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ObjectiveTo identify and summarise the digital health interventions (DHIs) implemented for non-communicable disease (NCD) management for COVID-19. DesignRapid scoping review. Three reviewers jointly screened titles-s and full texts. One reviewer screened all excluded records. Data were mapped to WHO DHI Classification and narratively summarised. Data sourcesPubMed, CENTRAL, CINAHL, EMBASE. Eligibility criteria for selecting studiesPeer-reviewed primary research published between 1 November 2019 and 19 September 2021 on DHI for NCD management during the COVID-19 pandemic. Reviews, editorials, letters, commentaries, opinions, conference s and grey literature were excluded. ResultsEighty-three studies drawn from 5275 records were included. A majority of the studies were quantitative in design. Forty per cent of the DHIs were implemented in the Americas. Nearly half of these DHIs targeted mental health conditions. A majority of the interventions were delivered remotely and via telephones. Zoom (26.5%), email (17%) and WhatsApp (7.5%) were the top three platforms for care delivery. Telemedicine, targeted client interventions, personal health tracking and on-demand information services for clients were the most frequently implemented interventions. Details regarding associated costs, sustainability, scalability and data governance of the DHI implementations were not described in the majority of the studies. ConclusionWhile DHIs supported NCD management during the COVID-19 pandemic, their implementation has not been equitable across geographies or NCDs. While offering promise towards supporting the continuum of care during care delivery disruptions, DHIs need to be embedded into healthcare delivery settings towards strengthening health systems rather than standalone parallel efforts to overcome system level challenges.
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Introduction: Access to kidney transplantation has always been a problem in the African countries with many patients having to travel to other medically advanced countries in Asia, Europe and America. This involves unnecessary excessive expenditure and the travails of journey and stay in an unknown foreign land. To ease this situation and to provide affordable Renal transplant services in their home land, we have made an effort to start the transplant services at our medical facility and have successfully carried out about 275 transplants over a period starting from Nov 2018 till September 2022. Method(s): All the Kidney transplants done between the period Nov 2018- September 2022 (275 cases) were included in the analysis. All the transplants were performed at a single center and the data were collected progressively during their Pre transplant evaluation, perioperative course and post op follow up. All the laboratory and radiological tests were done locally at the center except the HLA cross matches and tissue typing, which were outsourced to Transplant immunology labs outside the country. All the patients with positive DSA titres [about 70%], underwent Plasmapheresis and received IVIg before the transplantation. immunological assessment was done by NGS high resolution, for A B C DP DQ DR loci and X match was done by SAB analysis for class 1 and Class II antigens. All the patients underwent laparoscopic donor nephrectomy. All Patients received vaccinations for Hepatitis B, Pneumonia, Infuenza & Covid. Result(s): A series of 275 kidney transplants were performed over a period of 42 months [ Nov 2018- September 2022] at a private hospital successfully. All the cases were live donor kidney transplants with majority of the donors being 1st or 2nd degree relatives or spousal donors. About 70% of the patients had some degree of sensitization in the form of weakly positive B cell X match, or positive for DSAs at CL I, CLII with MFIs > 1000. All high-risk patients received induction with rabbit Thymoglobulin, and IV methyl prednisolone. Around 50 patients received Basiliximab. Of all patients, 4were HBsAg positive, and 6 were HIV positive,& HCV 1 patient. 8 patients required pretransplant Parathyroidectomy for refractory hyperparathyroidism, 3 patients required simultaneous native kidney nephrectomy at the time of transplant. 25 patients had multiple renal vessels which were double barreled and anastamosed.4 patients had lower urinary tract abnormalities requiring simultaneous/subsequent repair. Overall, 4 patients underwent 2nd transplant. All the donors underwent laparoscopic nephrectomy. Most of the patients had good immediate graft function except in 40 patients, who had delayed graft function;most of them improving over 2 - 6 weeks. 6 Patients had hyperacute rejection and the graft was lost,.4patients had main renal artery thrombosis, Renal allograft biopsy was done in 20 patients. Overall, the Patient survival was 95 %.at 1 year and graft survival 90%. Conclusion(s): Our experience shows that kidney transplantation is a viable and practical option for End stage kidney disease and can be performed even in resource constrained centers in third world countries and the survival rates of patients and the grafts are comparable to other centers across the world. No conflict of interestCopyright © 2023
