Klinik Araştırma
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The Effect of Estimated Glomerular Filtration Rate on Mortality in the Elderly COVID-19 Patients in the Intensive Care Unit

Yıl 2023, Cilt: 13 Sayı: 2, 371 - 376, 22.03.2023
https://doi.org/10.16899/jcm.1260398

Öz

Objective: Acute kidney injury (AKI) has been reported in patients with COVID-19 pneumonia and associated with higher mortality. Our study aimed to determine the relationship of eGFR during admission to the intensive care unit with mortality and clinical outcomes in the elderly COVID-19 patients.
Material and Method: This study in which the elderly patients were included was retrospectively performed in a single-center intensive care unit (ICU).
Results: A total of 152 patients including 75 female and 77 male patients were included in the study. Mean age of the patients was 74.3±7.3 years. The number of patients was 92 (60.5%) in eGFR Stage 1-2, 15 (9.9%) in Stage 3a, 26 (17.1%) in Stage 3b, and 19 (12.5%) in Stage 4-5. The rate of patients who received invasive mechanical ventilation was 40.8% and hospital mortality rate was 48.7%. According to the multivariate logistic regression analysis, eGFR, LDH, Charlson score, and duration of stay in the intensive care unit were effective on mortality. Compared to eGFR Stage 1-2 patients, the mortality risk was 4.836 times higher in Stage 3a patients, 12.233 times higher in Stage 3b patients and 10.242 times higher in Stage 4-5 patients.
Conclusion: Our results revealed that COVID-19 patients’ eGFR during admission to the intensive care unit, LDH, Charlson score, and duration of stay in the intensive care unit were effective on mortality.

Teşekkür

Doctor of the Clinical Biochemistry Department of our hospital, Dr. Sibel Kuzugüden and Doctor of Clinical Microbiology and Infectious Diseases Department thank you Dr. Esma Eren.

Kaynakça

  • 1. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020; 46(5): 846–48.
  • 2. Chan L, Chaudhary K, Saha A, et al. AKI in hospitalized patients with COVID-19. J Am Soc Nephrol. 2021;32(1):151–60.
  • 3. Napoli M, Provenzano M, Hu L, et al. Acute Kidney Injury and Blood Purification Techniques in Severe COVID-19 Patients. J. Clin. Med. 2022;11(21):6286.
  • 4. Levey A, Stevens L, Schmid C, et al. A new equation to estimate glomerular fltration rate. Ann Intern Med. 2009;150(9):604
  • 5. Carter B, Ramsay EA, Short R, et al. Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19: a multicentre, European, observational cohort study. BMC Geriatr. 2022;22(1):119.
  • 6. Mirijello A, Piscitelli P, de Matthaeis A, et al. Low eGFR is a strong predictor of worse outcome in hospitalized COVID-19 patients. J. Clin. Med. 2021;10(22):5224.
  • 7. Altiparmak MR, Seyahi N, Trabulus S, et al. Applicability of a different estimation equation of glomerular fltration rate in Turkey. Ren Fail 2013;35(8):1116–23.
  • 8. Stevens PE, Levin A. KDIGO Guideline development work group members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825–30
  • 9. Uribarri A, Núñez Gil I, Aparisi A, et al. Impact of renal function on admission in COVID 19 patients: an analysis of the international HOPE COVID 19 (health outcome predictive evaluation for COVID 19) registry. J Nephrol. 2020;33(4):737–45
  • 10. Williamson E, Walker A, Bhaskaran K, et al. Factors associated with COVID 19 related death using Open SAFELY. Nature. 2020;584(7821):430–6
  • 11. Schaubroeck H, Vandenberghe W, Boer W, et al. Acute kidney injury in critical COVID-19: a multicenter cohort analysis in seven large hospitals in Belgium. Crit Care. 2022;26(1):225.
  • 12. Nadim MK, Forni LG, Mehta RL, et al. COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nat Rev Nephrol. 2020;16(12):747–764.
  • 13. Sharma P, Ng JH, Bijol V, Jhaveri KD, Wanchoo R. Pathology of COVID-19 associated acute kidney injury. Clin Kidney J. 2021;14(Suppl 1):i30–i39.
  • 14. Legrand M, Bell S, Forni L, et al. Pathophysiology of COVID-19-associated acute kidney injury. Nat Rev Nephrol. 2021;17(11):751–764.
  • 15. Werion A, Belkhir L, Perrot M, et al. SARS-CoV-2 causes a specific dysfunction of the kidney proximal tubule. Kidney Int. 2020;98(5):1296–1307.
  • 16. Aukland EA, Klepstad P, Aukland SM, et al. Acute kidney injury in patients with COVID-19 in the intensive care unit: evaluation of risk factors and mortality in a national cohort. BMJ Open 2022;12:e059046.
  • 17. Silver SA, Beaubien-Souligny W, Shah PS, et al. The prevalence of acute kidney injury in patients hospitalized with COVID-19 infection: a systematic review and meta-analysis. Kidney Med. 2021;3(1):83–98 e1.
  • 18. Fisher M, Neugarten J, Bellin E, et al. AKI in hospitalized patients with and without COVID-19: A comparison study. J Am Soc Nephrol. 2020;31(9):2145–57.
  • 19. Fabrizi F, Alfieri C, Cerutti R, Lunghi G, Messa P. COVID-19 and acute kidney injury: A systematic review and meta-analysis. Pathogens. 2020;9(12):1052.
  • 20. Hansrivijit P, Qian C, Boonpheng B, et al. Incidence of acute kidney injury and its association with mortality in patients with COVID-19: A meta-analysis. J Investig Med. 2020;68(7):1261–70.
  • 21. Lin L, Wang X, Ren J, et al. Risk factors and prognosis for COVID-19-induced acute kidney injury: A meta-analysis. BMJ Open. 2020;10(11): 042573.
  • 22. Fu E, Janse R, de Jong Y, et al. Acute kidney injury and kidney replacement therapy in COVID-19: A systematic review and meta-analysis. Clin Kidney J. 2020;13(4):550–63.

