Acute Kidney Injury in Critical Care COVID-19 Patients on Invasive Mechanical Ventilation: The Potential Preventive Role of Dexamethasone.

Juan M Mejia-Vilet, Noemi Del Toro-Cisneros, Adrián E Caballero-Islas, Armando J Martínez-Rueda, John Hernández-Flores, Jefferson A Proaño-Zamudio, Víctor M Sacoto-Romo, Dheni A Fernández-Camargo, Roque A Comunidad-Bonilla, Megan A Navarro-Gerrard, José R Correa-Rotter, Olynka Vega-Vega
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Abstract

Background: A high incidence of acute kidney injury (AKI) has been reported in coronavirus disease 2019 (COVID-19) patients in critical care units and those undergoing invasive mechanical ventilation (IMV). The introduction of dexamethasone (DXM) as treatment for severe COVID-19 has improved mortality, but its effects in other organs remain under study.

Objective: The objective of this study was to evaluate the association between DXM and AKI in COVID-19.

Methods: In this prospective observational cohort study, we evaluated the incidence of AKI in critically ill COVID-19 patients undergoing mechanical ventilation, and the association of DXM treatment with the incidence, severity, and outcomes of AKI. The association between DXM treatment and AKI was evaluated by multivariable logistic regression. The association of the combination of DXM treatment and AKI on mortality was evaluated by Cox-regression analysis. Results: We included 552 patients. AKI was diagnosed in 311 (56%), of which 196 (63%) corresponded to severe (stage 2 or 3) AKI, and 46 (14.8%) received kidney replacement therapy. Two hundred and sixty-seven (48%) patients were treated with DXM. This treatment was associated to lower incidence of AKI (Odds Radio 0.34, 95% Confidence intervals [CI] 0.22-0.52, p < 0.001) after adjusting for age, body mass index, laboratory parameters, SOFA score, and vasopressor use. DXM treatment significantly reduced mortality in patients with severe AKI (HR 0.63, 95%CI 0.41-0.96, p = 0.032).

Conclusions: The incidence of AKI is high in COVID-19 patients under IMV. DXM treatment is associated with a lower incidence of AKI and a lower mortality in the group with severe AKI.

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重症监护COVID-19患者有创机械通气急性肾损伤:地塞米松的潜在预防作用。
背景:据报道,2019冠状病毒病(COVID-19)重症监护病房和有创机械通气(IMV)患者的急性肾损伤(AKI)发生率很高。引入地塞米松(DXM)治疗重症COVID-19已经降低了死亡率,但其对其他器官的影响仍在研究中。目的:本研究的目的是评估COVID-19患者DXM与AKI之间的关系。方法:在这项前瞻性观察队列研究中,我们评估了机械通气危重症COVID-19患者AKI的发生率,以及DXM治疗与AKI发生率、严重程度和结局的关系。采用多变量logistic回归评估DXM治疗与AKI之间的关系。采用cox回归分析评价DXM联合AKI治疗与死亡率的相关性。结果:纳入552例患者。311例(56%)被诊断为AKI,其中196例(63%)属于重度(2期或3期)AKI, 46例(14.8%)接受了肾脏替代治疗。267例(48%)患者接受了DXM治疗。在调整了年龄、体重指数、实验室参数、SOFA评分和血管加压药的使用后,这种治疗与AKI发生率较低相关(比值比0.34,95%可信区间[CI] 0.22-0.52, p < 0.001)。ddxm治疗可显著降低重症AKI患者的死亡率(HR 0.63, 95%CI 0.41-0.96, p = 0.032)。结论:IMV下新冠肺炎患者AKI发生率较高。ddxm治疗与严重AKI组较低的AKI发生率和较低的死亡率相关。
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来源期刊
CiteScore
3.00
自引率
0.00%
发文量
60
审稿时长
>12 weeks
期刊介绍: The Revista de Investigación Clínica – Clinical and Translational Investigation (RIC-C&TI), publishes original clinical and biomedical research of interest to physicians in internal medicine, surgery, and any of their specialties. The Revista de Investigación Clínica – Clinical and Translational Investigation is the official journal of the National Institutes of Health of Mexico, which comprises a group of Institutes and High Specialty Hospitals belonging to the Ministery of Health. The journal is published both on-line and in printed version, appears bimonthly and publishes peer-reviewed original research articles as well as brief and in-depth reviews. All articles published are open access and can be immediately and permanently free for everyone to read and download. The journal accepts clinical and molecular research articles, short reports and reviews. Types of manuscripts: – Brief Communications – Research Letters – Original Articles – Brief Reviews – In-depth Reviews – Perspectives – Letters to the Editor
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