Factors Associated with Worsening Oxygenation in Patients with Non-severe COVID-19 Pneumonia.

BACKGROUND: This study aimed to determine the parameters for worsening oxygenation in non-severe coronavirus disease 2019 (COVID-19) pneumonia. METHODS: This retrospective cohort study included cases of confirmed COVID-19 pneumonia in a public hospital in South Korea. The worsening oxygenation group was defined as that with SpO2 ≤94% or received oxygen or mechanical ventilation (MV) throughout the clinical course versus the non-worsening oxygenation group that did not experience any respiratory event. Parameters were compared, and the extent of viral pneumonia from an initial chest computed tomography (CT) was calculated using artificial intelligence (AI) and measured visually by a radiologist. RESULTS: We included 136 patients, with 32 (23.5%) patients in the worsening oxygenation group; of whom, two needed MV and one died. Initial vital signs and duration of symptoms showed no difference between the two groups; however, univariate logistic regression analysis revealed that a variety of parameters on admission were associated with an increased risk of a desaturation event. A subset of patients was studied to eliminate potential bias, that ferritin ≥280 µg/L (p=0.029), lactate dehydrogenase ≥240 U/L (p=0.029), pneumonia volume (p=0.021), and extent (p=0.030) by AI, and visual severity scores (p=0.042) were the predictive parameters for worsening oxygenation in a sex-, age-, and comorbid illness-matched case-control study using propensity score (n=52). CONCLUSION: Our study suggests that initial CT evaluated by AI or visual severity scoring as well as serum markers of inflammation on admission are significantly associated with worsening oxygenation in this COVID-19 pneumonia cohort.

Impact of chronic kidney disease among Korean adults with chronic obstructive pulmonary disease.

PURPOSE: Chronic kidney disease (CKD) is an emerging issue in patients with chronic obstructive pulmonary disease (COPD). In COPD, loss of muscle mass is relatively common finding, and diagnosis of CKD should be based on measured or estimated GFR (Cavailles et al. Eur Respir Rev 22:454-475, 2013; Gosker et al. Am J Clin Nutr 71:1033-1047, 2000; Delanaye and Mariat Nat Rev Nephrol 9:513-522, 2013). We aimed to determine the prevalence and impact of CKD, defined by using chronic kidney disease epidemiology collaboration (CKD-EPI) equation, in COPD patients. METHODS: This study analyzed data of 3393 adults 40 years of age or older who completed pulmonary function tests in the fifth Korea National Health and Nutritional Examination Survey 2012. Participants with normal lung function (NLF) and COPD were included. CKD was defined as an eGFR <60 mL/min/1.73 m2. Multivariate logistic regression analysis was performed to evaluate the relationship between CKD and COPD. RESULTS: Among 3393 participants, 528 (15.6%) were classified as COPD. The prevalence values of participants with eGFR level ≥90, 60-90, and <60 mL/min/1.73 m2 were 54.1, 43.6, and 2.2% in those with NLF and 39.8, 51.5, and 8.7% in those with COPD (p = 0.000). We analyzed the relationship between COPD and all factors that had a statistically significant association with COPD. The significant factors were older age, lower education, BMI, pulmonary tuberculosis, current bronchial asthma, smoking, and CKD. CONCLUSIONS: In a Korean population ≥40 years old, the prevalence of participants with COPD is 15.6%. CKD is an independent risk factor for COPD. In addition to CKD, older age, lower education, BMI, pulmonary tuberculosis, current bronchial asthma, and smoking are significantly associated with COPD.

Increased risk of acute kidney injury associated with higher infusion rate of mannitol in patients with intracranial hemorrhage.

OBJECT: Mannitol, an osmotic agent used to decrease intracranial pressure, can cause acute kidney injury (AKI). The objectives of this study were to assess the impact of mannitol on the incidence and severity of AKI and to identify risk factors and outcome for AKI in patients with intracranial hemorrhage (ICH). METHODS: The authors retrospectively evaluated 153 adult patients who received mannitol infusion after ICH between January 2005 and December 2009 in the neurosurgical intensive care unit. Multivariate analysis was used to evaluate the risk factors for AKI after ICH. Based on the odds ratio, weighted scores were assigned to predictors of AKI. RESULTS: The overall incidence of AKI among study participants was 10.5% (n = 16). Acute kidney injury occurred more frequently in patients who received mannitol infusion at a rate ≥ 1.34 g/kg/day than it did in patients who received mannitol infusion at a rate < 1.34 g/kg/day. A higher mannitol infusion rate was associated with more severe AKI. Independent risk factors for AKI were mannitol infusion rate ≥ 1.34 g/kg/day, age ≥ 70 years, diastolic blood pressure (DBP) ≥ 110 mm Hg, and glomerular filtration rate < 60 ml/min/1.73 m(2). The authors developed a risk model for AKI, wherein patients with a higher risk score showed a graded association with a higher incidence of AKI. CONCLUSIONS: The incidence of AKI following mannitol infusion in patients with ICH was 10.5%. A higher mannitol infusion rate was associated with more frequent and more severe AKI. Additionally, age ≥ 70 years, DBP ≥ 110 mm Hg, and established renal dysfunction before starting mannitol therapy were associated with development of AKI.

Minimal proteinuria one year after transplant is a risk factor for graft survival in kidney transplantation.

It is generally accepted that one-year post-transplant proteinuria over 0.5 gm per day has a negative impact on renal graft survival. In this study, the effects of minimal proteinuria less than 0.5 g/day were analyzed in 272 renal recipients who had survived for one year with a functioning graft. Recipients were classified by one-year post-transplant proteinuria: no proteinuria group (<0.2 g/day), minimal proteinuria group (0.2-0.5 g/day), and overt proteinuria group (>or=0.5 g/day). Recipients were followed up for 87.1+/-21 months after transplantation and 38 (13.9%) lost their graft during follow-up. Fifteen percent of patients had minimal proteinuria and 7.8% had overt proteinuria. Five-year graft survival in the minimal proteinuria group was 83.0%, and that in the overt proteinuria group was 70%, in contrast to 97.1% in the no proteinuria group (p=0.01 for trend). In a multivariate analysis, the minimal proteinuria group (relative risk [RR], 4.90; 95% confidence interval [CI], 2.09-11.46) and the overt proteinuria group (RR, 8.75; 95% CI, 3.29-23.29) had higher risks of graft failure than the no proteinuria group. Even minimal proteinuria at one year after transplantation was strongly associated with poor graft outcome. Therefore, it appears logical to consider a low level of proteinuria as a risk factor for graft survival in renal recipients.