Clinical Characteristics and Prognosis of Patients with COVID-19 on Mechanical Ventilation Undergoing Continuous Renal Replacement Therapy

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 Apr 3

PMID 38568934

Authors

Dae-Eun Choi

Duk Ki Kim

Sunghoon Park

Su Hwan Lee

Onyu Park

Taehwa Kim

Hye Ju Yeo

Jin Ho Jang

Woo Hyun Cho

Song I Lee

Affiliations

Soon will be listed here.

Abstract

Background: The coronavirus disease (COVID-19) pandemic has significantly strained global healthcare, particularly in the management of patients requiring mechanical ventilation (MV) and continuous renal replacement therapy (CRRT). This study investigated the characteristics and prognoses of these patients.

Methods: This multicenter retrospective cohort study gathered data from patients with COVID-19 across 26 medical centers. Logistic analysis was used to identify the factors associated with CRRT implementation.

Results: Of the 640 patients with COVID-19 who required MV, 123 (19.2%) underwent CRRT. Compared to the non-CRRT group, the CRRT group was older and exhibited higher sequential organ failure assessment scores. The incidence of hypertension, diabetes, cardiovascular disease, chronic neurological disease, and chronic kidney disease was also higher in the CRRT group. Moreover, the CRRT group had higher intensive care unit (ICU) (75.6% vs. 26.9%, p < 0.001) and in-hospital (79.7% vs. 29.6%, p < 0.001) mortality rates. CRRT implementation was identified as an independent risk factor for both ICU mortality (hazard ratio [HR]:1.833, 95% confidence interval [CI]:1.342-2.505, p < 0.001) and in-hospital mortality (HR: 2.228, 95% CI: 1.648-3.014, p < 0.001). Refractory respiratory failure (n = 99, 19.1%) was the most common cause of death in the non-CRRT death group, and shock with multi-organ failure (n = 50, 40.7%) was the most common cause of death in the CRRT death group. Shock with multi-organ failure and cardiac death were significantly more common in the CRRT death group, compared to non-CRRT death group.

Conclusion: This study indicates that CRRT is associated with higher ICU and in-hospital mortality rates in patients with COVID-19 who require MV. Notably, the primary cause of death in the CRRT group was shock with multi-organ failure, emphasizing the severe clinical course for these patients, while refractory respiratory failure was most common in non-CRRT patients.

References

Mubarik S, Liu X, Eshak E, Liu K, Liu Q, Wang F . The Association of Hypertension With the Severity of and Mortality From the COVID-19 in the Early Stage of the Epidemic in Wuhan, China: A Multicenter Retrospective Cohort Study. Front Med (Lausanne). 2021; 8:623608. PMC: 8149896. DOI: 10.3389/fmed.2021.623608. View

Yang X, Tian S, Guo H . Acute kidney injury and renal replacement therapy in COVID-19 patients: A systematic review and meta-analysis. Int Immunopharmacol. 2020; 90:107159. PMC: 7608016. DOI: 10.1016/j.intimp.2020.107159. View

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

Batlle D, Soler M, Sparks M, Hiremath S, South A, Welling P . Acute Kidney Injury in COVID-19: Emerging Evidence of a Distinct Pathophysiology. J Am Soc Nephrol. 2020; 31(7):1380-1383. PMC: 7350999. DOI: 10.1681/ASN.2020040419. View

Melero R, Mijaylova A, Rodriguez-Benitez P, Garcia-Prieto A, Cedeno J, Goicoechea M . Mortality and renal long-term outcome of critically ill COVID-19 patients with acute kidney failure, continuous renal replacement therapy and invasive mechanical ventilation. Med Clin (Engl Ed). 2022; 159(11):529-535. PMC: 9259468. DOI: 10.1016/j.medcle.2022.02.015. View

Myari A, Papapetrou E, Tsaousi C . Diagnostic value of white blood cell parameters for COVID-19: Is there a role for HFLC and IG?. Int J Lab Hematol. 2021; 44(1):104-111. PMC: 8653118. DOI: 10.1111/ijlh.13728. View

