RESUMEN
In the wake of the novel coronavirus disease 2019 (COVID-19) pandemic and its associated mortality and virulence, a high clinical suspicion must be maintained for all patients presenting with respiratory failure. However, there are well-known disease processes that may have a similar presentation. We present a case of a 25-year-old male who suffered a right tibia fracture after a motor vehicle collision. He had acute hypoxic respiratory failure within 24 hours of admission, requiring mechanical ventilation. His condition significantly improved with airway pressure release mode of ventilation and proning. Although his chest CT demonstrated characteristic findings of COVID-19, he subsequently tested negative. The differential included aspiration pneumonia and fat embolism syndrome from the lower extremity fracture. Fat embolism syndrome can very closely mimic COVID-19. The rapid onset and improvement of symptoms coupled with serial negative COVID-19 testing may aid in the diagnosis.
RESUMEN
INTRODUCTION: A large proportion of patients with COVID-19 develop acute kidney injury (AKI). While the most severe of these cases require renal replacement therapy (RRT), little is known about their clinical course. METHODS: We describe the clinical characteristics of COVID-19 patients in the ICU with AKI requiring RRT at an academic medical center in New York City and followed patients for outcomes of death and renal recovery using time-to-event analyses. RESULTS: Our cohort of 115 patients represented 23% of all ICU admissions at our center, with a peak prevalence of 29%. Patients were followed for a median of 29 days (2542 total patient-RRT-days; median 54 days for survivors). Mechanical ventilation and vasopressor use were common (99% and 84%, respectively), and the median Sequential Organ Function Assessment (SOFA) score was 14. By the end of follow-up 51% died, 41% recovered kidney function (84% of survivors), and 8% still needed RRT (survival probability at 60 days: 0.46 [95% CI: 0.36-0.56])). In an adjusted Cox model, coronary artery disease and chronic obstructive pulmonary disease were associated with increased mortality (HRs: 3.99 [95% CI 1.46-10.90] and 3.10 [95% CI 1.25-7.66]) as were angiotensin-converting-enzyme inhibitors (HR 2.33 [95% CI 1.21-4.47]) and a SOFA score >15 (HR 3.46 [95% CI 1.65-7.25). CONCLUSIONS AND RELEVANCE: Our analysis demonstrates the high prevalence of AKI requiring RRT among critically ill patients with COVID-19 and is associated with a high mortality, however, the rate of renal recovery is high among survivors and should inform shared-decision making.