ABSTRACT
Background:Acute kidney injury (AKI) affects 20%-40% of patients admitted to intensive care units who have COVID-19 and are critically ill. Although recent research indicates a link between AKI and COVID-19, the connection between clinical factors and COVID-19-associated AKI is still not established. The aim of the present study was to describe the epidemiology and outcomes of AKI in critically ill patients with COVID-19. Patients and Methods: This prospective observational cohort study enrolled 172 patients with COVID-19 who conducted in Zagazig University isolation ICU hospitals in 6 months duration from December 2021 to May 2022. Patients were divided into are group A included 100 patients with AKI and group B included 72 patients without AKI. Group A divided into 3 subgroups according to stages of AKI (stage 1-3). Patients were assessed by history, clinical examination, laboratory investigations and radiological evaluation. Result(s): There was significant difference between two main groups regarding leukocyte, neutrophil, monocyte, NLR, CRP, and procalcitonin. A Significant difference between the two main groups regarding sepsis and mechanical ventilation which was higher in group A.There was significant difference between two main groups regarding maximum creatinine, oliguria and outcome (RRT, favorable and mortality) which were highly significant in group A. There was significant difference between three subgroups of group A;stage 1, 2, and 3 regarding initial rising in serum creatinine. While for duration of AKI > 2 weeks, there was significant difference between stage 1 and 3, and stage 2 and 3. Concerning outcome in group A, there was significant difference between three subgroups of group A. RRT was represented in 13.7% of cases with stage 3 only. The outcome was favorable in 63.7% of stage 1, 44.5% of stage 2, and 10.3% of stage 3. The mortality rate in group A was 53%, represented in 36.3% of cases with stage 1, 55.5% of cases with stage 2, and 76% of cases with stage 3. Concerning outcome in group B;the mortality rate was 19.4%. A significant positive correlation between mortality and risk factors (RRT, age > 60 years, mechanical ventilation, oliguria, sepsis, duration of AKI>2 weeks, and stage 3) in group A. Our findings revealed that age>60 years, sepsis, platelets count<150.000, oliguria, and AKI stage 3 were independent risk factor for unfavorable outcome in cases with AKI (group A). Conclusion(s): COVID patients with AKI had more incidence, risk factors and mortality rate as a result of this connection, compared to COVID patients withoutAKI. The prognosis of these individuals could be improved and long-term effects could be avoided with the detection of susceptible patients at risk for AKI, prevention, and supportive strategies in patients prone to AKI. Copyright © 2022, Anka Publishers. All rights reserved.
ABSTRACT
BACKGROUND: COVID19 outbreak has become a pandemic worldwide. There has been a fairly high rate of clinical recovery among Covid patients but complete resolution or sequelae in terms of radiological findings need to be studied. AIM OF THE STUDY: 1. To understand the common pulmonary sequalae, time taken for complete resolution and factors affecting the resolution process in covid-19 patients who have been discharged after recovery, with Chest HRCT follow up. MATERIAL AND METHODS: This is an observational study which included a total of 100 discharged patients diagnosed with covid-19 by RTPCR at Index Medical College, Hospital & Research Centre, Indore-MP-India, from March 15 to June 30-2021.All the patients underwent an initial chest CT scan done 3-5 days after the onset of symptoms,followed by serial CT scans done at discharge and at 1st, 2nd and 3rd weeks after discharge. The radiological characteristics and patterns on CT chest were studied and a CT severity scoring was done for all the scans. RESULTS: GGO were the most common pattern seen (88%) on chest CT at discharge followed by fibrotic bands (61%) with the right lower lung (85%) most commonly involved.61% of patients showed complete resolution at the end of 3rd week after discharge indicating that COVID 19 induced pulmonary damage is reversible in majority of cases with no long term sequalae. However 39 patients demonstrated residual abnormalities. Older patients are at high risk for residual pulmonary lesions and there is no gender predilection. Patients having comorbidities like hypertension, diabetes or bronchial asthma were not at a higher risk of developing pulmonary sequalae. CONCLUSION: The resolution of most lesions by 3 weeks after discharge implies gradual resolution of inflammation with re-expansion of alveoli and perhaps the reversible nature of the lesions of Covid-19.