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Article: 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

TitleEpidemiology 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
Authors
Keywords28-day mortality
90-day mortality
Acute kidney injury
ARDS
Cohort study
COVID-19
Outcome
Issue Date5-Jan-2023
PublisherBioMed Central
Citation
Critical Care, 2023, v. 27, n. 1 How to Cite?
Abstract

Background

Acute 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.

Methods

The 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.

Results

Of 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.

Conclusion

AKI 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.


Persistent Identifierhttp://hdl.handle.net/10722/331022
ISSN
2023 Impact Factor: 8.8
2023 SCImago Journal Rankings: 2.975
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorMcNicholas, BA-
dc.contributor.authorRezoagli, E-
dc.contributor.authorSimpkin, AJ-
dc.contributor.authorKhanna, S-
dc.contributor.authorSuen, JY-
dc.contributor.authorYeung, PLE-
dc.contributor.authorBrodie, D-
dc.contributor.authorLi Bassi, G-
dc.contributor.authorPham, T-
dc.contributor.authorBellani, G-
dc.contributor.authorFraser, JF-
dc.contributor.authorLaffey, J-
dc.date.accessioned2023-09-21T06:52:04Z-
dc.date.available2023-09-21T06:52:04Z-
dc.date.issued2023-01-05-
dc.identifier.citationCritical Care, 2023, v. 27, n. 1-
dc.identifier.issn1364-8535-
dc.identifier.urihttp://hdl.handle.net/10722/331022-
dc.description.abstract<h3>Background</h3><p>Acute 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.</p><h3>Methods</h3><p>The 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.</p><h3>Results</h3><p>Of 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, <em>p</em> < 0.001) and stage 3 AKI (HR 1.95, <em>p</em> < 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%), <em>p</em> < 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.</p><h3>Conclusion</h3><p>AKI 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.</p>-
dc.languageeng-
dc.publisherBioMed Central-
dc.relation.ispartofCritical Care-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subject28-day mortality-
dc.subject90-day mortality-
dc.subjectAcute kidney injury-
dc.subjectARDS-
dc.subjectCohort study-
dc.subjectCOVID-19-
dc.subjectOutcome-
dc.titleEpidemiology 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-
dc.typeArticle-
dc.identifier.doi10.1186/s13054-022-04294-5-
dc.identifier.scopuseid_2-s2.0-85145645342-
dc.identifier.volume27-
dc.identifier.issue1-
dc.identifier.eissn1466-609X-
dc.identifier.isiWOS:000909466800001-
dc.identifier.issnl1364-8535-

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