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Abstract: PO0039

Volume Balance and AKI in Critically Ill Patients with SARS-CoV-2

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Gunning, Samantha, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • La, Ashley, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • Hung, Anthony, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • Rubin, Daniel S., University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • Koyner, Jay L., University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
Background

Evidence from the management of critically ill patients suggests restrictive volume management strategies and avoidance of volume overload improve ICU outcomes. Restrictive practices have been applied to the management of patients with SARS-CoV-2 (COVID-19), but data describing volume management and its associated outcomes in those with and without acute kidney injury (AKI) in this setting are lacking.

Methods

We conducted a single-center retrospective cohort study of ICU patients with COVID-19. 7-day cumulative volume balance from ICU admission in excess of -5% (negative balance) or +5% (positive balance) of ICU admission weight as well as AKI based on KDIGO guidelines were identified. Associations between volume balance, AKI and clinical outcomes (dialysis, mechanical ventilation, and inpatient mortality) were explored.

Results

194 of 374 ICU admissions (51.9%) had AKI with 60 of 374 (194) (16.0%, 30.9% of those with AKI) requiring dialysis. 110 of 374 (29.4%) developed negative balance and 40 of 374 (10.7%) developed positive balance. Inpatient mortality was higher in those with AKI and negative balance (28%) and positive balance (35%) compared to those with neutral balance (16%) (p=0.039). Of the subjects with negative balance (Table), despite no difference in their net volume balance, inpatient mortality was significantly higher in those with AKI compared to those without AKI (p=0.048). Using the Kaplan-Meier estimator, patients with no AKI had no difference in inpatient survival when compared on the basis of volume balance (p=0.69). However, in those with AKI, inpatient survival was significantly lower for positive and negative volume balance compared to neutral balance (p=0.01).

Conclusion

Negative and positive volume balance are associated with higher inpatient mortality particularly in patients with AKI. Future research must investigate the impact of negative balance on morbidity and mortality in patients with and without AKI.

Outcomes of ICU Patients with Negative Balance by AKI Status
 AKI (N=68)No AKI (N=42)p-value
Cumulative 7-Day Fluid Balance (L), Median (IQR)-6.1 (-7.7, -4.0)-6.1 (-7.8, -5.3)0.30
AKI-D25 (37%)  
Mechanical Ventilation29 (43%)11 (26%)0.081
Days of Mechanical Ventilation, Mean (SD)5.4 (3.4)6.3 (4.1)0.50
Mortality19 (28%)5 (12%)0.048