Yoğun Bakımda Yatan Yaşlı COVID-19 Hastalarında Tahmini Glomerüler Filtrasyon Hızının Mortaliteye Etkisi

Yıl 2023, Cilt: 13 Sayı: 2, 371 - 376, 22.03.2023
https://doi.org/10.16899/jcm.1260398

Öz

Amaç: Akut böbrek hasarı(AKI), COVID-19 pnömonisi olan hastalarda bildirilmiştir ve daha yüksek mortalite ile ilişkilidir. Çalışmamızın amacı yaşlı COVID-19 hastalarında yoğun bakıma yatıştaki eGFR ile mortalite ve klinik sonuçlar arasındaki ilişkiyi belirlemektir.
Gereç ve Yöntem: Yaşlı katılımcıların dahil edildiği bu çalışma, tek merkezli bir yoğun bakım ünitesinde (YBÜ) retrospektif olarak yapıldı.
Bulgular: Çalışmaya 75 kadın ve 77 erkek olmak üzere toplam 152 hasta dahil edildi. Hastaların yaş ortalaması 74.3±7.3 yıl idi. eGFR için Evre 1-2’deki hasta sayısı 92 (%60.5), Evre 3a’daki hasta sayısı 15 (%9.9), Evre 3b’deki hasta sayısı 26 (%17.1) ve Evre 4-5’deki hasta sayısı 19’dur (%12.5). İnvaziv mekanik ventilatör uygulanan hastalar %40.8, hastane mortalitesi %48.7 idi. Yapılan multivariate logistic regression analizine göre eGFR, LDH, Charlson skoru ve yoğun bakım yatış süresi mortalite üzerine etkili bulunmuştur. eGFR Evre 1-2’de olan hastalara göre mortalite riski Evre 3a hastalarında 4.836 kat, Evre 3b hastalarında 12.233 kat ve Evre 4-5 hastalarında 10.242 kat fazladır.
Sonuç: Bulgularımız, COVID-19 hastalarının yoğun bakım ünitesine başvuru anında eGFR, LDH, Charlson skoru ve yoğun bakım yatış süresi mortalite üzerine etkili bulunmuştur.

