Incidence of acute kidney injury in critically ill patients with COVID-19 and 90-day survival: Retrospective Cohort of a Public Intensive Care Unit, Joinville/Brazil
DOI:
https://doi.org/10.15343/0104-7809.202347e14502022PKeywords:
Survival, Hemodialysis, COVID-19, Acute Kidney InjuryAbstract
About one third of patients with COVID-19 in intensive care units (ICU) have acute kidney injury (AKI) requiring dialysis. Few studies have evaluated the survival ratel of patients with AKI in exclusively public ICUs. The aim of this study was to evaluate the 90-day in-hospital survival of patients with and without AKI requiring dialysis hospitalized with severe COVID-19. This is a historical cohort of a general hospital in Joinville, Santa Catarina/Brazil. All patients admitted to the ICU between March and December of 2020 with a confirmed diagnosis of COVID-19 were included. AKI was defined by the presence of acute renal function alteration requiring hemodialysis. A multivariate Cox regression model was used to assess the survival of patients with and without AKI requiring dialysis. The results of the study showed that, of the 187 patients included (55.5% men) with a mean age of 62.8±13.6 years, 37.4% had AKI requiring dialysis. Patients with AKI requiring dialysis used more vasoactive drugs, had greater severity on admission and higher mortality rate (84.3% vs. 63.2%; p=0.002) compared to those without AKI. The risk of death in patients with AKI was higher (crude RR= 1.60; 95% CI 1.13-2.26; p= 0.007). After adjustments for age, sex, comorbidities and clinical severity, the presence of AKI requiring dialysis remained associated with a higher frequency of 90-day mortality (RR= 1.49; 95% CI 1.03-2.15; p=0.032). The survival of patients with severe COVID-19 and AKI requiring dialysis in the studied sample was lower compared to private ICUs in Brazil, which suggests inequalities in the public system.
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References
Coronavírus Brasil [Internet]. covid.saude.br. Available from: http://covid.saude.gov.br
Teich VD, Klajner S, Almeida FAS de, Dantas ACB, Laselva CR, Torritesi MG, et al. Epidemiologic and clinical features of patients with COVID-19 in Brazil. Einstein (Sao Paulo) [Internet]. 2020;18:eAO6022. Available from: https://www.scielo.br/pdf/eins/v18/pt_2317- 6385-eins-18-eAO6022.pdf
Chang R, Elhusseiny KM, Yeh YC, Sun WZ. COVID-19 ICU and mechanical ventilation patient characteristics and outcomes-A systematic review and meta-analysis. Lazzeri C, editor. PLOS ONE. 2021;16.
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA [Internet]. 2020;323(20):2052–9. Available from: http://dx.doi.org/10.1001/jama.2020.6775
Lowe R, Ferrari M, Nasim-Mohi M, Jackson A, Beecham R, Veighey K, et al. Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single centre cohort study. BMC Nephrol [Internet]. 2021;22(1):92. Available from: http://dx.doi.org/10.1186/s12882-021-02296-z
Doher MP, Torres De Carvalho FR, Scherer PF, Matsui TN, Amm Irati AL, Silva CD. Lesão renal aguda e terapia renal substitutiva em pacientes críticos com COVID-19:Fatores de risco e desfechos: Experiências de um único centro no Brasil. Purificação do Sangue. 2021;50(4–5):520–30.
Casas-Aparicio GA, León-Rodríguez I, Alvarado-de la Barrera C, González-Navarro M, Peralta-Prado AB, Luna-Villalobos Y, et al. Acute kidney injury in patients with severe COVID-19 in Mexico. PLoS One [Internet]. 2021;16(2):e0246595. Available from: http:// dx.doi.org/10.1371/journal.pone.0246595
Tan E, Song J, Deane A, Plummer M. Global Impact of COVID-19 Infection Requiring Admission to the Intensive Care Unit: A Systematic Review and Meta-Analysis. Chest. 2020.
Kunutsor SK, Laukkanen JA. Hepatic manifestations and complications of COVID-19: A systematic review and meta-analysis. J Infect [Internet]. 2020;81(3):e72–4. Available from: http://dx.doi.org/10.1016/j.jinf.2020.06.043
Hardenberg J-HB, Stockmann H, Aigner A, Gotthardt I, Enghard P, Hinze C, et al. Critical illness and systemic inflammation are key risk factors of severe acute kidney injury in patients with COVID-19. Kidney Int Rep [Internet]. 2021;6(4):905–15. Available from: http://dx.doi.org/10.1016/j.ekir.2021.01.011
Miethke-Morais A, Cassenote A, Piva H, Tokunaga E, Cobello V, Gonçalves F. Análise de custo-resultado hospitalar relacionado ao COVID-19: O impacto de fatores clínicos e demográficos. Revista Brasileira de Doenças Infecciosas. 2021;25(4).
