ABSTRACT
BACKGROUND: COVID-19 is a multisystemic disorder that frequently causes acute kidney injury (AKI). However, the precise clinical and biochemical variables associated with AKI progression in patients with severe COVID-19 remain unclear. METHODS: We performed a retrospective study on 278 hospitalized patients who were admitted to the ward and intensive care unit (ICU) with COVID-19 between March 2020 and June 2020, at the University Hospital, São Paulo, Brazil. Patients aged ≥ 18 years with COVID-19 confirmed on RT-PCR were included. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the incidence of AKI, several clinical variables, medicines used, and outcomes in two sub-groups: COVID-19 patients with AKI (Cov-AKI), and COVID-19 patients without AKI (non-AKI). Univariate and multivariate analyses were performed. RESULTS: First, an elevated incidence of AKI (71.2%) was identified, distributed across different stages of the KDIGO criteria. We further observed higher levels of creatinine, C-reactive protein (CRP), leukocytes, neutrophils, monocytes, and neutrophil-to-lymphocyte ratio (NLR) in the Cov-AKI group than in the non-AKI group, at hospital admission. On univariate analysis, Cov-AKI was associated with older age (>62 years), hypertension, CRP, MCV, leucocytes, neutrophils, NLR, combined hydroxychloroquine and azithromycin treatment, use of mechanical ventilation, and vasoactive drugs. Multivariate analysis showed that hypertension and the use of vasoactive drugs were independently associated with a risk of higher AKI in COVID-19 patients. Finally, we preferentially found an altered erythrocyte and leukocyte cellular profile in the Cov-AKI group compared to the non-AKI group, at hospital discharge. CONCLUSIONS: In our study, the development of AKI in patients with severe COVID-19 was related to inflammatory blood markers and therapy with hydroxychloroquine/azithromycin, with vasopressor requirement and hypertension considered potential risk factors. Thus, attention to the protocol, hypertension, and some blood markers may help assist doctors with decision-making for the management of COVID-19 patients with AKI.
Subject(s)
Acute Kidney Injury/diagnosis , COVID-19/pathology , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Azithromycin/therapeutic use , Brazil/epidemiology , COVID-19/complications , COVID-19/virology , Creatinine/blood , Female , Glomerular Filtration Rate , Humans , Hydroxychloroquine/therapeutic use , Male , Middle Aged , Respiration, Artificial , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Severity of Illness Index , Vasodilator Agents/adverse effects , Vasodilator Agents/therapeutic use , Young Adult , COVID-19 Drug TreatmentABSTRACT
Contexto: A pancreatite aguda é uma inflamação aguda do pâncreas, na qual as enzimas digestivas pancreáticas são ativadas no parênquima do próprio órgão e na circulação sanguínea, levando a uma resposta inflamatória sistêmica. Diversos testes diagnósticos e intervenções terapêuticas são opções no manejo desses participantes. Objetivo: avaliar as evidências de revisões sistemáticas Cochrane sobre acurácia, efetividade e segurança no manejo da pancreatite aguda. Métodos: Foram incluídas revisões sistemáticas a partir de busca sistematizada na Biblioteca Cochrane. Dois autores avaliaram a concordância com os critérios de inclusão das revisões encontradas e apresentaram uma síntese qualitativa de seus achados. Resultados: Foram incluídas 11 revisões sistemáticas Cochrane que encontraram evidências de qualidade variada sobre testes diagnósticos e intervenções terapêuticas para pancreatite aguda. Nenhuma evidência atual é de alta qualidade. Nenhuma análise comparativa de acurácia foi realizada entre os testes diagnósticos. Evidência de qualidade moderada demonstrou superioridade da dieta enteral sobre a parenteral, e não houve evidência de benefícios da colangiopancreatografia retrógrada endoscópica precoce para casos em que não haja colangite ou coledocolitíase associada à pancreatite aguda. Conclusão: A única evidência de moderada qualidade (e, portanto, que pode ser modificada após a inclusão de novos estudos) é referente à maior efetividade e segurança da dieta enteral quando comparada à parenteral na pancreatite aguda.
