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SARS-CoV-2 Renal Impairment in Critical Care: An Observational Study of 42 Cases (Kidney COVID).
Molina Barragan, Antoine-Marie; Pardo, Emmanuel; Galichon, Pierre; Hantala, Nicolas; Gianinazzi, Anne-Charlotte; Darrivere, Lucie; Tsai, Eileen S; Garnier, Marc; Bonnet, Francis; Fieux, Fabienne; Verdonk, Franck.
  • Molina Barragan AM; Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France.
  • Pardo E; Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France.
  • Galichon P; Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
  • Hantala N; Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
  • Gianinazzi AC; Transplantation and Nephrology Department, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
  • Darrivere L; Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France.
  • Tsai ES; Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
  • Garnier M; Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France.
  • Bonnet F; Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
  • Fieux F; Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France.
  • Verdonk F; Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
J Clin Med ; 10(8)2021 Apr 08.
Article in English | MEDLINE | ID: covidwho-1526823
ABSTRACT
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to 5% to 16% hospitalization in intensive care units (ICU) and is associated with 23% to 75% of kidney impairments, including acute kidney injury (AKI). The current work aims to precisely characterize the renal impairment associated to SARS-CoV-2 in ICU patients. Forty-two patients consecutively admitted to the ICU of a French university hospital who tested positive for SARS-CoV-2 between 25 March 2020, and 29 April 2020, were included and classified in categories according to their renal function. Complete renal profiles and evolution during ICU stay were fully characterized in 34 patients. Univariate analyses were performed to determine risk factors associated with AKI. In a second step, we conducted a logistic regression model with inverse probability of treatment weighting (IPTW) analyses to assess major comorbidities as predictors of AKI. Thirty-two patients (94.1%) met diagnostic criteria for intrinsic renal injury with a mixed pattern of tubular and glomerular injuries within the first week of ICU admission, which lasted upon discharge. During their ICU stay, 24 patients (57.1%) presented AKI which was associated with increased mortality (p = 0.007), hemodynamic failure (p = 0.022), and more altered clearance at hospital discharge (p = 0.001). AKI occurrence was associated with lower pH (p = 0.024), higher PaCO2 (CO2 partial pressure in the arterial blood) (p = 0.027), PEEP (positive end-expiratory pressure) (p = 0.027), procalcitonin (p = 0.015), and CRP (C-reactive protein) (p = 0.045) on ICU admission. AKI was found to be independently associated with chronic kidney disease (adjusted OR (odd ratio) 5.97 (2.1-19.69), p = 0.00149). Critical SARS-CoV-2 infection is associated with persistent intrinsic renal injury and AKI, which is a risk factor of mortality. Mechanical ventilation settings seem to be a critical factor of kidney impairment.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Year: 2021 Document Type: Article Affiliation country: Jcm10081571

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Year: 2021 Document Type: Article Affiliation country: Jcm10081571