Samaan F, De Paula C, De Lima Souza E, Mendes F, Rossi L, Freitas P. Pacientes com lesão renal aguda associado à COVID-19 tradados com terapia renal substitutiva na unidade de terapia intensiva: Um estudo multicêntrico em São Paulo. Bhimma R, editor. PLOS ONE. 2022;17.
Requião-Moura LR, Viana LA, Cristelli MP, Andrade L, Garcia VD. Alta mortalidade entre receptores de transplante renal diagnosticados com doença de coronavírus 2019:resultados do estudo de coorte multicêntrico brasileiro. Remuzzi G, editor. PLOS ONE. 2021;16(7).
de Souza WM, Buss LF, Candido D da S, Carrera J-P, Li S, Zarebski AE, et al. Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil. Nat Hum Behav [Internet]. 2020 [cited 2023 Jun 22];4(8):856–65. Available from: https://www.nature. com/articles/s41562-020-0928-4
1.Cai X, Wu G, Zhang J, Yang L. Risk factors for acute kidney injury in adult patients with COVID-19: A systematic review and meta analysis. Front Med (Lausanne) [Internet]. 2021; 8:719472. Available from: http://dx.doi.org/10.3389/fmed.2021.719472
Pinto GRSP, Sousa HM de S, Cunha MAC, Melo MMCM, Teixeira CVPT, Moura IE dos SM, et al. Aspectos gerais das técnicas laboratoriais para o diagnóstico da COVID-19. Res Soc Dev [Internet]. 2020;9(9):e804997845. Available from: http://dx.doi. org/10.33448/rsd-v9i9.7845
Carvalho EB de, Leite TRS, Sacramento RF de M, Nascimento PRL do, Samary C dos S, Rocco PRM, et al. Justificativa e limitações da SpO2/FiO2 como possível substituta da PaO2/FiO2 em diferentes cenários pré-clínicos e clínicos. Rev Bras Ter Intensiva [Internet]. 2022;34(1). Available from: http://dx.doi.org/10.5935/0103-507x.20220013-pt
Moreno RP, Nassar AP. APACHE II é uma ferramenta útil para pesquisa clínica? Revista Brasileira de Terapia Intensiva. 2017; 29:264–7.
Peruzzo MB, Nakamura MR, Viana L, Cristelli M, Tedesco-Silva H. Capacidade preditiva de escores de gravidade e desfechos para mortalidade em receptores de transplante renal com doença por coronavírus 2019 internados na unidade de terapia intensiva: resultados de um estudo brasileiro de coorte unicêntrico. Revista Brasileira de Nefrologia. 2022;44(3):383–94.
Kurtz P, Bastos L, Salluh J, Bozza FA, Soares MD. Desempenho do SAPS-3 para predição de mortalidade hospitalar em 30.571 pacientes com COVID-19 internados em UTIs no Brasil. Medicina intensiva.
Ostermann M, Lumlertgul N, Forni LG, Hoste E, Ng JJ, Luo Y, et al. Acute kidney injury in hospitalized patients with coronavirus disease 2019 (COVID-19): A meta-analysis. Journal of Infection Journal of Infection. 2020;60(4):647–79.
Ng JJ, Luo Y, Phua K, Choong AMTL. Acute kidney injury in hospitalized patients with coronavirus disease 2019 (COVID-19): A meta-analysis. Journal of Infection. Journal of Infection; 2020;81(4):647–79.
Chan L, Chaudhary K, Saha A, Chauhan K, Vaid A, Zhao S, et al. AKI in hospitalized patients with COVID-19. J Am Soc Nephrol [Internet]. 2021;32(1):151–60. Available from: http://dx.doi.org/10.1681/ASN.2020050615.
Gupta S, Coca SG, Chan L, Melamed ML, Brenner SK, Hayek SS, et al. AKI treated with renal replacement therapy in critically ill patients with COVID-19. J Am Soc Nephrol [Internet]. 2021;32(1):161–76. Available from: http://dx.doi.org/10.1681/ASN.2020060897.
Costa RL da, Sória TC, Salles EF, Gerecht AV, Corvisier MF, Menezes MA de M, et al. Acute kidney injury in patients with Covid-19 in a Brazilian ICU: incidence, predictors and in-hospital mortality. J Bras Nefrol [Internet]. 2021;43(3):349–58. Available from: http:// dx.doi.org/10.1590/2175-8239-JBN-2020-0144.
