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Bobot M, Tonon D, Peres N, Guervilly C, Lefèvre F, Max H, Bommel Y, Volff M, Leone M, Lopez A, Simeone P, Carvelli J, Chopinet S, Hraiech S, Papazian L, Velly L, Bourenne J, Forel JM. Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically Ill Patients with COVID-19. J Clin Med 2022; 11:jcm11206130. [PMID: 36294451 PMCID: PMC9604787 DOI: 10.3390/jcm11206130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Acute kidney injury (AKI) is the second most frequent condition after acute respiratory distress syndrome (ARDS) in critically ill patients with severe COVID-19 and is strongly associated with mortality. The aim of this multicentric study was to assess the impact of the specific treatments of COVID-19 and ARDS on the risk of severe AKI in critically ill COVID-19 patients. Methods: In this cohort study, data from consecutive patients older than 18 years admitted to 6 ICUs for COVID-19-related ARDS requiring invasive mechanical ventilation were included. The incidence and severity of AKI, defined according to the 2012 KDIGO definition, were monitored during the entire ICU stay until day 90. Patients older than 18 years admitted to the ICU for COVID-19-related ARDS requiring invasive mechanical ventilation were included. Results: 164 patients were included in the final analysis; 97 (59.1%) displayed AKI, of which 39 (23.8%) had severe stage 3 AKI, and 21 (12.8%) required renal replacement therapy (RRT). In univariate analysis, severe AKI was associated with angiotensin-converting enzyme inhibitors (ACEI) exposure (p = 0.016), arterial hypertension (p = 0.029), APACHE-II score (p = 0.004) and mortality at D28 (p = 0.008), D60 (p < 0.001) and D90 (p < 0.001). In multivariate analysis, the factors associated with the onset of stage 3 AKI were: exposure to ACEI (OR: 4.238 (1.307−13.736), p = 0.016), APACHE II score (without age) (OR: 1.138 (1.044−1.241), p = 0.003) and iNO (OR: 5.694 (1.953−16.606), p = 0.001). Prone positioning (OR: 0.234 (0.057−0.967), p = 0.045) and dexamethasone (OR: 0.194 (0.053−0.713), p = 0.014) were associated with a decreased risk of severe AKI. Conclusions: Dexamethasone was associated with the prevention of the risk of severe AKI and RRT, and iNO was associated with severe AKI and RRT in critically ill patients with COVID-19. iNO should be used with caution in COVID-19-related ARDS.
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Affiliation(s)
- Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, 13005 Marseille, France
- Aix Marseille University, INSERM 1263, INRAE 1260, C2VN, European Center for Medical Imaging Research (CERIMED), Campus Santé Timone, 13005 Marseille, France
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
- Correspondence: ; Tel.: +33-491-383-042
| | - David Tonon
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Conception, AP-HM, 13005 Marseille, France
| | - Noémie Peres
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| | - Christophe Guervilly
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| | - Flora Lefèvre
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, 13005 Marseille, France
| | - Howard Max
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
| | - Youri Bommel
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
| | - Maxime Volff
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
| | - Marc Leone
- Service d’Anesthésie-Réanimation, Hôpital Nord, AP-HM, 13005 Marseille, France
| | - Alexandre Lopez
- Service d’Anesthésie-Réanimation, Hôpital Nord, AP-HM, 13005 Marseille, France
| | - Pierre Simeone
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
- CNRS, Institut des Neurosciences de la Timone, UMR7289, 13005 Marseille, France
| | - Julien Carvelli
- Service de Réanimation et Surveillance Continue, Hôpital de la Timone, AP-HM, Aix-Marseille University, 13005 Marseille, France
| | - Sophie Chopinet
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, AP-HM, 13005 Marseille, France
- European Center for Medical Imaging Research CERIMED, Laboratoire d’imagerie Interventionnelle Ex-périmentale (LIIE), Aix-Marseille Université, Campus Santé Timone, 13005 Marseille, France
| | - Sami Hraiech
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| | - Laurent Papazian
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| | - Lionel Velly
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
- CNRS, Institut des Neurosciences de la Timone, UMR7289, 13005 Marseille, France
| | - Jérémy Bourenne
- Service de Réanimation et Surveillance Continue, Hôpital de la Timone, AP-HM, Aix-Marseille University, 13005 Marseille, France
| | - Jean-Marie Forel
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
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Lao US, Law CF, Baptista-Hon DT, Tomlinson B. Systematic Review and Meta-Analysis of Statin Use and Mortality, Intensive Care Unit Admission and Requirement for Mechanical Ventilation in COVID-19 Patients. J Clin Med 2022; 11:jcm11185454. [PMID: 36143101 PMCID: PMC9501062 DOI: 10.3390/jcm11185454] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/04/2022] [Accepted: 09/14/2022] [Indexed: 11/26/2022] Open
Abstract
There is mounting evidence that statin use is beneficial for COVID-19 outcomes. We performed a systematic review and meta-analysis to evaluate the association between statin use and mortality, intensive care unit (ICU) admission and mechanical ventilation in COVID-19 patients, on studies which provided covariate adjusted effect estimates, or performed propensity score matching. We searched PubMed, Embase, Web of Science and Scopus for studies and extracted odds or hazard ratios for specified outcome measures. Data synthesis was performed using a random-effects inverse variance method. Risk of bias, heterogeneity and publication bias were analyzed using standard methods. Our results show that statin use was associated with significant reductions in mortality (OR = 0.72, 95% CI: 0.67–0.77; HR = 0.74, 95% CI: 0.69, 0.79), ICU admission (OR = 0.94, 95% CI: 0.89–0.99; HR = 0.76, 95% CI: 0.60–0.96) and mechanical ventilation (OR = 0.84, 95% CI: 0.78–0.92; HR = 0.67, 95% CI: 0.47–0.97). Nevertheless, current retrospective studies are based on the antecedent use of statins prior to infection and/or continued use of statin after hospital admission. The results may not apply to the de novo commencement of statin treatment after developing COVID-19 infection. Prospective studies are lacking and necessary.
