TY - JOUR
T1 - Perfusion deficits may underlie lung and kidney injury in severe COVID-19 disease
T2 - insights from a multicenter international cohort study
AU - and The LUNG-KIDNEY Interaction Multicenter Study Group
AU - Nova, Alice
AU - McNicholas, Bairbre
AU - Magliocca, Aurora
AU - Laffey, Matthew
AU - Zambelli, Vanessa
AU - Mariani, Ilaria
AU - Atif, Minahel
AU - Giacomini, Matteo
AU - Vitale, Giovanni
AU - Rona, Roberto
AU - Foti, Giuseppe
AU - Laffey, John
AU - Rezoagli, Emanuele
AU - O’Connor, Aine
AU - Giani, Marco
AU - Pozzi, Matteo
AU - Coppadoro, Andrea
AU - Sordi, Silvia
AU - Crippa, Ilaria Alice
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/12
Y1 - 2024/12
N2 - Background: Lung perfusion defects, mainly due to endothelial and coagulation activation, are a key contributor to COVID-19 respiratory failure. COVID-19 patients may also develop acute kidney injury (AKI) because of renal perfusion deficit. We aimed to explore AKI-associated factors and the independent prediction of standardized minute ventilation (MV)—a proxy of alveolar dead space—on AKI onset and persistence in COVID-19 mechanically ventilated patients. Methods: This is a multicenter observational cohort study. We enrolled 157 COVID-19 patients requiring mechanical ventilation and intensive care unit (ICU) admission. We collected clinical information, ventilation, and laboratory data. AKI was defined by the 2012 KDIGO guidelines and classified as transient or persistent according to serum creatinine criteria persistence within 48 h. Ordered univariate and multivariate logistic regression analyses were employed to identify variables associated with AKI onset and persistence. Results: Among 157 COVID-19 patients on mechanical ventilation, 47% developed AKI: 10% had transient AKI, and 37% had persistent AKI. The degree of hypoxia was not associated with differences in AKI severity. Across increasing severity of AKI groups, despite similar levels of paCO2, we observed an increased MV and standardized MV, a robust proxy of alveolar dead space. After adjusting for other clinical and laboratory covariates, standardized MV remained an independent predictor of AKI development and persistence. d-dimer levels were higher in patients with persistent AKI. Conclusions: In critically ill COVID-19 patients with respiratory failure, increased wasted ventilation is independently associated with a greater risk of persistent AKI. These hypothesis-generating findings may suggest that perfusion derangements may link the pathophysiology of both wasted ventilation and acute kidney injury in our population.
AB - Background: Lung perfusion defects, mainly due to endothelial and coagulation activation, are a key contributor to COVID-19 respiratory failure. COVID-19 patients may also develop acute kidney injury (AKI) because of renal perfusion deficit. We aimed to explore AKI-associated factors and the independent prediction of standardized minute ventilation (MV)—a proxy of alveolar dead space—on AKI onset and persistence in COVID-19 mechanically ventilated patients. Methods: This is a multicenter observational cohort study. We enrolled 157 COVID-19 patients requiring mechanical ventilation and intensive care unit (ICU) admission. We collected clinical information, ventilation, and laboratory data. AKI was defined by the 2012 KDIGO guidelines and classified as transient or persistent according to serum creatinine criteria persistence within 48 h. Ordered univariate and multivariate logistic regression analyses were employed to identify variables associated with AKI onset and persistence. Results: Among 157 COVID-19 patients on mechanical ventilation, 47% developed AKI: 10% had transient AKI, and 37% had persistent AKI. The degree of hypoxia was not associated with differences in AKI severity. Across increasing severity of AKI groups, despite similar levels of paCO2, we observed an increased MV and standardized MV, a robust proxy of alveolar dead space. After adjusting for other clinical and laboratory covariates, standardized MV remained an independent predictor of AKI development and persistence. d-dimer levels were higher in patients with persistent AKI. Conclusions: In critically ill COVID-19 patients with respiratory failure, increased wasted ventilation is independently associated with a greater risk of persistent AKI. These hypothesis-generating findings may suggest that perfusion derangements may link the pathophysiology of both wasted ventilation and acute kidney injury in our population.
KW - Acute kidney injury
KW - Dead space
KW - Mechanical ventilation
KW - Minute ventilation
KW - Perfusion
KW - Respiratory failure
UR - http://www.scopus.com/inward/record.url?scp=85197742956&partnerID=8YFLogxK
U2 - 10.1186/s44158-024-00175-1
DO - 10.1186/s44158-024-00175-1
M3 - Article
AN - SCOPUS:85197742956
SN - 2731-3786
VL - 4
JO - Journal of Anesthesia, Analgesia and Critical Care
JF - Journal of Anesthesia, Analgesia and Critical Care
IS - 1
M1 - 40
ER -