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BACKGROUND AND AIM: National surveys soliciting family experiences present challenges and opportunities. We performed a pan-Canadian, multi-centered, online survey of family experiences with restricted family presence in PICU during COVID-19. Sites chose from 6 respondent approach methods. This sub-study explores relationships between invitation methods and response rates. METHOD(S): Information was collected from the 11 participating sites via e-mail-based survey to determine: eligible participant numbers;invitation method;time from PICU admission to survey invitation;contact methods for bereaved and non-bereaved families;participation barriers and facilitators. Responses were quantified using descriptive statistics and Spearman's rank order correlation. Free texts were inductively coded. RESULT(S): Sites invited families of PICU patients admitted during 4-month periods, beginning March 2020 (n=9) and/or November 2020 (n=3). Invitations were sent a mean (SD) of 7.7 (2.8) months post-admission. The overall survey response rate was 270/1005 invited families (27%). The mean institution response rate was 27% (SD=13%, range 4-50%) and was highest for sites using postal invite with telephone follow-up (43%, n=2), followed by telephone approach (26%, n=7), text message paired with social media posts and posters (22%, n=1), and postal invite alone (n=1, 8%). Bereaved families received a personalized telephone call. Time from admission to invitation was inversely correlated with response rate (rs = -0.70, p=0.02). Most common recruitment barriers were lack of funded research personnel (n=4) and REB requiring initial contact by care team rather than researchers (n=3). CONCLUSION(S): Multi-centre surveys with unfunded site participation face challenges. Postal invitation with telephone follow-up may improve response rates.
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BACKGROUND AND AIM: The COVID-19 pandemic impacted high (HICs) and low to high- middle income countries (LHMICs) disproportionately. We sought to investigate factors contributing to disparate pediatric COVID-19 mortality. METHOD(S): We used the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) COVID-19 database, and stratified country group defined by World Bank criteria. All hospitalized patients aged less than 19 years with suspected or confirmed COVID-19 diagnosis from January 2020 through April 2021 were included. RESULT(S): A total of 12,860 patients with 3,819 cases from HICs and 9,041 cases from LHMICs were included in this study. Of these, 8,961 (73.8%) patiens were confirmed cases and 2444 (20.1%) were suspected COVID19. Overall in-hospital mortality was 425 (3.3%) patients, with 4.0% mortality in LHMICs (361/9041), which was higher than 1.7% mortality in HICs (64/3819);adjusted HR (aHR) 4.74, 95%CI 3.16-7.10, p<0.001. There were significant differences between country income groups in the use of interventions, with higher use of antibiotics, corticosteroid, prone position, high flow nasal cannula, and invasive mechanical ventilation in HICs, and higher use of anticoagulants and non-invasive ventilation in LHMICs. Infectious comorbidities such as tuberculosis and HIV/AIDS were shown to be more prevalent in LHMICs [2 (0.0%) vs 171 (1.9 %), 1 (0.0%) vs. 149 (1.6%) patients, respectively]. Mortality rates in children who received mechanical ventilation in LHMICs were higher compared with children in HICs [89 (43.6%) vs. 17 (7.2%) patients, aHR 12.0, CI95% 7.2-19.9, p<0.001]. CONCLUSION(S): Various contributing factors to COVID-19 mortality identified in this study may reflect management differences in HICs and LHMICs. (Figure Presented).
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Reflective practice is increasingly being recognized as an important component of doctors' professional development. Balint group practice is centered on the doctor-patient relationship: what it means, how it may be used to benefit patients, and why it commonly fails owing to a lack of understanding between doctor and patient. The COVID-19 pandemic led to unprecedented disruption to postgraduate medical training programs, including the mandatory Balint groups for psychiatric trainees. This editorial reports on the experience of online Balint groups in the North West of Ireland during the COVID-19 pandemic, and furthermore provides guidance for online Balint group practice into the future.
