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OBJECTIVE: To assess incidence, risk factors and impact of acute kidney injury(AKI) within 48 h of intensive care unit(ICU) admission on ICU mortality in patients with SARS-CoV-2 pneumonia. To assess ICU mortality and risk factors for continuous renal replacement therapy (CRRT) in AKI I and II patients. DESIGN: Retrospective observational study. SETTING: Sixty-seven ICU from Spain, Andorra, Ireland. PATIENTS: 5399 patients March 2020 to April 2022. MAIN VARIABLES OF INTEREST: Demographic variables, comorbidities, laboratory data (worst values) during the first two days of ICU admission to generate a logistic regression model describing independent risk factors for AKI and ICU mortality. AKI was defined according to current international guidelines (kidney disease improving global outcomes, KDIGO). RESULTS: Of 5399 patients included 1879 (34.8%) developed AKI. These patients had higher ICU mortality and AKI was independently associated with a higher ICU mortality (HR 1.32 CI 1.17-1.48; p < 0.001). Male gender, hypertension, diabetes, obesity, chronic heart failure, myocardial dysfunction, higher severity scores, and procalcitonine were independently associated with the development of AKI. In AKI I and II patients the need for CRRT was 12.6% (217/1710). In these patients, APACHE II, need for mechanical ventilation in the first 24 h after ICU admission and myocardial dysfunction were associated with risk of needing CRRT. AKI I and II patients had a high ICU mortality (38.5%), especially if CRRT were required (64.1% vs. 34,8%; p < 0.001). CONCLUSIONS: Critically ill patients with SARS-CoV-2 pneumonia and AKI have a high ICU mortality. Even AKI I and II stages are associated with high risk of needing CRRT and ICU mortality.
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OBJECTIVE: To evaluate the impact of obesity on ICU mortality. DESIGN: Observational, retrospective, multicentre study. SETTING: Intensive Care Unit (ICU). PATIENTS: Adults patients admitted with COVID-19 and respiratory failure. INTERVENTIONS: None. PRIMARY VARIABLES OF INTEREST: Collected data included demographic and clinical characteristics, comorbidities, laboratory tests and ICU outcomes. Body mass index (BMI) impact on ICU mortality was studied as (1) a continuous variable, (2) a categorical variable obesity/non-obesity, and (3) as categories defined a priori: underweight, normal, overweight, obesity and Class III obesity. The impact of obesity on mortality was assessed by multiple logistic regression and Smooth Restricted cubic (SRC) splines for Cox hazard regression. RESULTS: 5,206 patients were included, 20 patients (0.4%) as underweight, 887(17.0%) as normal, 2390(46%) as overweight, 1672(32.1) as obese and 237(4.5%) as class III obesity. The obesity group patients (nâ¯=â¯1909) were younger (61 vs. 65 years, pâ¯<â¯0.001) and with lower severity scores APACHE II (13 [9-17] vs. 13[10-17, pâ¯<â¯0.01) than non-obese. Overall ICU mortality was 28.5% and not different for obese (28.9%) or non-obese (28.3%, pâ¯=â¯0.65). Only Class III obesity (ORâ¯=â¯2.19, 95%CI 1.44-3.34) was associated with ICU mortality in the multivariate and SRC analysis. CONCLUSIONS: COVID-19 patients with a BMIâ¯>â¯40 are at high risk of poor outcomes in the ICU. An effective vaccination schedule and prolonged social distancing should be recommended.
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COVID-19 , Sobrepeso , Adulto , Humanos , Sobrepeso/complicações , Sobrepeso/epidemiologia , Estado Terminal , Estudos Retrospectivos , Magreza/complicações , COVID-19/complicações , Obesidade/complicações , Obesidade/epidemiologiaRESUMO
BACKGROUND: Procalcitonin (PCT) and C-Reactive Protein (CRP) are useful biomarkers to differentiate bacterial from viral or fungal infections, although the association between them and co-infection or mortality in COVID-19 remains unclear. METHODS: The study represents a retrospective cohort study of patients admitted for COVID-19 pneumonia to 84 ICUs from ten countries between (March 2020-January 2021). Primary outcome was to determine whether PCT or CRP at admission could predict community-acquired bacterial respiratory co-infection (BC) and its added clinical value by determining the best discriminating cut-off values. Secondary outcome was to investigate its association with mortality. To evaluate the main outcome, a binary logistic regression was performed. The area under the curve evaluated diagnostic performance for BC prediction. RESULTS: 4635 patients were included, 7.6% fulfilled BC diagnosis. PCT (0.25[IQR 0.1-0.7] versus 0.20[IQR 0.1-0.5]ng/mL, p<0.001) and CRP (14.8[IQR 8.2-23.8] versus 13.3 [7-21.7]mg/dL, p=0.01) were higher in BC group. Neither PCT nor CRP were independently associated with BC and both had a poor ability to predict BC (AUC for PCT 0.56, for CRP 0.54). Baseline values of PCT<0.3ng/mL, could be helpful to rule out BC (negative predictive value 91.1%) and PCT≥0.50ng/mL was associated with ICU mortality (OR 1.5,p<0.001). CONCLUSIONS: These biomarkers at ICU admission led to a poor ability to predict BC among patients with COVID-19 pneumonia. Baseline values of PCT<0.3ng/mL may be useful to rule out BC, providing clinicians a valuable tool to guide antibiotic stewardship and allowing the unjustified overuse of antibiotics observed during the pandemic, additionally PCT≥0.50ng/mL might predict worsening outcomes.