Kaynakça

  • 1. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020; 46(5): 846–48.
  • 2. Chan L, Chaudhary K, Saha A, et al. AKI in hospitalized patients with COVID-19. J Am Soc Nephrol. 2021;32(1):151–60.
  • 3. Napoli M, Provenzano M, Hu L, et al. Acute Kidney Injury and Blood Purification Techniques in Severe COVID-19 Patients. J. Clin. Med. 2022;11(21):6286.
  • 4. Levey A, Stevens L, Schmid C, et al. A new equation to estimate glomerular fltration rate. Ann Intern Med. 2009;150(9):604
  • 5. Carter B, Ramsay EA, Short R, et al. Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19: a multicentre, European, observational cohort study. BMC Geriatr. 2022;22(1):119.
  • 6. Mirijello A, Piscitelli P, de Matthaeis A, et al. Low eGFR is a strong predictor of worse outcome in hospitalized COVID-19 patients. J. Clin. Med. 2021;10(22):5224.
  • 7. Altiparmak MR, Seyahi N, Trabulus S, et al. Applicability of a different estimation equation of glomerular fltration rate in Turkey. Ren Fail 2013;35(8):1116–23.
  • 8. Stevens PE, Levin A. KDIGO Guideline development work group members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825–30
  • 9. Uribarri A, Núñez Gil I, Aparisi A, et al. Impact of renal function on admission in COVID 19 patients: an analysis of the international HOPE COVID 19 (health outcome predictive evaluation for COVID 19) registry. J Nephrol. 2020;33(4):737–45
  • 10. Williamson E, Walker A, Bhaskaran K, et al. Factors associated with COVID 19 related death using Open SAFELY. Nature. 2020;584(7821):430–6
  • 11. Schaubroeck H, Vandenberghe W, Boer W, et al. Acute kidney injury in critical COVID-19: a multicenter cohort analysis in seven large hospitals in Belgium. Crit Care. 2022;26(1):225.
  • 12. Nadim MK, Forni LG, Mehta RL, et al. COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nat Rev Nephrol. 2020;16(12):747–764.
  • 13. Sharma P, Ng JH, Bijol V, Jhaveri KD, Wanchoo R. Pathology of COVID-19 associated acute kidney injury. Clin Kidney J. 2021;14(Suppl 1):i30–i39.
  • 14. Legrand M, Bell S, Forni L, et al. Pathophysiology of COVID-19-associated acute kidney injury. Nat Rev Nephrol. 2021;17(11):751–764.
  • 15. Werion A, Belkhir L, Perrot M, et al. SARS-CoV-2 causes a specific dysfunction of the kidney proximal tubule. Kidney Int. 2020;98(5):1296–1307.
  • 16. Aukland EA, Klepstad P, Aukland SM, et al. Acute kidney injury in patients with COVID-19 in the intensive care unit: evaluation of risk factors and mortality in a national cohort. BMJ Open 2022;12:e059046.
  • 17. Silver SA, Beaubien-Souligny W, Shah PS, et al. The prevalence of acute kidney injury in patients hospitalized with COVID-19 infection: a systematic review and meta-analysis. Kidney Med. 2021;3(1):83–98 e1.
  • 18. Fisher M, Neugarten J, Bellin E, et al. AKI in hospitalized patients with and without COVID-19: A comparison study. J Am Soc Nephrol. 2020;31(9):2145–57.
  • 19. Fabrizi F, Alfieri C, Cerutti R, Lunghi G, Messa P. COVID-19 and acute kidney injury: A systematic review and meta-analysis. Pathogens. 2020;9(12):1052.
  • 20. Hansrivijit P, Qian C, Boonpheng B, et al. Incidence of acute kidney injury and its association with mortality in patients with COVID-19: A meta-analysis. J Investig Med. 2020;68(7):1261–70.
  • 21. Lin L, Wang X, Ren J, et al. Risk factors and prognosis for COVID-19-induced acute kidney injury: A meta-analysis. BMJ Open. 2020;10(11): 042573.
  • 22. Fu E, Janse R, de Jong Y, et al. Acute kidney injury and kidney replacement therapy in COVID-19: A systematic review and meta-analysis. Clin Kidney J. 2020;13(4):550–63.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orjinal Araştırma
Yazarlar

Sevda Onuk 0000-0001-7601-1601

Erken Görünüm Tarihi 23 Ocak 2023
Yayımlanma Tarihi 22 Mart 2023
Kabul Tarihi 15 Mart 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 13 Sayı: 2

Kaynak Göster

AMA Onuk S. The Effect of Estimated Glomerular Filtration Rate on Mortality in the Elderly COVID-19 Patients in the Intensive Care Unit. J Contemp Med. Mart 2023;13(2):371-376. doi:10.16899/jcm.1260398