Abstract: PO0035
Association of Endotoxemia with AKI in Critically Ill Patients with SARS-CoV-2 Infection
Session Information
- COVID-19: AKI and Basic Science
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Khan, Sobia N., Stony Brook University, Stony Brook, New York, United States
- Bolotova, Olena, Stony Brook University, Stony Brook, New York, United States
- Gordon, Chris R., Stony Brook University, Stony Brook, New York, United States
- Mallipattu, Sandeep K., Stony Brook University, Stony Brook, New York, United States
Background
AKI is frequently complicated by sepsis. Endotoxin (lipopolysaccharide), a component of the outer wall of gram-negative bacteria, has been investigated and acknowledged as one of the triggers of lethal shock during sepsis and drivers of cytokine storm. In studies, septic shock was present in 6.4% patients with severe COVID-19, but blood cultures and respiratory cultures were negative in 76%. Initial cohort study of COVID-19 patients from China showed 4.5% developed AKI, subsequent reports showed higher prevalence. While these data suggest that patients with COVID-19 are at risk for septic shock and AKI, mechanisms mediating these processes in the setting of severe coronavirus 2 (SARS-CoV-2) infection remain unclear.
Methods
We conducted a single-center, cross-sectional study in critically ill patients with COVID-19 to test the prevalence of endotoxemia and whether endotoxemia is associated with the development of AKI.
Patients were recruited using criteria: Age ≥ 18yr, MODS ≥ 9, sepsis and intensive care unit admission, excluded if pregnant, requiring chronic dialysis or chronic immunosuppressive medications. Blood endotoxin activity (EA) measured in patients who met the criteria using the FDA-approved Endotoxin Activity Assay (EAA). EAA is a chemiluminescent bio-assay based on the oxidative burst reaction of activated neutrophils to complement coated LPS-IgM immune complexes. Patients divided into low (0.0 – 0.39 EA units), intermediate (0.40 – 0.59 EA units), high (≥ 0.60 EA units), and non-responder (NR) (patients whose neutrophils do not have the ability to respond to preformed immune complexes in the EAA) group based on measurements from the EAA.
Results
In this study, endotoxemia observed in 24/32 (75%) of our critically ill patients with COVID-19, despite only 2 patients having positive blood cultures for gram-negative organisms. The incidence of AKI was higher in the high EA group (7/14, 50%) as compared to intermediate EA group (1/10, 10%), p=0.01. The need for renal replacement therapy (RRT) was higher in the elevated EA group (4/14, 29%), with none of the patients in the intermediate group requiring RRT, p=0.008.
Conclusion
This study demonstrates the high prevalence of endotoxemia in critically ill patients with COVID-19, regardless of presence of bacteremia. We also observed that high EA was associated with AKI and the need for RRT.