期刊论文详细信息
Critical Care
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
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
PDF
【 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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