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Vol. 45. Issue 6.
Pages 325-331 (August - September 2021)
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Vol. 45. Issue 6.
Pages 325-331 (August - September 2021)
Original
DOI: 10.1016/j.medine.2021.02.006
Outcomes of renal replacement therapy in the critically ill with COVID-19
Resultados de la terapia de reemplazo renal en pacientes críticamente enfermos con COVID-19
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E. Burkea, E. Habera, C.W. Pikeb, R. Sontia,
Corresponding author
a Medstar Georgetown University Hospital, Division of Pulmonary, Critical Care, and Sleep Medicine, Washington, DC 20007, United States
b Georgetown University School of Medicine, Medical Dental Building, 3900 Reservoir Road, NW, Washington, DC, United States
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Tables (3)
Table 1. Patient Demographics.
Table 2. ICU course.
Table 3. Inpatient Mortality.
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Abstract
Objective

To describe outcomes of critically ill patients with COVID-19, particularly the association of renal replacement therapy to mortality.

Design

A single-center prospective observational study was carried out.

Setting

ICU of a tertiary care center.

Patients

Consecutive adults with COVID-19 admitted to the ICU.

Intervention

Renal replacement therapy.

Main variables of interest

Demographic data, medical history, illness severity, type of oxygen therapy, laboratory data and use of renal replacement therapy to generate a logistic regression model describing independent risk factors for mortality.

Results

Of the total of 166 patients, 51% were mechanically ventilated and 26% required renal replacement therapy. The overall hospital mortality rate was 36%, versus 56% for those requiring renal replacement therapy, and 68% for those with both mechanical ventilation and renal replacement therapy. The logistic regression model identified four independent risk factors for mortality: age (adjusted OR 2.8 [95% CI 1.8–4.4] for every 10-year increase), mechanical ventilation (4.2 [1.7–10.6]), need for continuous venovenous hemofiltration (2.3 [1.3–4.0]) and C-reactive protein (1.1 [1.0–1.2] for every 10mg/L increase).

Conclusions

In our cohort, acute kidney injury requiring renal replacement therapy was associated to a high mortality rate similar to that associated to the need for mechanical ventilation, while multiorgan failure necessitating both techniques implied an extremely high mortality risk.

Keywords:
ARDS
COVID-19
Renal replacement
Resumen
Objetivo

Describir los resultados de pacientes críticamente enfermos con COVID-19, especialmente la asociación de la terapia de reemplazo renal con la mortalidad.

Diseño

Estudio observacional, prospectivo y unicéntrico.

Ámbito

En la unidad de cuidados intensivos (UCI) de un centro de atención terciaria.

Pacientes

Pacientes adultos con COVID-19 ingresados de forma consecutiva en la UCI.

Intervención

Administración de terapia de reemplazo renal.

Variables de interés principales

Datos demográficos, antecedentes médicos, gravedad de la enfermedad, tipo de oxigenoterapia, datos analíticos y uso de terapia de reemplazo renal para generar un modelo de regresión logística que describa factores de riesgo independientes de la mortalidad.

Resultados

De los 166 pacientes, el 51% recibieron ventilación mecánica (VM) y el 26% requirió terapia de reemplazo renal (TRR). La mortalidad hospitalaria global fue del 36%, frente al 56% en el caso de los pacientes que requirieron TRR y el 68% en el subconjunto de pacientes que necesitó tanto VM como RTT. Un modelo de regresión logística señala cuatro factores de riesgo independientes de la mortalidad: edad (OR ajustada: 2,8 [IC del 95%: 1,8-4,4] por cada incremento de 10 años), ventilación mecánica (4,2 [1,7-10,6]), necesidad de hemofiltración venovenosa continua (HVVC) (2,3 [1,3-4,0]), y proteína C reactiva (1,1 [1,0-1,2] por cada incremento de 10mg/L).

Conclusiones

En nuestra cohorte, la lesión renal aguda que necesita TRR se asocia con una mortalidad similarmente elevada a la de los pacientes que requieren VM, y la insuficiencia multiorgánica que hace necesarias ambas intervenciones se asocia con un riesgo de mortalidad extremadamente alta.

Palabras clave:
SARD
COVID-19
Reemplazo renal

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