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Abstract: PO0683

Association of Ventilatory Time and AKI in a Bronx Cohort of COVID-19 Patients

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Basalely, Abby Miriam, Children's Hospital at Montefiore, Bronx, New York, United States
  • Liu, Diane, Children's Hospital at Montefiore, Bronx, New York, United States
  • Fisher, Molly, Montefiore Medical Center, Bronx, New York, United States
  • Golestaneh, Ladan, Montefiore Medical Center, Bronx, New York, United States
  • Bellin, Eran Y., Montefiore Medical Center, Bronx, New York, United States
  • Reidy, Kimberly J., Children's Hospital at Montefiore, Bronx, New York, United States
Background

The relationship of lung-kidney interactions in COVID19 has not been well described. AKI has been associated with increased mechanical ventilation times. Recent publications have shown a strong association of COVID19-AKI with mortality and a high incidence of AKI occurring peri-intubation. We hypothesized that mechanical ventilation (MV) time would be increased in patients with COVID19-AKI and longer in those with severe AKI.

Methods

We analyzed a cohort of incident COVID19 patients who required MV. Patients with end stage renal disease were excluded . AKI was defined using KDIGO criteria (0.3 mg/dL increase or greater than a 50% increase from the baseline Cr) between the maximum Cr and baseline Cr. AKI stage was defined by KDIGO criteria. Days of total MV was measured in days from date of initial intubation, including subsequent intubation/extubation events, until successful extubation or death. Censored data was not included. Linear regression models were utilized to evaluate associations.

Results

We analyzed 318 patients. 62% were male, 37% were black/African American and 33% were Hispanic/Latino. Hypertension was prevalent in the cohort (N=212) and over 50% were obese. Median MV time was 4.67 days (IQR 1.76, 9.95). AKI occurred in 89% (N=283) of the cohort. Stage 3 AKI developed in over 50% (N=161) of patients. In models adjusted for age, hypertension, diabetes and disease related group weight, patients with AKI had 3.46 more days of MV, however this finding did not reach statistical significance (95%CI 0.92-6.00). This association however was significant and increased linearly with stage of AKI (p for trend <0.001).

Conclusion

This is one of the first studies to evaluate the association of COVID19-AKI and MV time. Even after adjusting for severity of illness, patients with increased stage of AKI had longer MV times. This may be due to pathophysiologic kidney-lung interactions seen in non-COVID19 disease and/or direct effect of COVID19 on the kidneys. As few patients in our cohort were spared from kidney injury, inferences comparing those with and without AKI are difficult to discern. We plan to explore this question in a larger cohort to determine whether COVID19-AKI alone is associated with ventilatory time.

Funding

  • NIDDK Support