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This paper investigates the financial performance of the largest Gulf Cooperation Council (GCC) banks by total assets before and during the recent COVID-19 pandemic. The purpose of the study was to identify the impact of the COVID-19 pandemic on banks' financial performance. Financial ratios analysis during the period 2017-2020 is employed to measure the financial performance of the largest GCC banks mainly based in Saudi Arabia, Qatar, United Arab Emirates, Kuwait, Oman, and Bahrain. The ratios cover key performance areas such as profitability, efficiency, liquidity, asset quality, asset risk, and expense management. Two significant developments in 2020 are the COVID-19 pandemic and severe drop in oil prices, both of which led to a sharp drop in the region's GDP growth rate from an average of -0.09% in year 2019 to -5.9% in 2020, which in turn is expected to negatively impact bank performance. Using paired samples t-test the research study found statistically significant results that the financial performance of all banks suffered on almost all the key parameters in 2020 compared to the earlier period which can explained by the decline in economic activity due to COVID-19. The focus of this study and its conclusions are novel to the extent that there are no country specific studies related to impact of COVID 19 on the biggest banks in a country. Further as far as the authors know there are no studies on the topic of impact of COVID-19 on big banks operating in the Gulf cooperation council countries. The conclusions of the study would of importance to the regulators who would not like the big banks to fail. © Al Kharusi S., Murthy S.R., 2022.
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Objective: To identify and summarise the digital health interventions (DHIs) implemented for non-communicable disease (NCD) management for COVID-19. Design: Rapid scoping review. Three reviewers jointly screened titles-s and full texts. One reviewer screened all excluded records. Data were mapped to WHO DHI Classification and narratively summarised. Data sources: PubMed, CENTRAL, CINAHL, EMBASE. Eligibility criteria for selecting studies: Peer-reviewed primary research published between 1 November 2019 and 19 September 2021 on DHI for NCD management during the COVID-19 pandemic. Reviews, editorials, letters, commentaries, opinions, conference s and grey literature were excluded. Results: Eighty-three studies drawn from 5275 records were included. A majority of the studies were quantitative in design. Forty per cent of the DHIs were implemented in the Americas. Nearly half of these DHIs targeted mental health conditions. A majority of the interventions were delivered remotely and via telephones. Zoom (26.5%), email (17%) and WhatsApp (7.5%) were the top three platforms for care delivery. Telemedicine, targeted client interventions, personal health tracking and on-demand information services for clients were the most frequently implemented interventions. Details regarding associated costs, sustainability, scalability and data governance of the DHI implementations were not described in the majority of the studies. Conclusion: While DHIs supported NCD management during the COVID-19 pandemic, their implementation has not been equitable across geographies or NCDs. While offering promise towards supporting the continuum of care during care delivery disruptions, DHIs need to be embedded into healthcare delivery settings towards strengthening health systems rather than standalone parallel efforts to overcome system level challenges. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Background: Coronavirus has been found to interact with and affect the cardiovascular system leading to myocardial damage and cardiac and endothelial dysfunction. Respiratory symptoms are worse in COVID-19 affected patients with pre-existing cardiac ailments;however, new-onset cardiac dysfunction is common in this subset. Most patients with COVID-19 have cardiac symptoms like chest pain, palpitations along respiratory symptoms. Methods: It is a single-centre observational study. This study was conducted in tertiary health care from May 2020 to December 2020(9 months) with COVID-19 infection having cardiac symptoms. The patient's clinical features, electrocardiogram (ECG), Echocardiography, cardiac biomarkers, haematological and biochemical parameters are studied in detail. Result: The mean age of the patients was 48±16 years. Male: Female ratio was 7:3. The percentage of onset of cardiac dysfunction was more in the less than 40year age group compared to other age groups. Nearly 46.7% of people have co-morbidities such as diabetes mellitus, hypertension and COPD. In the study population, elevated levels of biomarkers were noted. Abnormal electrocardiogram and echocardiogram was observed. The recovery rate from COVID-19 with cardiac manifestation was observed to be 76.7% in our study population. Conclusion: Cardiac injury is a common condition among patients hospitalized with COVID-19, and it is associated with a higher risk of in-hospital mortality. A combined evaluation of cardiac biomarkers with ECG and ECHO findings is likely to give a better picture of the severity of cardiac function in newly onset of cardiac dysfunction due to COVID-19 infection for better management and prognosis. [ FROM AUTHOR] Copyright of Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research) is the property of Journal of Cardiovascular Disease Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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The following sections are included: Key Message Introduction Making Sense of the Overwhelming Evidence Pre-Exposure and Post-Exposure Prophylaxis Treatment of Non-Severe COVID-19 Patients Viral-Based Treatment Options for the Pulmonary Phase Host-Based Treatment Options for Pulmonary and Inflammatory Phases Other Therapies References. © 2022 World Scientific Publishing Company.
