Epidemiology and outcomes of early-onset AKI in COVID-19-related ARDS in comparison with non-COVID-19-related ARDS: insights from two prospective global cohort studies

Critical Care

Research

John Laffey¹  Bairbre A. McNicholas¹  Daniel Brodie²  Pauline Yeung³  Sankalp Khanna⁴  Jacky Y. Suen⁵  John F. Fraser⁵  Gianluigi Li Bassi⁵  Giacomo Bellani⁶  Emanuele Rezoagli⁶  Andrew J. Simpkin⁷  Tai Pham⁸ 

[1] Department of Anaesthesia and Intensive Care Medicine, School of Medicine, Clinical Sciences Institute, University of Galway, Galway University Hospital, Saolta Hospital Group, H91 YR71, Galway, Ireland;School of Medicine, University of Galway, Galway, Ireland;Department of Medicine, Columbia College of Physicians and Surgeons, and Center for Acute Respiratory Failure, New-York-Presbyterian Hospital, New York, NY, USA;Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong, Hong Kong, China;Queensland University of Technology, Brisbane, Australia;CSIRO Australian e-Health Research Centre AU, Herston, Australia;Queensland University of Technology, Brisbane, Australia;University of Queensland, Brisbane, Australia;School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy;Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy;School of Medicine, University of Galway, Galway, Ireland;Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France;UVSQ, Inserm U1018, Equipe d’Epidémiologie Respiratoire Intégrative, Université Paris-Saclay, Villejuif, France;

关键词: Acute kidney injury;    Cohort study;    COVID-19;    28-day mortality;    90-day mortality;    Outcome;    ARDS;   

DOI  :  10.1186/s13054-022-04294-5

 received in 2022-09-13, accepted in 2022-12-25,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundAcute kidney injury (AKI) is a frequent and severe complication of both COVID-19-related acute respiratory distress syndrome (ARDS) and non-COVID-19-related ARDS. The COVID-19 Critical Care Consortium (CCCC) has generated a global data set on the demographics, management and outcomes of critically ill COVID-19 patients. The LUNG-SAFE study was an international prospective cohort study of patients with severe respiratory failure, including ARDS, which pre-dated the pandemic.MethodsThe incidence, demographic profile, management and outcomes of early AKI in patients undergoing invasive mechanical ventilation for COVID-19-related ARDS were described and compared with AKI in a non-COVID-19-related ARDS cohort.ResultsOf 18,964 patients in the CCCC data set, 1699 patients with COVID-19-related ARDS required invasive ventilation and had relevant outcome data. Of these, 110 (6.5%) had stage 1, 94 (5.5%) had stage 2, 151 (8.9%) had stage 3 AKI, while 1214 (79.1%) had no AKI within 48 h of initiating invasive mechanical ventilation. Patients developing AKI were older and more likely to have hypertension or chronic cardiac disease. There were geo-economic differences in the incidence of AKI, with lower incidence of stage 3 AKI in European high-income countries and a higher incidence in patients from middle-income countries. Both 28-day and 90-day mortality risk was increased for patients with stage 2 (HR 2.00, p < 0.001) and stage 3 AKI (HR 1.95, p < 0.001). Compared to non-COVID-19 ARDS, the incidence of shock was reduced with lower cardiovascular SOFA score across all patient groups, while hospital mortality was worse in all groups [no AKI (30 vs 50%), Stage 1 (38 vs 58%), Stage 2 (56 vs 74%), and Stage 3 (52 vs 72%), p < 0.001]. The time profile of onset of AKI also differed, with 56% of all AKI occurring in the first 48 h in patients with COVID-19 ARDS compared to 89% in the non-COVID-19 ARDS population.ConclusionAKI is a common and serious complication of COVID-19, with a high mortality rate, which differs by geo-economic location. Important differences exist in the profile of AKI in COVID-19 versus non-COVID-19 ARDS in terms of their haemodynamic profile, time of onset and clinical outcomes.

【 授权许可】

CC BY   
© The Author(s) 2023

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