Risk Factors of AKI in Acute Respiratory Distress Syndrome: A Time-Dependent Competing Risk Analysis on Severe COVID-19 Patients
Introduction: Acute kidney injury (AKI) is frequently observed in patients with COVID-19 admitted to intensive care units (ICUs). Observational studies suggest that cardiovascular comorbidities and mechanical ventilation (MV) are the most important risk factors for AKI. However, no studies have inve...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-01-01
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| Series: | Canadian Journal of Kidney Health and Disease |
| Online Access: | https://doi.org/10.1177/20543581221145073 |
| _version_ | 1797956918085419008 |
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| author | Antoine Marchiset Valerie Serazin Omar Ben Hadj Salem Claire Pichereau Lionel Lima Da Silva Siu-Ming Au Christophe Barbier Yann Loubieres Jan Hayon Julia Gross Herve Outin Matthieu Jamme |
| author_facet | Antoine Marchiset Valerie Serazin Omar Ben Hadj Salem Claire Pichereau Lionel Lima Da Silva Siu-Ming Au Christophe Barbier Yann Loubieres Jan Hayon Julia Gross Herve Outin Matthieu Jamme |
| author_sort | Antoine Marchiset |
| collection | DOAJ |
| description | Introduction: Acute kidney injury (AKI) is frequently observed in patients with COVID-19 admitted to intensive care units (ICUs). Observational studies suggest that cardiovascular comorbidities and mechanical ventilation (MV) are the most important risk factors for AKI. However, no studies have investigated the renal impact of longitudinal covariates such as drug treatments, biological variations, and/or MV parameters. Methods: We performed a monocentric, prospective, longitudinal analysis to identify the dynamic risk factors for AKI in ICU patients with severe COVID-19. Results: Seventy-seven patients were included in our study (median age: 63 [interquartile range, IQR: 53-73] years; 58 (75%) men). Acute kidney injury was detected in 28 (36.3%) patients and occurred at a median time of 3 [IQR: 2-6] days after ICU admission. Multivariate Cox cause-specific time-dependent analysis identified a history of hypertension (cause-specific hazard (CSH) = 2.46 [95% confidence interval, CI: 1.04-5.84]; P = .04), a high hemodynamic Sequential Organ Failure Assessment score (CSH = 1.63 [95% CI: 1.23-2.16]; P < .001), and elevated Pa co 2 (CSH = 1.2 [95%CI: 1.04-1.39] per 5 mm Hg increase in P co 2 ; P = .02) as independent risk factors for AKI. Concerning the MV parameters, positive end-expiratory pressure (CSH = 1.11 [95% CI: 1.01-1.23] per 1 cm H 2 O increase; P = .04) and the use of neuromuscular blockade (CSH = 2.96 [95% CI: 1.22-7.18]; P = .02) were associated with renal outcome only in univariate analysis but not after adjustment. Conclusion: Acute kidney injury is frequent in patients with severe COVID-19 and is associated with a history of hypertension, the presence of hemodynamic failure, and increased P co 2 . Further studies are necessary to evaluate the impact of hypercapnia on increasing the effects of ischemia, particularly in the most at-risk vascular situations. |
| first_indexed | 2024-04-10T23:56:14Z |
| format | Article |
| id | doaj.art-f9c8e27eaadb4c5db6e304a250f59339 |
| institution | Directory Open Access Journal |
| issn | 2054-3581 |
| language | English |
| last_indexed | 2024-04-10T23:56:14Z |
| publishDate | 2023-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Canadian Journal of Kidney Health and Disease |
| spelling | doaj.art-f9c8e27eaadb4c5db6e304a250f593392023-01-10T13:33:41ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812023-01-011010.1177/20543581221145073Risk Factors of AKI in Acute Respiratory Distress Syndrome: A Time-Dependent Competing Risk Analysis on Severe COVID-19 PatientsAntoine Marchiset0Valerie Serazin1Omar Ben Hadj Salem2Claire Pichereau3Lionel Lima Da Silva4Siu-Ming Au5Christophe Barbier6Yann Loubieres7Jan Hayon8Julia Gross9Herve Outin10Matthieu Jamme11Médecine intensive - Réanimation, Centre hospitalier de Poissy - Saint Germain en Laye, Poissy, FranceLaboratoire de biologie, Centre hospitalier de Poissy - Saint Germain en Laye, Poissy, FranceMédecine intensive - Réanimation, Centre hospitalier de Poissy - Saint Germain en