that would offer maximal sensitivity and specificity for predicting pancreatitis. RESULT(S): We reviewed 499 cases of COVID-19 pneumonia and found 154 patients that were on propofol for sedation for a sufficient period of time. Among these we identified 6 cases of suspected pancreatitis. Using the ROC analysis and Youden's index we identified optimal cut-offs for peak triglyceride levels (688 mg/dl), number of days on propofol (4.5 days), Average daily propofol dose (3007 mg/ day), cumulative propofol dose (24,113 mg) to indicate low risk of pancreatitis. The NPVs for suspected pancreatitis for these cut-offs were found to be from 0.98 to 1. CONCLUSION(S): Our study suggests that patients who have triglyceride levels less than 688 mg/dl, have been on propofol for less than 4.5 days, received less than 3007 mg of propofol per day or have received less than 24113 mg in total of propofol may have a lower risk of developing pancreatitis. While these results are encouraging, larger prospective studies with more confirmed cases of pancreatitis are still necessary.
ABSTRACT
Background: Acute kidney injury (AKI) is a well-recognized complication of COVID-19. In this retrospective cohort study, we describe the clinical characteristics and outcomes of patients with severe COVID-19 in 8 intensive care units (ICUs) during the first wave of the pandemic. Methods: Demographic, clinical, laboratory characteristics, and outcome data, including need for renal replacement therapy (RRT), mechanical ventilation, mortality, and RRT dependence at discharge and at 3 and 6 months, were extracted from the electronic medical record (EMR) between March and July 2020. Using nadir-to-peak serum creatinine, AKI and its stages were defined by the KDIGO consensus. Group comparisons were performed using ANOVA and chi square tests. Results: After excluding 20 patients with end-stage kidney failure, 479 patients with severe COVID-19 were included. Table 1 displays the characteristics and outcomes of the cohort stratified by AKI. 409 (89.2%) patients developed AKI, with 194 (42.3%) developing stage-3 AKI. Male gender, white race, obesity, and COPD were associated with higher stages of AKI severity. 83 patients (18.1%) required RRT of which 27 (32.5%) survived, and 12 (44.4%) remained dialysis-dependent at hospital discharge. Follow up at 3-months and 6-months indicated dialysis dependence in 5 (45.5%) and 4 (36.4%) of 11 patients (1 died), respectively. Conclusions: AKI is highly prevalent in our cohort and peak serum creatinine occurs within 3 days of intubation. Long-term dialysis dependence is of concern and merits further study. Multivariable analyses are under way to identify factors that are associated with severe AKI, need for RRT and in-hospital death.