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Abstract: PO0038

Dexamethasone Reduces AKI in Critical COVID-19 Patients

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Del Toro-Cisneros, Noemi, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  • Mejia, Juan M., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  • Caballero-Islas, Adrián Esteban, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  • Martinez-Rueda, Armando Jezael, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  • Hernandez Flores, John, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  • Proaño Zamudio, Jefferson Alejandro, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  • Sacoto, Victor Miguel, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  • Gerrard, Megan Ashley Navarro, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  • Comunidad Bonilla, Roque Armando, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  • Correa-Rotter, Ricardo, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  • Vega, Olynka, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
Background

More than 50% of severe COVID-19 patients develop acute kidney injury (AKI) and a high percentage of them will require renal replacement therapy (RRT). The aims of this study were to identify AKI prevalence and associated factors in patients with COVID-19 and invasive mechanical ventilation (IMV).

Methods

Prospective cohort analysis of all COVID-19 patients with IMV, admitted to our Institute in Mexico City (Mar 2020 - Jan 2021). AKI was defined according to KDIGO guidelines. Patients with CKD stages 4 or 5 were excluded. Demographic, clinical, laboratory, and treatment variables were registered. AKI development was analyzed by uni- and multivariate logistic regression, mortality by survival analysis.

Results

Of 552 COVID-19 patients, AKI was detected in 196 (35.5%). Among AKI; 80 (40.8%) were Stage 2, and 116 (59.2%) Stage 3. The incidence of each AKI stage was lower in patients treated with dexamethasone (DEXA, Fig. 1A) and decreased the requirement of RRT (30 vs 16, p=0.05). For the multivariate analysis, AKI was grouped into no AKI/Stage1 and Stage 2/3 AKI; DEXA treatment was associated with less AKI incidence (OR 0.34, 95%CI 0.23-0.51) and lower mortality in the adjusted Cox-regression analysis (Fig. 1B).

Conclusion

AKI is associated with increased mortality in COVID-19 patients with IMV. The use of DEXA is associated with lower AKI severity and lower mortality.

Table 1: Characteristics and in-hospital outcomes for AKI vs no AKI.
 All (N=552)No-AKI (N=356)AKI (N=196)P value
Age (yr), median (IQR)53 (44-63)53 (41-62)54 (46-64)0.03
Male, n (%)397 (72)167 (69)230 (74)0.56
Comorbidities, n (%)
Diabetes mellitus
Hypertension
151 (27.4)
152 (27.6)
93 (26)
90 (25.4)
58 (29.6)
62 (31.6)
0.38
0.11
BMI (kg/m2), median (IQR)30.1 (27.3-34.1)29.7 (27.1-33.2)30.9 (27.5-35.4)0.45
PCR (mg/dL)
Ferritin (mg/dL)
PaO2/FiO2 ratio
19.2 (12.3-28.5)
794 (458-1300)
107 (82-147)
18.9 (10.8-25.7)
763 (459-1281)
105 (83-144.8)
21.1 (13.9-30)
790 (459-1344)
105.5 (76-144.8)
0.48
0.57
0.52
Dexamethasone, n (%)267 (48.4)201 (56.5)66 (35.5)<0.01
SOFA ICU, median (IQR)4 (4-6)4 (4-6)5 (4-7)<0.01
Mortality, n (%)215 (39)107 (49.8)108 (55)<0.01

Figure 1: A. AKI development according to DEXA use. B. Mortality according DEXA use.