Pontes L, Danski MTR, Piubello SMN, Pereira J de FG, Jantsch LB, Costa LB, et al. Perfil clínico e fatores associados ao óbito de pacientes COVID-19 nos primeiros meses da pandemia. Esc Anna Nery [Internet]. 2022;26. Available from: http://dx.doi. org/10.1590/2177-9465-ean-2021-0203
Athanazio J. Lesão renal aguda em pacientes com COVID-19 atendidos em uma UTI do interior paulista. In: São Paulo (SP): Unisagrado. 2021.
Bezerra R. Perfil clínico e desfechos de pacientes criticamente doentes com lesão renal aguda infectados pelo SARS-CoV-2: um estudo observacional. Recife (PE); 2022.
Santos DDS, Silva JIB da, Melo IA de, Marques CR de G, Ribeiro HDL, Santos ES. ASSOCIAÇÃO DA LESÃO RENAL AGUDA COM DESFECHOS CLÍNICOS DE PACIENTES EM UNIDADE DE TERAPIA INTENSIVA. Cogitare Enferm [Internet]. 2021;26. Available from: http://dx.doi.org/10.5380/ce.v26i0.73926.
Charytan DM, Parnia S, Khatri M, Petrilli CM, Jones S, Benstein J. Decreasing Incidence of Acute Kidney Injury in Patients with COVID-19 Critical Illness in New York City. Kidney International Reports. Kidney International Reports Kidney International Reports. 2021;6(4):916–27.
Oliveira JKL de, Figueiredo VM, Oliveira KCL de, Alkas PG de C, González YLL. Perfil clínico-epidemiológico de pacientes cirróticos internados em hospital público de referência do estado de Roraima. Revista Saúde & Diversidade [Internet]. 2020 [cited 2023 Jun 22];4(2):80–3. Available from: https://revista.ufrr.br/hd/article/view/7536.
Sottocornola SF, Silva RR da, Barbosa SJ, Queiroz AGS, Souza RZ de, Bulgarelli ÉMN. Terapia de substituição renal em pacientes acometidos pela Covid-19 em uma Unidade de Terapia Intensiva no interior de Rondônia. Res Soc Dev [Internet]. 2021;10(17):e188101723921. Available from: http://dx.doi.org/10.33448/rsd-v10i17.23921.
Carvalho LF, Paula TCGQ de, Peixoto VS. Lesão renal aguda em pacientes diagnosticados com COVID-19 em uma UTI do sudoeste goiano. Res Soc Dev [Internet]. 2021;10(17):e157101724492. Available from: http://dx.doi.org/10.33448/rsd-v10i17.24492.
Cui Y, Tian M, Huang D, Wang X, Huang Y, Fan L, et al. A 55-day-old female infant infected with 2019 novel Coronavirus disease: Presenting with pneumonia, liver injury, and heart damage. J Infect Dis [Internet]. 2020 [cited 2023 Jun 22];221(11):1775–81. Available from: https://academic.oup.com/jid/article/221/11/1775/5807961?login=true
Ranzani OT, Bastos L, Gelli J, Marchesi JF, Baião F, Hamacher S. Characterisation of the first 250000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data. The Lancet Respiratory Medicine. 2021.
Oliveira M, Lima A, Caliari L, Vieira CC, Paste AA, Souza LE. Caracterização dos pacientes que evoluíram com lesão renal aguda no hospital de referência para Covid-19 no Estado da Bahia em 2020. The Brazilian Journal of Infectious Diseases. The Brazilian Journal of Infectious Diseases. 2022;26.
Noronha Kvm De S, Guedes GR, Turra CM, Andrade MV, Botega L, Nogueira D. The COVID-19 pandemic in Brazil: analysis of supply and demand of hospital and ICU beds and mechanical ventilators under different scenarios. Cadernos de Saúde Pública. 36.
Rache B, Rocha R, Nunes L, Spinola P, Malik AN, Massuda A. Necessidades de Infraestrutura do SUS em Preparo ao Covid-19: Leitos de UTI, Respiradores e Ocupação Hospitalar. Instituto de Estudos para Políticas de Saúde. 2020.
Costa DCAR, Bahia L, Carvalho EMCL de, Cardoso AM, Souza PMS. Oferta pública e privada de leitos e acesso aos cuidados à saúde na pandemia de Covid-19 no Brasil. Saúde em Debate [Internet].2020[cited2021Dec12];44(spe4):23247.
Nisula S, Kaukonen K-M, Vaara ST, Korhonen A-M, Poukkanen M, Karlsson S, et al. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med [Internet]. 2013;39(3):420–8. Available from: http://dx.doi.org/10.1007/s00134-012-2796-5
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