ABSTRACT
The World Health Organization declared the SARS-CoV-2 infection causing severe acute respiratory distress a global pandemic in March 2020. While respiratory features are commonly at the forefront of the disease, cardiovascular complications have been observed and associated with a poorer prognosis. The ACE2 enzyme intrinsically involved in the physiology of cardiac function and in the development of hypertension and diabetes has been identified as a functional receptor for SARS-CoV-2. It is difficult to highlight the precise mechanisms of cardiac damage because of its possible multiple implications, through direct damage from SARS-CoV-2 responsible for viral myocarditis or indirect damage from the state of exacerbated systemic inflammation associated with hypoxaemia. The treatments of the disease may also induce adverse effects such as an increase in QT segment duration. Measurements of cardiac biomarkers are required if myocardial damage is suspected and are part of a panel of arguments confronted with clinical features, ultrasonic monitoring and electrocardiogram. As the cardiac disorders increase post-hospital morbidity, risk stratification with cardiac MRI and prolonged follow-up are required.
ABSTRACT
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to 5% to 16% hospitalization in intensive care units (ICU) and is associated with 23% to 75% of kidney impairments, including acute kidney injury (AKI). The current work aims to precisely characterize the renal impairment associated to SARS-CoV-2 in ICU patients. Forty-two patients consecutively admitted to the ICU of a French university hospital who tested positive for SARS-CoV-2 between 25 March 2020, and 29 April 2020, were included and classified in categories according to their renal function. Complete renal profiles and evolution during ICU stay were fully characterized in 34 patients. Univariate analyses were performed to determine risk factors associated with AKI. In a second step, we conducted a logistic regression model with inverse probability of treatment weighting (IPTW) analyses to assess major comorbidities as predictors of AKI. Thirty-two patients (94.1%) met diagnostic criteria for intrinsic renal injury with a mixed pattern of tubular and glomerular injuries within the first week of ICU admission, which lasted upon discharge. During their ICU stay, 24 patients (57.1%) presented AKI which was associated with increased mortality (p = 0.007), hemodynamic failure (p = 0.022), and more altered clearance at hospital discharge (p = 0.001). AKI occurrence was associated with lower pH (p = 0.024), higher PaCO2 (CO2 partial pressure in the arterial blood) (p = 0.027), PEEP (positive end-expiratory pressure) (p = 0.027), procalcitonin (p = 0.015), and CRP (C-reactive protein) (p = 0.045) on ICU admission. AKI was found to be independently associated with chronic kidney disease (adjusted OR (odd ratio) 5.97 (2.1-19.69), p = 0.00149). Critical SARS-CoV-2 infection is associated with persistent intrinsic renal injury and AKI, which is a risk factor of mortality. Mechanical ventilation settings seem to be a critical factor of kidney impairment.
Subject(s)
COVID-19/complications , Critical Illness/therapy , Malnutrition/therapy , Nutritional Support/methods , SARS-CoV-2 , COVID-19/rehabilitation , Contraindications , Critical Care , Energy Intake , Enteral Nutrition/adverse effects , Enteral Nutrition/methods , Humans , Malnutrition/etiology , Nutritional Support/adverse effects , Parenteral NutritionABSTRACT
Patients with severe cases of COVID-19 are at high nutritional risk during their ICU stay. Prolonged immobilization associated with an exacerbated systemic inflammatory response is a major provider of ICU-acquired muscle weakness. Early enteral nutrition is recommended to gradually reach the energy target of 25 kcal/kg/day and protein target of 1.3 g/kg/day around D4. The occurrence of a Refeeding syndrome should be closely monitored. In case of feeding intolerance refractory to a prokinetic treatment, complementary or total parenteral nutrition is advised, favouring new generation mixed lipid emulsions (containing fish oil) and regular monitoring of triglyceridemia. Nutrition care of critically ill patients should be carried out with limited procedures that may pose a risk of contamination for the healthcare staff.