ABSTRACT
Background: Managing fluid balance in COVID-19 patients can be challenging, particularly if they develop acute kidney injury (AKI). We study the relationship between fluid net input and output (FNIO) in patients with confirmed COVID-19 infection with development of AKI, time to development of AKI, in-hospital length of stay (LOS), and in-hospital mortality. Method(s): This is a retrospective study of patients (n=403) with confirmed COVID-19. Data for FNIO was from day 1 through day 10 or until development of AKI were recorded, whichever occurred first. Available FNIO data was calculated as a mean due to information not available for all days. Covariates included demographics, comorbidities, treatment, and management variables. Result(s): Mean age was 58.1 (SD=16.5) years. There were 39.5% female and 53.1% Hispanic. Mean FNIO average was 612.2 (SD=747.4) mL. For the outcome variables, AKI occurred in 22.8%, in-hospital mortality occurred in 26.3%, mean days to AKI were 7.7 (SD=6.3), and mean LOS was 11.4 (SD=13.2) days. In the multivariate logistic regression analyses, increased FNIO mean was significantly associated with slightly increased odds for mortality (OR=1.001, 95% CI:1.00, 1.001, p=0.03) but was not significantly associated with AKI (p=0.82). In the multivariate linear regression analyses, increased FNIO mean was significantly associated with lesser days to AKI (B=-6.92*10-5, SE=<0.001, p=0.002) while FNIO mean was not significantly associated with LOS (p=0.75). Conclusion(s): Increased fluid balance was associated with AKI development and increased mortality. Physicians should exercise caution with administering fluid in patients with COVID-19 to prevent such adverse outcomes.
ABSTRACT
SESSION TITLE: New Developments in the Diagnosis and Management of Mycobacterial and Bacterial Chest Infections SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: The United States has become the new epicenter for COVID-19 infection. The role of obesity in COVID-19 infection and ARDS is unclear. Previous studies indicate obese hospitalized patients may have better outcomes including mortality, a phenomenon referred to as “obesity paradox.” This study aims to evaluate the effect of obesity on patients admitted with COVID-19 infection in a suburban safety-net hospital in New York. METHODS: A retrospective unmatched single-center study of the first 142 patients (age≥18 y) admitted to our facility from March 9, 2020 to March 30, 2020 with the diagnosis of COVID-19 infection. Body mass index (kg/m2) was used to stratify patients into nonobese (BMI <30) and obese (BMI>30). Further subdivisions based on WHO classification include underweight (<18.5), normal weight (≥18.5 to 24.9), overweight (≥25.0 to 29.9). Obesity subdivided into Class I (30.0 to 34.9), Class II (35.0 to 39.9), Class III morbid obesity (≥40). Statistical analyses were performed using SPSS. The primary outcome was all-cause mortality, secondary outcomes include ICU admission, intubation, ARDS and more. RESULTS: Out of the total 142 patients, 54 (37.46%) were obese. Obese patients had statistically significant higher rates of requiring ICU admission (50% vs 27% p=0.014), developing ARDS (48.1% vs. 29.2%), had longer hospital length of stay (11.2 vs. 8.2, p=0.031) and were more likely to be admitted directly to the ICU from ED (29.6% vs. 11.2%, p=0.019). Obese patients had higher mortality (42.6% vs. 36.0%, p= 0.429) than nonobese. Obese Covid-19 patients had more severe hypoxia on initial presentation (55.6% vs. 42.7% p=0.136), intubation (40.7% vs. 28.1%, p=0.118), worse PaO2/FIO2 ratios (173.9 vs. 276.6, p=0.635) and septic shock (31.5% vs. 20.2%, p=0.129). No statistical significance was seen between groups in terms of ethnicities, comorbidities including hypertension, diabetes and Charlson Comorbidity Index. No statistical significance was observed in obesity subdivisions, however the morbidly obese group had the highest frequency of mortality at 54%. CONCLUSIONS: Our study does not support the evidence of “Obesity Paradox” in COVID-19 infection, as obesity does not confer a statistical reduction in mortality. In contrast, our study suggests increased morbidity based on increased ICU admissions, development of ARDS and longer hospital stay in obese patients. Further studies are required to evaluate the role of obesity as an independent risk factor in COVID-19. CLINICAL IMPLICATIONS: Contrary to the "Obesity Paradox", Obese patients with COVID-19 infection may have worse clinical outcomes than non-obese. DISCLOSURES: No relevant relationships by Shiva Arjun, source=Web Response No relevant relationships by Andres Castillo, source=Web Response No relevant relationships by Jiten Desai, source=Web Response No relevant relationships by Kristen Farraj, source=Web Response No relevant relationships by Sandra Gomez Paz, source=Web Response No relevant relationships by Jaehyuck Im, source=Web Response No relevant relationships by Javed Iqbal, source=Web Response No relevant relationships by Paul Mustacchia, source=Web Response No relevant relationships by Upenkumar Patel, source=Web Response No relevant relationships by Rajmohan Rammohan, source=Web Response No relevant relationships by Kevin Yeroushalmi, source=Web Response