ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) is a newly emerging disease caused by the SARS-CoV-2 virus resulting in a global crisis. Activation of the cytokine cascades plays a crucial role in the pathophysiology of severe pneumonia caused by COVID-19. Several treatments targeting pro-inflammatory cytokines have been introduced, however, their efficacy remains controversial. We aimed to demonstrate the comparative efficacy between hemoperfusion and tocilizumab in the reduction of mortality from severe COVID-19 pneumonia. Method(s): A multicentered, ambispective study was conducted on adult patients who were diagnosed with COVID-19 pneumonia between January 1st, 2020, and December 31th, 2021. Clinical parameters including the specific therapy with hemoperfusion (Hemoadsorption cartridge, HA330 JACFRON) or tocilizumab were collected for analysis. Univariable and multivariable regression analyses were performed to determine the association between the specific therapy and the 28-day mortality. Result(s): A total of 92 patients with COVID-19 pneumonia were eligible for analyses (25 patients received hemoperfusion and 67 patients received tocilizumab). The 28-day mortality in the hemoperfusion and tocilizumab groups were 64.0% and 25.4% respectively (p=0.001). However, receiving Tocilizumab was not associated with mortality rate, compared to hemoperfusion in the multivariable analysis [OR 0.56 (95%CI 0.13 -2.39);p=0.428]. Receiving invasive mechanical ventilator (%), duration of hospitalization, and successful withdrawal of invasive mechanical ventilation was not different between the two groups. Inflammatory marker (CRP) was significantly reduced with hemoperfusion and tocilizumab -46.2 (-88.37, -24.9) (p=0.013) and -45.1 (-54.6, -26.15) (p=<0.001). Conclusion(s): The 28-day mortality of COVID-19 pneumonia patients receiving hemoperfusion and tocilizumab were comparable.
ABSTRACT
Background: Acute kidney injury (AKI) is common in patients with coronavirus disease 2019 (COVID-19). Pathogenesis of AKI and mechanism of renal recovery in COVID-19 are multifactorial. Data of recovery from AKI after COVID-19 remains sparse. This study aims to elucidate natural history of recovery from AKI in COVID-19 patients. Method: A prospective cohort study included all COVID-19 patients with diagnosed AKI during admission in a university hospital in Thailand, between March 12, 2020 and April 30, 2020. AKI and stage of AKI were defined by KDIGO criteria. Recovery of AKI describes serum creatinine turn to baseline of kidney function within 7 days of the initiating event. Acute kidney disease (AKD) was defined as loss of kidney function for a duration of between 7 and 90 days after exposure to an AKI initiating event. Result: A total of 148 patients with confirmed COVID-19, 13 (8.8%) patients diagnosed AKI were studied. Of these 13 patients, the median age was 44.6 (range, 23.5-68.7) years and 69.2% of patients were males. Ten (76.9%) patients had pneumonia. Five (38.4%) patients had acute respiratory distress syndrome. The median duration of AKI period was 10 (range, 3-68) days. Ten (76.9%) patients were classified as stage 1 and the other three as stage 3. For patients with AKI stage 1, 5 (50%) had a recovery of AKI, and the rest recovered from AKI within 2 months. Whereas patients with AKI stage 3, 2 (66.6%) died and the other developed AKD. Conclusion: AKI in COVID-19 may develop early during hospitalization. The severity of AKI in COVID-19 patients contribute to renal outcome and recovery. Our work may be useful for better care optimization and prognostication of patients with COVID-19.