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The COVID-19 pandemic has caused teachers across India to use Edtech products in teaching. But teachers face multiple challenges, ranging from selecting appropriate Edtech tools to developing their own teaching practice for teaching with Edtech. The currently available taxonomies and landscapes of Edtech products either address student-facing products or focus on a niche category of teacher-facing products like assessment tools or open-source tools. In this paper, we present a taxonomy of teacher-facing Edtech products that contains a hierarchy of three levels with learner-centric activity tools and teacher professional development forming the base layer. Each category further spins off into multiple subcategories based on various teacher objectives like products for conducting learner-centric activities, generating summative assessments, or developing their teaching competencies. This taxonomy emerged from a systematic literature review and a field-driven affordance analysis of a representative set of eighty products. Our analysis showed that the product landscape was skewed towards learner-centric activity tools (70% of the 80 Edtech products analyzed), revealing the need for more products that support teachers' professional development (TPD). This taxonomy informs teachers about the products available under different Edtech categories. It also includes an affordance analysis that provides additional information about the affordances typical to that particular sub-category.
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The demand and supply of EdTech products have surged in the past decade and especially post-Covid19. Yet key challenges exist, such as inadequate quality standards and lack of reliable product evaluations. Consequently, stakeholders in the EdTech ecosystem such as schools, teachers, parents, governments, philanthropists, and investors face difficulty in making informed adoption decisions and feel the need for a systematic quality evaluation framework of educational technology (EdTech) products. In such a scenario, we analyze a Research-Practice Partnership between educational researchers, government decision-makers, and a non-governmental organization working on policy and strategy, who collaborated on designing and implementing EdTech quality standards. We examine the co-design process of the 'Tulna EdTech evaluation index' at various stages in the partnership. We adopted the Design-based Implementation Research (DBIR) approach for guiding our partnership. We examine what can be learned from the process of co-design in our RPP that might be useful for our ongoing partnership going forward, as well as for other RPPs. We found that the stakeholders navigated through tensions and iteratively negotiated the design of the evaluation index based on their individual expectations, perspectives, and expertise. Our retrospective, qualitative analysis supports understanding of how researchers and practitioners might engage in co-design and the role co-design might play in establishing a healthy EdTech ecosystem.
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Objective: To report longitudinal differences in baseline characteristics, treatment, and outcomes in patients with coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) between the first and second waves of COVID-19 in Australia. Design, setting and participants: SPRINT-SARI Australia is a multicentre, inception cohort study enrolling adult patients with COVID-19 admitted to participating ICUs. The first wave of COVID-19 was from 27 February to 30 June 2020, and the second wave was from 1 July to 22 October 2020. Results: A total of 461 patients were recruited in 53 ICUs across Australia;a higher number were admitted to the ICU during the second wave compared with the first: 255 (55.3%) versus 206 (44.7%). Patients admitted to the ICU in the second wave were younger (58.0 v 64.0 years;P = 0.001) and less commonly male (68.9% v 60.0%;P = 0.045), although Acute Physiology and Chronic Health Evaluation (APACHE) II scores were similar (14 v 14;P = 0.998). High flow oxygen use (75.2% v 43.4%;P < 0.001) and non-invasive ventilation (16.5% v 7.1%;P = 0.002) were more common in the second wave, as was steroid use (95.0% v 30.3%;P < 0.001). ICU length of stay was shorter (6.0 v 8.4 days;P = 0.003). In-hospital mortality was similar (12.2% v 14.6%;P = 0.452), but observed mortality decreased over time and patients were more likely to be discharged alive earlier in their ICU admission (hazard ratio, 1.43;95% CI, 1.13–1.79;P = 0.002). Conclusion: During the second wave of COVID-19 in Australia, ICU length of stay and observed mortality decreased over time. Multiple factors were associated with this, including changes in clinical management, the adoption of new evidence-based treatments, and changes in patient demographic characteristics but not illness severity. © 2021, College of Intensive Care Medicine. All rights reserved.
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On April 9, 2021, only two days after receiving its first shipment of the COVID-19 vaccine, Saint Vincent and the Grenadines suffered an enormous volcanic eruption. Plumes of smoke and ash billowed across the main island, necessitating a large-scale evacuation of its residents to neighboring countries. But, as Prime Minister Ralph Gonsalves explained in an emotional press conference, only vaccinated residents could be evacuated. The transporting ships, and the islands themselves, had vaccine mandates. This meant that only residents with preferential access to the vaccine—at the time, 10,805 out of a population of approximately 111,000—had the opportunity to flee © 2022, Dissent.All Rights Reserved.
