Abstract: PO0038
Dexamethasone Reduces AKI in Critical COVID-19 Patients
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
- 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.