Clinical Characteristics and Outcomes of Patients With Severe COVID-19 Induced Acute Kidney Injury.

BACKGROUND: The incidence and outcome of Coronavirus disease 2019 (COVID-19)-induced kidney injury have been variably described. We aimed to describe the clinical characteristics, correlates and outcomes of critically ill patients with severe COVID-19 complicated by acute kidney injury (AKI). METHODS: We performed a multicenter retrospective cohort study of 671 critically ill adults with laboratory-confirmed COVID-19 from 19 hospitals in China between January 1 to February 29, 2020. Data were captured on demographics, comorbidities, symptoms, acute physiology, laboratory parameters, interventions, and outcomes. The primary exposure was ICU admission for confirmed COVID-19 related critically illness. The primary outcome was 28-day mortality. Secondary outcomes included factors associated with AKI, organ dysfunction, treatment intensity, and health services use. MEASUREMENTS AND MAIN RESULTS: Of 671 severe COVID-19 patients (median [IQR] 65 [56-73] years; male sex 65% (n = 434); hypertension 43% (n = 287) and APACHE II score 10 [7-14]), 39% developed AKI. Patients with AKI were older, had greater markers of inflammation and coagulation activation, and had greater acuity and organ dysfunction as presentation. Despite similar treatment with antivirals, patients with AKI had lower viral conversion negative rates than those without AKI. The 28-day mortality was much higher in AKI patients than patients without AKI (72% vs. 42%), and there was an increase in 28-day mortality according to the severity of AKI. Non-survivors were less likely to receive antiviral therapy [132 (70%) vs. 65 (88%)] compared with survivors and have lower viral negative conversion rate [17 (9%) vs. 47 (64%)]. CONCLUSIONS: Acute kidney injury was quite common in severe COVID-19 pneumonia, which associated with higher mortality.

[Clinical characteristics of liver damage in 30 patients with severe coronavirus disease 2019 in Sichuan area].

OBJECTIVE: To describe the characteristics of liver damage in severe coronavirus disease 2019 (COVID-19) patients in Sichuan area and the effect of antiviral drugs on liver function. METHODS: The clinical data of severe COVID-19 patients admitted to Chengdu Public Health Clinical Medical Center from January 21 to February 24, 2020 were retrospectively collected, including demographic data, clinical manifestations and liver function changes within 1 week after admission to intensive care unit (ICU). The changes of liver function during the course of disease in severe COVID-19 patients were analyzed and summarized, and group analysis was performed. RESULTS: A total of 30 COVID-19 patients with complete clinical data were enrolled. The incidence of severe COVID-19 in elderly men was higher (60.0%), with median age of 61 (47, 79) years old, and those aged 80 or above accounted for 23.3%. The severe COVID-19 patients mainly presented with respiratory symptoms such as fever (96.7%), cough (80.0%) and dyspnea (66.7%). The alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and prothrombin time (PT) of 30 patients were increased to various degrees within 1 week after ICU admission, and albumin (ALB) was decreased. (1) The patients were divided into two groups according to whether to take lopinavir/ritonavir (kaletra). It was shown that the incidence of liver dysfunction in patients taking kaletra was significantly higher than those who did not take kaletra (7-day abnormal rate of ALT was 54% vs. 33%, the abnormal rate of AST was 38% vs. 33%, the abnormal rate of TBil was 8% vs. 0%), but there were no statistical differences (all P > 0.05). (2) The patients were divided into normal dose group (500 mg, twice a day, n = 19) and reduced dose group (250 mg, twice a day, n = 5) according to the dosage of kaletra. It was shown that patients taking low-dose kaletra had a smaller effect on liver function within 1 week after ICU admission than those receiving normal dosage, and ALB, TBil in the reduced dose group were significantly lower than those in the normal dose group on the 2nd day after ICU admission [ALB (g/L): 33.3±2.0 vs. 37.5±4.0, TBil (µmol/L): 6.3±3.3 vs. 11.3±4.8, both P < 0.05]. CONCLUSIONS: Severe COVID-19 patients in Sichuan area suffered obvious liver damage in the early course of the disease and have a slower recovery. It is important to pay attention to avoid using drugs that can aggravate liver damage while treating the disease. If there is no alternative drug, liver protection treatment should be considered appropriately.

COVID-19 with rheumatic diseases: a report of 5 cases.

The coronavirus disease 2019 (COVID-19), the result of an infection with the new virus, SARS-CoV-2, is rapidly spreading worldwide. It is largely unknown whether the occurrence of COVID-19 in patients with rheumatic immune diseases has some specific manifestations, or makes them more prone to rapidly progress into severe COVID-19. In this case report, we describe the clinical features of 5 rheumatic immune disease patients with the concomitant presence of COVID-19. Amongst these patients, 4 had rheumatoid arthritis (RA) and 1 had systemic sclerosis (SSc). Two patients had a history of close contact with a COVID-19 patient. The age of the patients ranged between 51 and 79 years. Fever (80%), cough (80%), dyspnea (40%), and fatigue (20%) were the most common presenting symptoms. Laboratory investigations revealed leukopenia and lymphopenia in 2 patients. In all the patients, chest computerized tomography (CT) revealed patchy ground glass opacities in the lungs. During the hospital stay, the condition of two patients remained the same (i.e., mild COVID-19), two patients progressed to the severe COVID-19, and one patient worsened to the critically ill COVID-19. These patients were treated with antiviral agents for COVID-19, antibiotics for secondary bacterial infections, and immunomodulatory agents for rheumatic immune diseases. All the patients responded well, were cured of COVID-19, and subsequently discharged.