Laye, Poissy, FranceMédecine intensive - Réanimation, Centre hospitalier de Poissy - Saint Germain en Laye, Poissy, FranceMédecine intensive - Réanimation, Centre hospitalier de Poissy - Saint Germain en Laye, Poissy, FranceMédecine intensive - Réanimation, Centre hospitalier de Poissy - Saint Germain en Laye, Poissy, FranceMédecine intensive - Réanimation, Centre hospitalier de Poissy - Saint Germain en Laye, Poissy, FranceMédecine intensive - Réanimation, Centre hospitalier de Poissy - Saint Germain en Laye, Poissy, FranceMédecine intensive - Réanimation, Centre hospitalier de Poissy - Saint Germain en Laye, Poissy, FranceMédecine intensive - Réanimation, Centre hospitalier de Poissy - Saint Germain en Laye, Poissy, FranceMédecine intensive - Réanimation, Centre hospitalier de Poissy - Saint Germain en Laye, Poissy, FranceRéanimation et Unité de Soins Continus, Hôpital privé de l’Ouest Parisien, Ramsay Générale de santé, Trappes, FranceIntroduction: Acute kidney injury (AKI) is frequently observed in patients with COVID-19 admitted to intensive care units (ICUs). Observational studies suggest that cardiovascular comorbidities and mechanical ventilation (MV) are the most important risk factors for AKI. However, no studies have investigated the renal impact of longitudinal covariates such as drug treatments, biological variations, and/or MV parameters. Methods: We performed a monocentric, prospective, longitudinal analysis to identify the dynamic risk factors for AKI in ICU patients with severe COVID-19. Results: Seventy-seven patients were included in our study (median age: 63 [interquartile range, IQR: 53-73] years; 58 (75%) men). Acute kidney injury was detected in 28 (36.3%) patients and occurred at a median time of 3 [IQR: 2-6] days after ICU admission. Multivariate Cox cause-specific time-dependent analysis identified a history of hypertension (cause-specific hazard (CSH) = 2.46 [95% confidence interval, CI: 1.04-5.84]; P = .04), a high hemodynamic Sequential Organ Failure Assessment score (CSH = 1.63 [95% CI: 1.23-2.16]; P < .001), and elevated Pa co 2 (CSH = 1.2 [95%CI: 1.04-1.39] per 5 mm Hg increase in P co 2 ; P = .02) as independent risk factors for AKI. Concerning the MV parameters, positive end-expiratory pressure (CSH = 1.11 [95% CI: 1.01-1.23] per 1 cm H 2 O increase; P = .04) and the use of neuromuscular blockade (CSH = 2.96 [95% CI: 1.22-7.18]; P = .02) were associated with renal outcome only in univariate analysis but not after adjustment. Conclusion: Acute kidney injury is frequent in patients with severe COVID-19 and is associated with a history of hypertension, the presence of hemodynamic failure, and increased P co 2 . Further studies are necessary to evaluate the impact of hypercapnia on increasing the effects of ischemia, particularly in the most at-risk vascular situations.https://doi.org/10.1177/20543581221145073 |
| spellingShingle | Antoine Marchiset Valerie Serazin Omar Ben Hadj Salem Claire Pichereau Lionel Lima Da Silva Siu-Ming Au Christophe Barbier Yann Loubieres Jan Hayon Julia Gross Herve Outin Matthieu Jamme Risk Factors of AKI in Acute Respiratory Distress Syndrome: A Time-Dependent Competing Risk Analysis on Severe COVID-19 Patients Canadian Journal of Kidney Health and Disease |
| title | Risk Factors of AKI in Acute Respiratory Distress Syndrome: A Time-Dependent Competing Risk Analysis on Severe COVID-19 Patients |
| title_full | Risk Factors of AKI in Acute Respiratory Distress Syndrome: A Time-Dependent Competing Risk Analysis on Severe COVID-19 Patients |
| title_fullStr | Risk Factors of AKI in Acute Respiratory Distress Syndrome: A Time-Dependent Competing Risk Analysis on Severe COVID-19 Patients |
| title_full_unstemmed | Risk Factors of AKI in Acute Respiratory Distress Syndrome: A Time-Dependent Competing Risk Analysis on Severe COVID-19 Patients |
| title_short | Risk Factors of AKI in Acute Respiratory Distress Syndrome: A Time-Dependent Competing Risk Analysis on Severe COVID-19 Patients |
| title_sort | risk factors of aki in acute respiratory distress syndrome a time dependent competing risk analysis on severe covid 19 patients |
| url | https://doi.org/10.1177/20543581221145073 |
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