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Introduction: Coronavirus Disease 2019 (COVID-19) is associated with an increased risk of stroke and worse stroke outcomes. A clinical score that can identify high-risk patients could enable closer monitoring and targeted preventative strategies. Methods: We used data from the AHA's COVID-19 CVD Registry to create a clinical score to predict the risk of stroke among patients hospitalized with COVID-19. We included patients aged >18 years who were hospitalized with COVID-19 at 122 centers from March 2020-March 2021. To build our score, we used demographics, preexisting comorbidities, home medications, and vital sign and lab values at admission. The outcome was a cerebrovascular event, defined as any ischemic or hemorrhagic stroke, TIA, or cerebral vein thrombosis. We used two separate analytical approaches to build the score. First, we used Cox regression with cross validation techniques to identify factors associated with the outcome in both univariable (p<0.10) and multivariable analyses (p<0.05), then assigned points for each variable based on corresponding coefficients. Second, we used regularized Cox regression, XGBoost, and Random Forest machine learning techniques to create an estimator using all available covariates. We used Harrel's C-statistic to measure discriminatory performance. Results: Among 21,420 patients hospitalized with COVID-19 (mean age 61 years, 54% men), 312 (1.5%) had a cerebrovascular event. Using traditional Cox regression, we created and internally validated a risk stratification score (CANDLE) (Fig) with a C-statistic of 0.66 (95% CI, 0.60-0.72). The machine learning estimator had similar discriminatory performance, with a C-statistic of 0.69 (95% CI, 0.65-0.72). For ischemic stroke or TIA, CANDLE's C-statistic was 0.67 (95% 0.59-0.76). Conclusion: We developed an easy-to-use clinical score, with similar performance to a machine learning estimator, to help stratify stroke risk among patients hospitalized with COVID-19.
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Background: Therapies for managing COVID-19 disease may interact with other drugs, particularly in hospitalized patients with comorbidities. Objectives: Characterize the prevalence of drug-drug interactions (DDIs) between investigational/approved medications for managing COVID-19 (COVID-meds) and co-medications (co-meds) in hospitalized COVID-19 patients. Methods: Multicentre retrospective observational study of hospitalized COVID-19 patients screened for the CATCO trial between 1-Apr-20 and 15-Sep-20. Patients' co-meds were assessed for potential DDIs with the following COVID-meds: hydroxychloroquine (HQ), lopinavir/ritonavir (LPV), remdesivir (REM), dexamethasone (DEX), azithromycin (AZ), interferon beta-1B (IFN) and tocilizumab (TOC). The Liverpool-COVID DDI website and Lexicomp were used to identify and characterize DDI severity (red: do not co-administer, amber: potential interaction) and potential clinical impact. QT prolongation risk was assessed with the Tisdale risk score. The primary outcome was the prevalence of subjects with =1 potential clinically significant (red/amber) DDI between each COVID-med and co-med. Secondary outcomes included DDI severity and potential clinical impact. Descriptive statistics are presented as medians (range) or proportions. Results: Data from 51 patients are available: 61% male, age 74 (44-95) years, 6 (1-15) comorbidities, Tisdale risk score 6 (31.4% moderate risk, 11.8% high risk) and 10 (0-19) co-meds. LPV had the highest rate of potential DDIs (92.2%, 45% red, 3 DDIs per patient) with risk of increased co-med toxicity (most commonly psychotropics, anticoagulants/antiplatelets), while REM and IFN had the least (2% and 9.6%, respectively). Most patients (75%) had =1 DEX DDI (mostly amber, 1per patient) with risk of increased co-med toxicity. The most common DDIs with HQ and AZ involved increased risk of QTc prolongation. Over one-third (35%) of patients were deemed ineligible for CATCO at screening due to DDIs with LPV. Conclusions: Hospitalized COVID-19 patients are at high risk of DDIs with many investigational/approved COVID medications. Routine DDI screening is recommended, ideally using both general and COVID-specific DDI resources.
