ABSTRACT
Background Critically ill COVID-19 patients are at risk of developing major complications with high mortality rate. Aspirin might have favorable effects in severe COVID-19 via various mechanisms besides inhibition of platelet aggregation. The role of aspirin as adjuvant therapy in critically ill patients with COVID-19 has not been studied. In this study, we investigated the correlation between aspirin use and the clinical outcome in critically ill COVID-19 patients. Methods This is a retrospective cohort observational study of critically ill COVID-19 Egyptian patients. Participants were divided into two groups: patients who received aspirin, 150 mg per day orally, upon admission to the intensive care unit, and those who did not. The primary outcome in this study was the shift to invasive ventilatory support. Results A total of 1190 patients were involved in the study, 660 patients received aspirin, while 530 patients did not. Among aspirin group compared to non-aspirin group, invasive ventilatory support, DVT, PE, stroke, ACS, ARDS, AKI, septic shock, and mortality were less frequent, and the differences were significant except for ACS, AKI, and septic shock. Major bleeding was non-significantly more frequent. The length of ICU stay was significantly longer among non-survivors, and shorter among survivors. The variations between the two groups were significant among subgroups >= 40 or 60. Conclusions In critically ill patients with COVID-19, aspirin has the potential role as an adjuvant therapeutic, lowering the risk of mechanical ventilation, thromboembolic events, ARDS, and ICU mortality. Patients older than 40 years were a significant category that might benefit from aspirin.
ABSTRACT
Background: Prediction and early diagnosis of acute kidney injury (AKI) in critically ill Coronavirus disease 2019 (COVID-19) patients are of great importance. Therefore, using promising renal biomarkers such as cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) to identify the risk of future AKI is crucial. Materials and Methods: A total of 89 adult patients with COVID-19 were included in this study. Serum cystatin C and NGAL concentration were assessed on intensive care unit (ICU) admission then repeated after 48 hours. Serum creatinine was followed for 7 days to report the development of AKI. Results: Among the COVID-19 patients, 28.1% developed AKI. Although admission serum creatinine was not significantly different between the AKI group and the non-AKI group (p=0.375), admission Cystatin C (p=0.018), and NGAL (p<0.001) were significantly different between both groups. After 48 hours, a change in Cystatin C level (p<0.001) but not NGAL (p=0.4) was a predictor for AKI. Logistic regression model including age (p=0.031), Cystatin C on 48 hrs (p=0.003) and NGAL on admission (p=0.015) could predict AKI in COVID-19 patients. Conclusion: Serum Cystatin C and NGAL in ICU could be used to predict AKI in COVID-19 patients. A logistic regression model including age, Cystatin C on 48hrs, and NGAL on admission might be a tool for individualized risk estimation of AKI in COVID-19 patients.