Acute kidney injury in critical care COVID-19 patients on invasive mechanical ventilation: the potential preventive role of dexamethasone
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 mortali...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Permanyer
2023-04-01
|
| Series: | Revista de Investigación Clínica |
| Subjects: | |
| Online Access: | https://www.clinicalandtranslationalinvestigation.com/frame_esp.php?id=458 |
| _version_ | 1827943998556209152 |
|---|---|
| author | Juan M. Mejía-Vilet Noemí 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 Ricardo Correa-Rotter Olynka Vega-Vega |
| author_facet | Juan M. Mejía-Vilet Noemí 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 Ricardo Correa-Rotter Olynka Vega-Vega |
| author_sort | Juan M. Mejía-Vilet |
| collection | DOAJ |
| description | 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.
|
| first_indexed | 2024-03-13T10:23:46Z |
| format | Article |
| id | doaj.art-56bbe91d999a46fd824ffdf1cd149683 |
| institution | Directory Open Access Journal |
| issn | 0034-8376 2564-8896 |
| language | English |
| last_indexed | 2024-03-13T10:23:46Z |
| publishDate | 2023-04-01 |
| publisher | Permanyer |
| record_format | Article |
| series | Revista de Investigación Clínica |
| spelling | doaj.art-56bbe91d999a46fd824ffdf1cd1496832023-05-19T18:29:12ZengPermanyerRevista de Investigación Clínica0034-83762564-88962023-04-0175210.24875/RIC.23000034Acute kidney injury in critical care COVID-19 patients on invasive mechanical ventilation: the potential preventive role of dexamethasoneJuan M. Mejía-Vilet0Noemí Del Toro-Cisneros1Adrián E. Caballero-Islas2Armando J. Martínez-Rueda3John Hernández-Flores4Jefferson A. Proaño-Zamudio5Víctor M. Sacoto-Romo6Dheni A. Fernández-Camargo7Roque A. Comunidad-Bonilla8Megan A. Navarro-Gerrard9Ricardo Correa-Rotter10Olynka Vega-Vega11Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoBackground: 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. https://www.clinicalandtranslationalinvestigation.com/frame_esp.php?id=458Acute kidney injury. COVID-19. Invasive mechanical ventilation. Dexamethasone. Mortality. |
| spellingShingle | Juan M. Mejía-Vilet Noemí 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 Ricardo Correa-Rotter Olynka Vega-Vega Acute kidney injury in critical care COVID-19 patients on invasive mechanical ventilation: the potential preventive role of dexamethasone Revista de Investigación Clínica Acute kidney injury. COVID-19. Invasive mechanical ventilation. Dexamethasone. Mortality. |
| title | Acute kidney injury in critical care COVID-19 patients on invasive mechanical ventilation: the potential preventive role of dexamethasone |
| title_full | Acute kidney injury in critical care COVID-19 patients on invasive mechanical ventilation: the potential preventive role of dexamethasone |
| title_fullStr | Acute kidney injury in critical care COVID-19 patients on invasive mechanical ventilation: the potential preventive role of dexamethasone |
| title_full_unstemmed | Acute kidney injury in critical care COVID-19 patients on invasive mechanical ventilation: the potential preventive role of dexamethasone |
| title_short | Acute kidney injury in critical care COVID-19 patients on invasive mechanical ventilation: the potential preventive role of dexamethasone |
| title_sort | acute kidney injury in critical care covid 19 patients on invasive mechanical ventilation the potential preventive role of dexamethasone |
| topic | Acute kidney injury. COVID-19. Invasive mechanical ventilation. Dexamethasone. Mortality. |
| url | https://www.clinicalandtranslationalinvestigation.com/frame_esp.php?id=458 |
| work_keys_str_mv | AT juanmmejiavilet acutekidneyinjuryincriticalcarecovid19patientsoninvasivemechanicalventilationthepotentialpreventiveroleofdexamethasone AT noemideltorocisneros acutekidneyinjuryincriticalcarecovid19patientsoninvasivemechanicalventilationthepotentialpreventiveroleofdexamethasone AT adrianecaballeroislas acutekidneyinjuryincriticalcarecovid19patientsoninvasivemechanicalventilationthepotentialpreventiveroleofdexamethasone AT armandojmartinezrueda acutekidneyinjuryincriticalcarecovid19patientsoninvasivemechanicalventilationthepotentialpreventiveroleofdexamethasone AT johnhernandezflores acutekidneyinjuryincriticalcarecovid19patientsoninvasivemechanicalventilationthepotentialpreventiveroleofdexamethasone AT jeffersonaproanozamudio acutekidneyinjuryincriticalcarecovid19patientsoninvasivemechanicalventilationthepotentialpreventiveroleofdexamethasone AT victormsacotoromo acutekidneyinjuryincriticalcarecovid19patientsoninvasivemechanicalventilationthepotentialpreventiveroleofdexamethasone AT dheniafernandezcamargo acutekidneyinjuryincriticalcarecovid19patientsoninvasivemechanicalventilationthepotentialpreventiveroleofdexamethasone AT roqueacomunidadbonilla acutekidneyinjuryincriticalcarecovid19patientsoninvasivemechanicalventilationthepotentialpreventiveroleofdexamethasone AT megananavarrogerrard acutekidneyinjuryincriticalcarecovid19patientsoninvasivemechanicalventilationthepotentialpreventiveroleofdexamethasone AT ricardocorrearotter acutekidneyinjuryincriticalcarecovid19patientsoninvasivemechanicalventilationthepotentialpreventiveroleofdexamethasone AT olynkavegavega acutekidneyinjuryincriticalcarecovid19patientsoninvasivemechanicalventilationthepotentialpreventiveroleofdexamethasone |