Renal Function Dynamics Among Mechanically Ventilated Patients With Acute Kidney Injury (AKI) And COVID-19 Pneumonia

The incidence of COVID-19 associated AKI in hospitalized patients is variable, but majority of literature suggests that it affects >20% of the population. Long-term outcomes are also variable – a proportion of which may progress to chronic kidney disease (CKD) with worsening of baseline renal function. There is an insufficient data regarding long-term outcomes of AKI in intubated COVID-19 patients. The purpose of this study was to determine the likelihood and the risk of CKD in intubated COVID- 19 patients 90 days after the first episode of inpatient AKI. The study population included all intubated patients with confirmed COVID-19 pneumonia and bacterial pneumonia admitted from Jan 1, 2020 to Dec 31, 2020, who developed AKI during admission and were discharged alive. Diagnosis of AKI was based on KDIGO definition. Serum creatinine on admission, during first episode of AKI, on discharge and 90 days after first episode of AKI were collected. Logistic regression analysis was conducted to determine the 0dds ratio for CKD on day 90. Cox proportional hazard ratio was conducted to assess the risk of CKD at day 90 after AKI. The study included 125 patients. 56 (45%) had COVID-19 pneumonia while 69 (55%) had bacterial pneumonia. There was no noted differences in the baseline characteristics. Emergent inpatient hemodialysis was higher amongst COVID-19 patients (20% vs 7%, p<0.043), which equated to more patients requiring dialysis after discharge (18% vs 3%, p<0.005). The likelihood of having CKD in COVID-19 patients was 2.62 (1.06-6.45, p =0.037) and Hazard Ratio for CKD was 2.48 (1.06-5.78, p=0.036). COVID-19 patients with AKI has higher likelihood (2.62) and increased risk (148%) of developing CKD after AKI compared to bacterial pneumonia patients, regardless of comorbidities, mechanical ventilation days, or highest AKI stage. Critically ill COVID-19 patients requiring mechanical ventilator who develop AKI on admission need close monitoring of renal function both during hospital stay and most especially upon discharge. (Figure Presented)

Acute Neurological Inflammatory Diseases in Colombia: A Multi-center Observational Study from Zika outbreak to SARS-CoV-2 pandemic

Objective: To evaluate clinical, laboratory, and epidemiological features of acute neuroinflammatory disorders (ANIDs) that followed the 2016 Zika epidemic in Colombia. Background: The outbreak of Zika virus infection in Colombia in 2015-2016, produced an increased incidence of Guillain-Barré Syndrome (GBS) and other ANID cases. The Neuroviruses Emerging in the Americas Study (NEAS) network was established in 2016 as a multicenter-based observatory of ANIDs to investigate the role of emerging pathogens in neuroinflammatory diseases. Design/Methods: NEAS serves as a multi-center study based on 13 hospitals in 7 cities in Colombia which study all newly diagnosed patients who fulfill established criteria for GBS, encephalitis, myelitis, meningoencephalitis, or cranial nerve disorders as part of an observational cohort. We analyzed the clinical and epidemiological features of all cases evaluated between January 2016 and September 2021. Results: An observational cohort of 825 patients with ANIDs were recruited during the study period. 58.8% of cases were male with a median age of 43 (IQR 25-58) years. The most frequent ANIDs were GBS (46.1%) and facial nerve palsy (28.7%). The diagnosis of encephalitis (9.5%), myelitis (6.5%), and optic neuritis (5.9%) were less frequent. Patients with GBS were predominantly male (70.6%) and had a median age of 49 (IQR 32-60) years. Interestingly, there was an increase incidence of GBS in 2019. Conclusions: The outbreak of Zika in Colombia produced a marked increase in the incidence of GBS in 2016. Although cases of GBS and other ANIDs continued to emerge after the incidence of Zika infection decreased in July 2016, the recent SARS-CoV-2 pandemic has not produced any significant increase in the incidence of GBS in Colombia.

Effectiveness of contact tracing to reduce fatality from COVID-19: preliminary evidence from Colombia.

OBJECTIVES: Conducting contact tracing (CT) programs in low- and middle-income countries is challenging, and there is no evidence of their effectiveness in Latin America. We evaluated the effectiveness of CT on reducing fatality from COVID-19 in Colombia. STUDY DESIGN: The study design is a retrospective cohort study with nation-wide data of suspected and confirmed cases of severe acute respiratory syndrome (SARS-CoV-2) infection and their registered contacts. METHODS: We analyzed confirmed and suspected COVID-19 cases and their chains of contact using a nation-wide registry from March 28, 2020 to January 13, 2021. To estimate the effect of CT on fatality, we adjusted a multilevel negative binomial model using the number of deaths and the number of people within a chain of contacts as the outcome variable and offset variable, respectively. Sensitivity analysis was conducted using different cutoff values of contacts traced and a logistic model for the effect of CT on death at an individual level. RESULTS: We analyzed 1.4 million cases, 542,936 chains of contact, and 46,087 deaths. Only, 5.8% of total cases and contacts were included in a chain of a case and five or more contacts. We found that tracing of at least five contacts per case reduces fatality by 48% (95% confidence interval: 45-51), and, at the current levels of tracing in Colombia, it prevents 1.8% of deaths. Results obtained from the sensitivity analysis were consistent with the reduction of fatality at an individual level and higher protective effect with the higher number of contacts traced. CONCLUSIONS: In Colombia, tracing of at least five contacts per case reduces fatality from COVID-19. The coverage and intensity of tracing needs to be increased as a strategy to mitigate fatality in Colombia.

Premature deaths and years of potential life lost, what has changed in Colombia during the COVID-19 pandemic? [Spanish]

Introduction: The COVID-19 pandemic is one of the greatest global challenges of the time. For a better understanding of its population effects, it is necessary to analyze complementary measures to mortality. Objetive: To estimate the potential years of life lost in Colombia due to premature deaths from all causes and from COVID-19 in the March-July period between 2015 and 2020. Materials and methods: We carried out an ecological, longitudinal and retrospective study, based on secondary sources. Years of life potentially lost were calculated according to sex and age group, using life expectancy and the DANE actuarial tables.