Kim S, Lee J, Yun D, Kang M, Kim Y, Kim D . Hyperlactatemia is a predictor of mortality in patients undergoing continuous renal replacement therapy for acute kidney injury. BMC Nephrol. 2023; 24(1):11. PMC: 9840420. DOI: 10.1186/s12882-023-03063-y. View

Lin L, Wang X, Ren J, Sun Y, Yu R, Li K . Risk factors and prognosis for COVID-19-induced acute kidney injury: a meta-analysis. BMJ Open. 2020; 10(11):e042573. PMC: 7656886. DOI: 10.1136/bmjopen-2020-042573. View

Ahmadian E, Hosseiniyan Khatibi S, Soofiyani S, Abediazar S, Shoja M, Ardalan M . Covid-19 and kidney injury: Pathophysiology and molecular mechanisms. Rev Med Virol. 2020; 31(3):e2176. PMC: 7646060. DOI: 10.1002/rmv.2176. View

10.

Chen Y, Shao S, Hsu C, Wu I, Hung M, Chen Y . Incidence of acute kidney injury in COVID-19 infection: a systematic review and meta-analysis. Crit Care. 2020; 24(1):346. PMC: 7296284. DOI: 10.1186/s13054-020-03009-y. View

11.

Ng J, Hirsch J, Hazzan A, Wanchoo R, Shah H, Malieckal D . Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury. Am J Kidney Dis. 2020; 77(2):204-215.e1. PMC: 7833189. DOI: 10.1053/j.ajkd.2020.09.002. View

12.

Soto G, Frank A, Christiani D, Gong M . Body mass index and acute kidney injury in the acute respiratory distress syndrome. Crit Care Med. 2012; 40(9):2601-8. PMC: 3423468. DOI: 10.1097/CCM.0b013e3182591ed9. View

13.

Petrucelli Doher M, Carvalho F, Scherer P, Matsui T, Ammirati A, da Silva B . Acute Kidney Injury and Renal Replacement Therapy in Critically Ill COVID-19 Patients: Risk Factors and Outcomes: A Single-Center Experience in Brazil. Blood Purif. 2020; 50(4-5):520-530. PMC: 7801990. DOI: 10.1159/000513425. View

14.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J . Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020; 323(11):1061-1069. PMC: 7042881. DOI: 10.1001/jama.2020.1585. View

15.

Alhazzani W, Evans L, Alshamsi F, Moller M, Ostermann M, Prescott H . Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update. Crit Care Med. 2021; 49(3):e219-e234. DOI: 10.1097/CCM.0000000000004899. View

16.

Wang H, Kang X, Shi Y, Bai Z, Lv J, Sun J . SOFA score is superior to APACHE-II score in predicting the prognosis of critically ill patients with acute kidney injury undergoing continuous renal replacement therapy. Ren Fail. 2020; 42(1):638-645. PMC: 7470067. DOI: 10.1080/0886022X.2020.1788581. View

17.

Eriksson K, Campoccia-Jalde F, Rysz S, Rimes-Stigare C . Continuous renal replacement therapy in intensive care patients with COVID-19; survival and renal recovery. J Crit Care. 2021; 64:125-130. PMC: 8052481. DOI: 10.1016/j.jcrc.2021.04.002. View

18.

Richardson S, Hirsch J, Narasimhan M, Crawford J, McGinn T, Davidson K . Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020; 323(20):2052-2059. PMC: 7177629. DOI: 10.1001/jama.2020.6775. View

19.

He W, Liu X, Hu B, Li D, Chen L, Li Y . Mechanisms of SARS-CoV-2 Infection-Induced Kidney Injury: A Literature Review. Front Cell Infect Microbiol. 2022; 12:838213. PMC: 9237415. DOI: 10.3389/fcimb.2022.838213. View

20.

Legrand M, Bell S, Forni L, Joannidis M, Koyner J, Liu K . Pathophysiology of COVID-19-associated acute kidney injury. Nat Rev Nephrol. 2021; 17(11):751-764. PMC: 8256398. DOI: 10.1038/s41581-021-00452-0. View