Acute Kidney Injury in Critical Care COVID-19 Patients on Invasive Mechanical Ventilation: The Potential Preventive Role of Dexamethasone
Abstract Background. A high incidence of acute kidney injury (AKI) has been reported in COVID-19 patients in critical care units and those undergoing invasive mechanical ventilation (IMV). The introduction of dexamethasone as treatment for severe COVID-19 has improved mortality, but its effects in other organs remain under study. 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 dexamethasone treatment with the incidence, severity, and outcomes of AKI. The association between dexamethasone treatment and AKI was evaluated by multivariate logistic regression. The association of the combination of dexamethasone 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 renal replacement therapy (RRT). Two hundred and sixty-seven (48%) patients were treated with dexamethasone. This treatment was associated to lower incidence of AKI (OR 0.34, 95%CI 0.22-0.52, p<0.001) after adjusting for age, body mass index, laboratory parameters, SOFA score, and vasopressor use. Dexamethasone 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. Dexamethasone treatment is associated with a lower incidence of AKI and a lower mortality in the group with severe AKI..
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Preprint| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
ResearchSquare.com - (2022) vom: 07. Jan. Zur Gesamtaufnahme - year:2022 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
Vega, Olynka Vega [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| doi: |
10.21203/rs.3.rs-1238066/v1 |
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| PPN (Katalog-ID): |
XRA034932070 |
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| 520 | |a Abstract Background. A high incidence of acute kidney injury (AKI) has been reported in COVID-19 patients in critical care units and those undergoing invasive mechanical ventilation (IMV). The introduction of dexamethasone as treatment for severe COVID-19 has improved mortality, but its effects in other organs remain under study. 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 dexamethasone treatment with the incidence, severity, and outcomes of AKI. The association between dexamethasone treatment and AKI was evaluated by multivariate logistic regression. The association of the combination of dexamethasone 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 renal replacement therapy (RRT). Two hundred and sixty-seven (48%) patients were treated with dexamethasone. This treatment was associated to lower incidence of AKI (OR 0.34, 95%CI 0.22-0.52, p<0.001) after adjusting for age, body mass index, laboratory parameters, SOFA score, and vasopressor use. Dexamethasone 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. Dexamethasone treatment is associated with a lower incidence of AKI and a lower mortality in the group with severe AKI. | ||
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