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Abstract: FR-PO023

Role of Urinary IL-6 (uIL-6) and Mechanical Ventilation (MV) Parameters in the Development of AKI in Severely Ill Patients With SARS-CoV-2

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Escamilla-Illescas, David, Medica Sur, Ciudad de Mexico, Distrito Federal, Mexico
  • Casas-Aparicio, Gustavo Alejandro, Instituto Nacional de Enfermedades Respiratorias, Mexico, DF, Mexico
Background

MV Parameters and biomarkers have been associated with the development of AKI in patients with ARDS due to SARS-COV-2. The objective was to analyze these factors in patients who required early MV (<6 hours from hospital admission).

Methods

Single center, prospectively study, conducted at the National Institute of Respiratory Diseases (INER) in Mexico City. We included patients with Pneumonia caused by SARS-COV-2 confirmed by rPCR who require early MV in September 2021. We recorded MV parameters and took a urine sample for measurement of IL-6 by ELISA immediately after the start of MV. Clinical and laboratories data was gathered from medical file. Patients were followed up during hospitalization to analyze outcomes. We define AKI according to KDIGO criteria using only serum creatinine.
We used chi-squared and Mann Whitney-U test as appropriate, to compare variables between patients who developed AKI and those who did not. We calculated the area under the curve (AUC) for IL-6 and stablished a sensibility and specificity balanced cut-off point. We performed a multivariate logistic regression.

Results

We included 45 patients with a median age of 57 years-old, 66.7% were men. Plateau Pressure (PP), Peak Inspiratory Pressure (PIP), Driving Pressure (DP) and Static Compliance (SC) as well as uIL-6 were higher in the group with AKI. The AUC for uIL-6 was 0.819 (95% CI: 0.687-0.951; p <0.01), the cutoff with the best accuracy was 1.5 pg/mL. The results of univariate and multivariate logistic regression are show in table 1.

Conclusion

Higher levels of uIL-6 and PP in patients who require early MV were associated to development of AKI during hospitalization. Pulmonary inflammation and stiffness may play a role in the development of AKI.

Univariate and multivariate analysis for AKI
VariablesUnadjusted OR (95% CI)pAdjusted OR (95% CI)p
Age1.02 (0.99-1.06)0.161.03 (0.97-1.09)0.25
Male1.51 (0.43-5.310.525.68 (0.57-56.10)0.13
u-IL-6 > 1.5 pg/mL7.27 (1.69-31.25)0.019.33 (1.04-83.46)0.04
Plateau Pressure1.23 (1.04-1.45)0.013.04 (1.004-9.2)0.04
Driving Pressure1.21 (1.03-1.43)0.020.92 (0.55-1.53)0.75
Static Compliance0.93 (0.87-1.00)0.0490.95 (0.76-1.19)0.95
Peak Inspiratory Pressure1.16 (1.02-1.33)0.010.50 (0.22-1.11)0.09

CI: Confidence Interval; OR: Odds Ratio; u-IL-6: Urinary Interleukine-6

Funding

  • Government Support – Non-U.S.