Dataset Information

Mortality and evolution between community and hospital-acquired COVID-AKI.

ABSTRACT:

Background

Acute kidney injury (AKI) is associated with poor outcomes in COVID patients. Differences between hospital-acquired (HA-AKI) and community-acquired AKI (CA-AKI) are not well established.

Methods

Prospective, observational cohort study. We included 877 patients hospitalized with COVID diagnosis at two third-level hospitals in Mexico. Primary outcome was all-cause mortality at 28 days compared between COVID patients with CA-AKI and HA-AKI. Secondary outcomes included the need for KRT, and risk factors associated with the development of CA-AKI and HA-AKI.

Results

A total of 377 patients (33.7%) developed AKI. CA-AKI occurred in 202 patients (59.9%) and HA-AKI occurred in 135 (40.1%). Patients with CA-AKI had more significant comorbidities, including diabetes (52.4% vs 38.5%), hypertension (58.4% vs 39.2%), CKD (30.1% vs 14.8%), and COPD (5.9% vs 1.4%), than those with HA-AKI. Patients' survival without AKI was 87.1%, with CA-AKI it was 75.4%, and with HA-AKI it was 69.6%, log-rank test p < 0.001. Only age > 60 years (OR 1.12, 95% CI 1.06-1.18, p <0.001), COVID severity (OR 1.09, 95% CI 1.03-1.16, p = 0.002), the need in mechanical lung ventilation (OR 1.67, 95% CI 1.56-1.78, p <0.001), and HA-AKI stage 3 (OR 1.16, 95% CI 1.05-1.29, p = 0.003) had a significant increase in mortality. The presence of CKD (OR 1.48, 95% CI 1.391.56, p < 0.001), serum lymphocytes < 1000 μL (OR 1.03, 95% CI 1.00-1.07, p = 0.03), the need in mechanical lung ventilation (OR 1.06, 95% CI 1.02-1.11, p = 0.003), and CA-AKI stage 3 (OR 1.37, 95% CI 1.29-1.46, p < 0.001) were the only variables associated with a KRT start.

Conclusions

We found that COVID patients who are complicated by CA-AKI have more comorbidities and worse biochemical parameters at the time of hospitalization than HA-AKI patients, but despite these differences, their probability of dying is similar.

SUBMITTER: Chavez-Iniguez JS

PROVIDER: S-EPMC8568145 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

Mortality and evolution between community and hospital-acquired COVID-AKI.

Chávez-Íñiguez Jonathan S JS Cano-Cervantes José H JH Maggiani-Aguilera Pablo P Lavelle-Góngora Natashia N Marcial-Meza Josué J Camacho-Murillo Estefanía P EP Moreno-González Cynthia C Tanaka-Gutiérrez Jarumi A JA Villa Zaragoza Ana P AP Rincón-Souza Karla E KE Muñoz-López Sandra S Montoya-Montoya Olivia O Navarro-Blackaller Guillermo G Sánchez-Cedillo Aczel A Morales-Buenrostro Luis E LE García-García Guillermo G

PloS one 20211104 11

<h4>Background</h4>Acute kidney injury (AKI) is associated with poor outcomes in COVID patients. Differences between hospital-acquired (HA-AKI) and community-acquired AKI (CA-AKI) are not well established.<h4>Methods</h4>Prospective, observational cohort study. We included 877 patients hospitalized with COVID diagnosis at two third-level hospitals in Mexico. Primary outcome was all-cause mortality at 28 days compared between COVID patients with CA-AKI and HA-AKI. Secondary outcomes included the ...[more]

PMID: 34735451

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Project description:Background and objectivesThe exploration of electronic hospital records offers a unique opportunity to describe in-depth the prevalence of conditions associated with diagnoses at an unprecedented level of comprehensiveness. We used a diagnosis-wide approach, adapted from phenome-wide association studies (PheWAS), to perform an exhaustive analysis of all diagnoses associated with hospital-acquired AKI (HA-AKI) in a French urban tertiary academic hospital over a period of 10 years.Design, setting, participants, & measurementsWe retrospectively extracted all diagnoses from an i2b2 (Informatics for Integrating Biology and the Bedside) clinical data warehouse for patients who stayed in this hospital between 2006 and 2015 and had at least two plasma creatinine measurements performed during the first week of their stay. We then analyzed the association between HA-AKI and each International Classification of Diseases (ICD)-10 diagnostic category to draw a comprehensive picture of diagnoses associated with AKI. Hospital stays for 126,736 unique individuals were extracted.ResultsHemodynamic impairment and surgical procedures are the main factors associated with HA-AKI and five clusters of diagnoses were identified: sepsis, heart diseases, polytrauma, liver disease, and cardiovascular surgery. The ICD-10 code corresponding to AKI (N17) was recorded in 30% of the cases with HA-AKI identified, and in this situation, 20% of the diagnoses associated with HA-AKI corresponded to kidney diseases such as tubulointerstitial nephritis, necrotizing vasculitis, or myeloma cast nephropathy. Codes associated with HA-AKI that demonstrated the greatest increase in prevalence with time were related to influenza, polytrauma, and surgery of neoplasms of the genitourinary system.ConclusionsOur approach, derived from PheWAS, is a valuable way to comprehensively identify and classify all of the diagnoses and clusters of diagnoses associated with HA-AKI. Our analysis delivers insights into how diagnoses associated with HA-AKI evolved over time. On the basis of ICD-10 codes, HA-AKI appears largely underestimated in this academic hospital.

Project description:ObjectivesSARS-CoV-2 may cause acute lung injury, and secondary infections are thus relevant complications in patients with COVID-19 pneumonia. However, detailed information on community- and hospital-acquired infections among patients with COVID-19 pneumonia is scarce.MethodsWe identified 220 SARS-CoV-2-positive patients hospitalized at the University Hospital Basel, Switzerland (between 25 February and 31 May 2020). We excluded patients who declined the general consent (n = 12), patients without clinical evidence of pneumonia (n = 29), and patients hospitalized for < 24 h (n = 17). We evaluated the frequency of community- and hospital-acquired infections using respiratory and blood culture materials with antigen, culture-based, and molecular diagnostics. For ICU patients, all clinical and microbial findings were re-evaluated interdisciplinary (intensive care, infectious disease, and clinical microbiology), and agreement reached to classify patients with infections.ResultsIn the final cohort of 162 hospitalized patients (median age 64.4 years (IQR, 50.4-74.2); 61.1% male), 41 (25.3%) patients were admitted to the intensive care unit, 34/41 (82.9%) required mechanical ventilation, and 17 (10.5%) of all hospitalized patients died. In total, 31 infections were diagnosed including five viral co-infections, 24 bacterial infections, and three fungal infections (ventilator-associated pneumonia, n = 5; tracheobronchitis, n = 13; pneumonia, n = 1; and bloodstream infection, n = 6). Median time to respiratory tract infection was 12.5 days (IQR, 8-18) and time to bloodstream infection 14 days (IQR, 6-30). Hospital-acquired bacterial and fungal infections were more frequent among ICU patients than other patients (36.6% vs. 1.7%). Antibiotic or antifungal treatment was administered in 71 (43.8%) patients.ConclusionsCommunity-acquired viral and bacterial infections were rare among COVID-19 pneumonia patients. By contrast, hospital-acquired bacterial or fungal infections were frequently complicating the course among ICU patients.

Dataset Information

Mortality and evolution between community and hospital-acquired COVID-AKI.

Background

Methods

Results

Conclusions

Publications

Mortality and evolution between community and hospital-acquired COVID-AKI.

Similar Datasets

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