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The world has been severely affected by COVID-19, an infectious disease caused by the SARS-Cov-2 coronavirus. COVID-19 incubates in a patient for 7 days before symptoms manifest. The identification of the presence of COVID-19 is challenging as its symptoms are similar to influenza symptoms such as cough, cold, runny nose, and chills. COVID-19 affects human speech sub-systems involved in respiration, phonation, and articulation. We propose a deep anomaly detection framework for passive, speech-based detection of COVID-related anomalies in voice samples of COVID-19 affected individuals. The low percentage of positive cases and extreme imbalance in available COVID audio datasets present a challenge to machine learning classifiers but create an opportunity to utilize anomaly detection techniques. We investigate COVID detection from audio using various types of deep anomaly detectors and convolutional autoencoders. Contrastive loss methods are also explored to force our models to learn discrepancies between COVID and non-COVID cough data representations. In contrast with prior work that controlled data collection, our work focuses on crowdsourced datasets that are true representatives of the general population. In rigorous evaluation, the variational autoencoder with the elliptic envelope as the anomaly detector analyzing Mel Filterbanks audio representations performed best with an AUC of 0.65, outperforming the state of the art. © 2021 IEEE.
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BACKGROUND: Acute kidney injury (AKI) is a potentially fatal complication of Coronavirus Disease-2019 (COVID-19). Binding of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, to its viral receptor, angiotensin converting enzyme 2 (ACE2), results in viral entry and may cause AKI. OBJECTIVES: We performed a systematic review and meta-analysis of the frequencies of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients and compared those frequencies with patients who were infected by respiratory viruses that bind or downregulate ACE2 (ACE2-associated viruses) and viruses that do not bind nor downregulate ACE2 (non-ACE2-associated viruses). DESIGN: Systematic review and meta-analysis. SETTING: Observational studies on COVID-19 and other respiratory viral infections reporting AKI and RRT were included. The exclusion criteria were non-English articles, non-peer-reviewed articles, review articles, studies that included patients under the age of 18, studies including fewer than 10 patients, and studies not reporting AKI and RRT rates. PATIENTS: Adult COVID-19, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and influenza patients. MEASUREMENTS: We extracted the following data from the included studies: author, year, study location, age, sex, race, diabetes mellitus, hypertension, chronic kidney disease, shock, vasopressor use, mortality, intensive care unit (ICU) admission, ICU mortality, AKI, and RRT. METHODS: We systematically searched PubMed and EMBASE for articles reporting AKI or RRT. AKI was defined by authors of included studies. Critical illness was defined by ICU admission. We performed a random effects meta-analysis to calculate pooled estimates for the AKI and RRT rate within each virus group using a random intercept logistic regression model. RESULTS: Of 23 655 hospitalized, critically ill COVID-19 patients, AKI frequencies were not significantly different between COVID-19 patients (51%, 95% confidence interval [CI]: 44%-57%) and critically ill patients infected with ACE2-associated (56%, 95% CI: 37%-74%, P = .610) or non-ACE2-associated viruses (63%, 95% CI: 43%-79%, P = .255). Pooled RRT rates were also not significantly different between critically ill, hospitalized patients with COVID-19 (20%, 95% CI: 16%-24%) and ACE2-associated viruses (18%, 95% CI: 8%-33%, P = .747). RRT rates for both COVID-19 and ACE2-associated viruses were significantly different (P < .001 for both) from non-ACE2-associated viruses (49%, 95% CI: 44%-54%). After adjusting for shock or vasopressor use, AKI and RRT rates were not significantly different between groups. LIMITATIONS: Limitations of this study include the heterogeneity of definitions of AKI that were used across different virus studies. We could not match severity of infection or do propensity matching across studies. Most of the included studies were conducted in retrospective fashion. Last, we did not include non-English publications. CONCLUSIONS: Our findings suggest that viral ACE2 association does not significantly alter the rates of AKI and RRT among critically ill patients admitted to the ICU. However, the rate of RRT is lower in patients with COVID-19 or ACE2-associated viruses when compared with patients infected with non-ACE2-binding viruses, which might partly be due to the lower frequencies of shock and use of vasopressors in these two virus groups. Prospective studies are necessary to demonstrate whether modulation of the ACE2 axis with Renin-Angiotensin System inhibitors impacts the rates of AKI and whether they are beneficial or harmful in COVID-19 patients.
