ABSTRACT
Background: Acute kidney injury (AKI) is a common complication of COVID-19 and related with severity and outcomes. However, relatively little is known about risk factors of AKI and outcomes among Thai hospitalized patients with COVID-19. The study described the incidence of different stages of AKI, risk factors and renal outcomes in hospitalized COVID-19-associated AKI patients. Method(s): The observational study involved a review of data from health records of COVID-19 pneumonia patients aged >=18 years in the tertiary care center from June 1 to September 30, 2021. We describe the frequency of AKI, dialysis requirement, and adjusted hazard ratios (adjusted HR) with AKI. Result(s): A total of 966 hospitalized COVID-19 pneumonia patients, AKI occurred in 170 (17.5%) and AKI stage 1, 2 and 3 was 45.2% (N=77), 25.2% (N=43) and 29.4% (n =50). 23 patients (13% of AKI) required dialysis. The independent risk factors for AKI were pre-existing CKD (aHR 1.74, 95%CI 1.03-2.93), cardiovascular disease (aHR 2.42, 95%CI 1.38-4.24), serum ferritin (aHR 1.001, 95%CI 1.001-1.002), history of diuretic use (aHR 2.68, 95%CI 1.08-6.64), respiratory support (aHR 3.33, 95%CI 1.65-6.73), and presence of septic shock (aHR 3.23, 95%CI 1.59-6.56). 44.7% had non renal recovery. In-hospital mortality in AKI patients was 54.1%. An adjustment for demographics, and laboratory values, the aOR for death was 2 (95%CI, 1.01-4.05) Conclusion(s): AKI is common among patients hospitalized with COVID-19 and is associated with non-renal recovery and death. The predisposing factors are pre-existing CKD, cardiovascular disease, history of diuretic use and more severe COVID-19 presentation.
ABSTRACT
Introduction: Cytokine release syndrome is associated with multiple organ dysfunction in COVID-19 infection. Implementing extracorporeal blood purification could be benefit in omitting inflammatory mediators and supporting organ systems. We aims to investigate the effectiveness of hemoperfusion in combination with standard therapy in critically ill COVID-19 patients and examine factors associated with in-hospital mortality. Methods: The observational study included critically ill COVID-19 patients on HA-330 hemoperfusion (Jafron Biomedical Co, Ltd). Clinical and laboratory findings were monitored after hemoperfusion. Factors associated with death after hemoperfusion were also examined. Results: Fifty-five patients with COVID-19 pneumonia on hemoperfusion were analyzed. A total of 43 patients (78.2%) received mechanical ventilation and in-hospital mortality was 58.2%. Overall, mean Sequential Organ Function Assessment (SOFA) score was 8.56 ± 3.62. The hemoperfusion resulted in a significant increase in the PaO2/FiO2, white blood cell count and a significant decrease in the hsCRP and platelet counts of patients. Multi-factor Cox analysis showed increasing odds of in-hospital death associated with older age (HR 1.08, 95%CI 1.02-1.14), high body mass index (HR 1.16, 95%CI 1.07-1.26), high serum LDH level (HR 1.01, 95%CI 1.01-1.02), and high SOFA score (HR 1.26, 95%CI 1.02-1.55). Additionally, changes in patient profiles after hemoperfusion including increase in white blood cell count of > 60%, serum creatinine of > 20%, serum ferritin of > 50%, SOFA score of > 40%, norepinephrine dosage of > 25% and PaO2/FiO2 of < 50% was associated with increased risk of death. Conclusions: In this study of patients with severe COVID-19, hemoperfusion therapy improve respiratory distress and cell response, and decreased inflammatory mediators. Aging, obesity, worsening in inflammatory response, renal function and no critical improving oxygenation were associated with in-hospital mortality.