Respiratory failure & ventilation
Epidemiology and outcomes of early-onset acute kidney injury (AKI) in COVID-19-related acute respiratory distress syndrome (ARDS) in comparison with non-COVID-19-related ARDS: insights from two prospective global cohort studies
An erratum to this article was published (Crit Care, 26 May 2023 ↗)
Authors' conclusion
AKI is a common and serious complication of COVID-19, with a high mortality rate, which differs by geo-economic location. Important differences exist in the profile of AKI in COVID-19 versus non-COVID-19 ARDS in terms of their haemodynamic profile, time of onset and clinical outcomes.
Study context
- Population
- Patients undergoing invasive mechanical ventilation for COVID-19-related ARDS (CCCC data set), compared with a non-COVID-19-related ARDS cohort (LUNG-SAFE)of 18,964 in CCCC data set
- Participants
- 1,699 patients
- Exposure
- Early AKI (by stage) vs no AKI in COVID-19-related ARDS; COVID-19 vs non-COVID-19 ARDS
- No AKIn = 1,214reference
- Stage 1n = 110
- Stage 2n = 94
- Stage 3n = 151
- Outcome
- Incidence of early AKI
- Follow-up
- Within 48 h of initiating invasive mechanical ventilation
Methodological detailsinternational, comparison of two prospective global cohorts (CCCC and LUNG-SAFE)
- International
- Comparison of two prospective global cohorts (CCCC and LUNG-SAFE)
Main finding
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | HR | P value |
|---|---|---|
| 28-day and 90-day mortality riskStage 2 vs No AKI | 2.00 | P < 0.001 |
| 28-day and 90-day mortality riskStage 3 vs No AKI | 1.95 | P < 0.001 |
Hospital mortality, COVID-19 vs non-COVID-19 ARDS (by AKI stage)
- No AKI: 30 vs 50%
- Stage 1: 38 vs 58%
- Stage 2: 56 vs 74%
- Stage 3: 52 vs 72%
- p < 0.001
- As printed: "hospital mortality was worse in all groups"
Shock and cardiovascular SOFA, COVID-19 vs non-COVID-19 ARDS
- Incidence of shock reduced with lower cardiovascular SOFA score across all patient groups
Proportion of all AKI occurring in first 48 h
- COVID-19 ARDS
- 56%
- Non-COVID-19 ARDS
- 89%
Risk factors for AKI
- Patients developing AKI older and more likely to have hypertension or chronic cardiac disease
Original publication
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