MISE EN CONTEXTE: L'insuffisance rénale aiguë (IRA) est une complication potentiellement mortelle de la maladie à coronavirus-2019 (COVID-19). Obligatoire du Coronavirus 2 du Syndrome Respiratoire Aigu Sévère (SARS-CoV-2), le virus responsable du COVID-19, à son récepteur, l'enzyme de conversion de l'angiotensine 2 (ACE2), entraîne une entrée virale et peut provoquer une IRA. OBJECTIFS DE L'ÉTUDE: Nous avons effectué une revue systématique et une méta-analyse des fréquences de l'IRA et de la thérapie de remplacement renal (RRT) chez les patients COVID-19 gravement malades et a comparé ces fréquences avec les patients qui ont été infectés par des voies respiratoires virus qui lient ou régulent négativement l'ACE2 (virus associés à l'ACE2) et les virus qui ne régulent pas négativement ni ne lient l'ACE2 (virus non associés à l'ACE2). CADRE ET TYPE D'ÉTUDE: Revue systématique et méta-analyse. Des études d'observation sur le COVID-19 et d'autres infections virales respiratoires signalant une AKI et une RRT ont été incluses. Les critères d'exclusion étaient des articles non anglophones, des articles non évalués par des pairs, des articles de revue, des études incluant des patients moins de 18 ans, les études incluant moins de 10 patients et les études ne rapportant pas les taux d'IRA et de RRT. PATIENTS: Adultes COVID-19, syndrome respiratoire aigu sévère (SRAS), syndrome respiratoire du Moyen-Orient (MERS) et malades de la grippe. MESURES: Nous avons extrait les données suivantes des études incluses : auteur, année, lieu de l'étude, âge, sexe, race, diabète sucré, hypertension, maladie rénale chronique, état de choc, utilisation de vasopresseurs, mortalité, admission en unité de soins intensifs (USI), Mortalité en soins intensifs, AKI et RRT. MÉTHODOLOGIE: Nous avons systématiquement recherché dans PubMed et EMBASE les articles rapportant AKI ou RRT. AKI a été défini par les auteurs des études incluses. La maladie grave a été définie par l'admission aux soins intensifs. Nous avons effectué une méta-analyse à effets aléatoires pour calculer estimations regroupées pour le taux d'IRA et de RRT au sein de chaque groupe de virus à l'aide d'un modèle de régression logistique d'interception aléatoire. RÉSULTATS: Sur 23 655 patients hospitalisés et gravement malades COVID-19, les fréquences AKI n'étaient pas significativement différentes entre patients COVID-19 (51 %, intervalle de confiance à 95 % [IC] : 44 %-57 %) et patients gravement malades infectés par l'ACE2 associé (56 %, IC à 95 % : 37 % à 74 %, P = 0,610) ou des virus non associés à l'ACE2 (63 %, IC à 95 % : 43 % à 79 %, P = 0,255). Tarifs RRT groupés n'étaient pas non plus significativement différents entre les patients hospitalisés gravement malades atteints de COVID-19 (20 %, IC à 95 % : 16 % à 24 %) et virus associés à l'ACE2 (18 %, IC à 95 % : 8 % à 33 %, P = 0,747). Taux de RRT pour les virus associés au COVID-19 et à l'ACE2 étaient significativement différents (P < 0,001 pour les deux) des virus non associés à l'ACE2 (49 %, IC à 95 % : 44 % à 54 %). Après ajustement pour le choc ou l'utilisation de vasopresseurs, les taux d'IRA et de RRT n'étaient pas significativement différents entre les groupes. LIMITES DE L'ÉTUDE: Les limites de cette étude incluent l'hétérogénéité des définitions de l'IRA qui ont été utilisées pour différents virus études. Nous n'avons pas pu faire correspondre la gravité de l'infection ou faire une correspondance de propension entre les études. La plupart des études incluses ont été menées de manière rétrospective. Enfin, nous n'avons pas inclus les publications non anglophones. CONCLUSIONS: Nos résultats suggèrent que l'association virale ACE2 ne modifie pas de manière significative les taux d'IRA et de RRT parmi les patients gravement malades admis aux soins intensifs. Cependant, le taux de RRT est plus faible chez les patients atteints de COVID-19 ou associés à l'ACE2 virus par rapport aux patients infectés par des virus ne se liant pas à l'ACE2, ce qui pourrait être dû en partie à la plus faible fréquences de choc et utilisation de vasopresseurs dans ces deux groupes de virus. Des études prospectives sont nécessaires pour démontrer si la modulation de l'axe ACE2 avec les inhibiteurs du système rénine-angiotensine a un impact sur les taux d'IRA et si ells sont bénéfiques ou nocifs chez les patients COVID-19.