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Infecções Bacterianas , COVID-19 , Coinfecção , Pró-Calcitonina , Infecções Respiratórias , Infecções Bacterianas/diagnóstico , Biomarcadores , Proteína C-Reativa/análise , COVID-19/diagnóstico , Coinfecção/diagnóstico , Humanos , Valor Preditivo dos Testes , Curva ROC , Estudos RetrospectivosRESUMO
Objective To evaluate the impact of obesity on ICU mortality. Design Observational, retrospective, multicentre study. Setting Intensive Care Unit (ICU). Patients Adults patients admitted with COVID-19 and respiratory failure. Interventions None. Primary variables of interest Collected data included demographic and clinical characteristics, comorbidities, laboratory tests and ICU outcomes. Body mass index (BMI) impact on ICU mortality was studied as (1) a continuous variable, (2) a categorical variable obesity/non-obesity, and (3) as categories defined a priori: underweight, normal, overweight, obesity and Class III obesity. The impact of obesity on mortality was assessed by multiple logistic regression and Smooth Restricted cubic (SRC) splines for Cox hazard regression. Results 5,206 patients were included, 20 patients (0.4%) as underweight, 887(17.0%) as normal, 2390(46%) as overweight, 1672(32.1) as obese and 237(4.5%) as class III obesity. The obesity group patients (n = 1909) were younger (61 vs. 65 years, p < 0.001) and with lower severity scores APACHE II (13 [917] vs. 13[10−17, p < 0.01) than non-obese. Overall ICU mortality was 28.5% and not different for obese (28.9%) or non-obese (28.3%, p = 0.65). Only Class III obesity (OR = 2.19, 95%CI 1.443.34) was associated with ICU mortality in the multivariate and SRC analysis. Conclusions COVID-19 patients with a BMI > 40 are at high risk of poor outcomes in the ICU. An effective vaccination schedule and prolonged social distancing should be recommended. (AU)
Objetivo Evaluar el impacto de la obesidad en la mortalidad de la UCI. Diseño Estudio observacional, retrospectivo y multicéntrico. Ámbito Unidad de Cuidados Intensivos (UCI). Pacientes Pacientes adultos con COVID-19 e insuficiencia respiratoria. Intervenciones Ninguna. Variables de interés principales Características demográficas y clínicas, comorbilidades, pruebas de laboratorio y evolución en la UCI. El impacto del índice de masa corporal (IMC) sobre la mortalidad se estudió como (1) una variable continua, (2) una variable categórica obesidad/no obesidad, y (3) como categorías definidas a priori: bajo peso, normal, sobrepeso, obesidad y obesidad clase III. El impacto de la obesidad se evaluó mediante regresión logística múltiple y splines cúbicos suaves restringidos (SRC) para la regresión de riesgos de Cox. Resultados Se incluyeron 5.206 pacientes, 20 (0,4%) con bajo peso, 887 (17,0%) con peso normal, 2.390 (46%) con sobrepeso, 1.672 (32,1%) con obesidad y 237 (4,5%) con obesidad clase III. Los pacientes obesos (n = 1909) eran más jóvenes (61 vs. 65 años, p < 0,001) y con un nivel más bajo de APACHE II (13 [917] frente a 13[10−17, p < 0,01) que los no obesos. La mortalidad global en la UCI fue del 28,5% y no fue diferente entre obesos (28,9%) y no obesos (28,3%,p = 0,65). Sólo la obesidad clase III (OR = 2,19; IC del 95%: 1,44−3,34) se asoció con la mortalidad en la UCI en el análisis multivariante y SRC. Conclusiones Los pacientes con COVID-19 con un IMC > 40 tienen un alto riesgo de mala evolución en la UCI. Debe recomendarse un calendario de vacunación eficaz y un distanciamiento social prolongado. (AU)