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Affiliation(s)
- Ut-Sam Lao
- Center for Biomedicine and Innovations, Faculty of Medicine, Macau University Science and Technology, Taipa, Macau SAR 999078, China
| | - Chak-Fun Law
- Center for Biomedicine and Innovations, Faculty of Medicine, Macau University Science and Technology, Taipa, Macau SAR 999078, China
| | - Daniel T. Baptista-Hon
- Center for Biomedicine and Innovations, Faculty of Medicine, Macau University Science and Technology, Taipa, Macau SAR 999078, China
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee DD1 4HN, UK
- Correspondence: (D.T.B.-H.); (B.T.)
| | - Brian Tomlinson
- Center for Biomedicine and Innovations, Faculty of Medicine, Macau University Science and Technology, Taipa, Macau SAR 999078, China
- Correspondence: (D.T.B.-H.); (B.T.)
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Bartoli A, Fournel J, Ait-Yahia L, Cadour F, Tradi F, Ghattas B, Cortaredona S, Million M, Lasbleiz A, Dutour A, Gaborit B, Jacquier A. Automatic Deep-Learning Segmentation of Epicardial Adipose Tissue from Low-Dose Chest CT and Prognosis Impact on COVID-19. Cells 2022; 11:cells11061034. [PMID: 35326485 PMCID: PMC8947414 DOI: 10.3390/cells11061034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To develop a deep-learning (DL) pipeline that allowed an automated segmentation of epicardial adipose tissue (EAT) from low-dose computed tomography (LDCT) and investigate the link between EAT and COVID-19 clinical outcomes. Methods: This monocentric retrospective study included 353 patients: 95 for training, 20 for testing, and 238 for prognosis evaluation. EAT segmentation was obtained after thresholding on a manually segmented pericardial volume. The model was evaluated with Dice coefficient (DSC), inter-and intraobserver reproducibility, and clinical measures. Uni-and multi-variate analyzes were conducted to assess the prognosis value of the EAT volume, EAT extent, and lung lesion extent on clinical outcomes, including hospitalization, oxygen therapy, intensive care unit admission and death. Results: The mean DSC for EAT volumes was 0.85 ± 0.05. For EAT volume, the mean absolute error was 11.7 ± 8.1 cm3 with a non-significant bias of −4.0 ± 13.9 cm3 and a correlation of 0.963 with the manual measures (p < 0.01). The multivariate model providing the higher AUC to predict adverse outcome include both EAT extent and lung lesion extent (AUC = 0.805). Conclusions: A DL algorithm was developed and evaluated to obtain reproducible and precise EAT segmentation on LDCT. EAT extent in association with lung lesion extent was associated with adverse clinical outcomes with an AUC = 0.805.
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Affiliation(s)
- Axel Bartoli
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
- CRMBM—UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France;
- Correspondence: ; Tel.: +33-6-64-53-16-82
| | - Joris Fournel
- CRMBM—UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France;
| | - Léa Ait-Yahia
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
| | - Farah Cadour
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
- CRMBM—UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France;
| | - Farouk Tradi
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
| | - Badih Ghattas
- I2M—UMR CNRS 7373, Luminy Faculty of Sciences, Aix-Marseille University, 163 Avenue de Luminy, Case 901, 13009 Marseille, France;
| | - Sébastien Cortaredona
- IHU Méditerranée Infection, 19–21 Boulevard Jean Moulin, 13005 Marseille, France; (S.C.); (M.M.)
- VITROME, SSA, IRD, Aix-Marseille University, 13005 Marseille, France
| | - Matthieu Million
- IHU Méditerranée Infection, 19–21 Boulevard Jean Moulin, 13005 Marseille, France; (S.C.); (M.M.)
- MEPHI, IRD, AP-HM, Aix Marseille University, 13005 Marseille, France
| | - Adèle Lasbleiz
- C2VN, INRAE, INSERM, Aix Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France; (A.L.); (A.D.); (B.G.)
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, AP-HM, 13915 Marseille, France
| | - Anne Dutour
- C2VN, INRAE, INSERM, Aix Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France; (A.L.); (A.D.); (B.G.)
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, AP-HM, 13915 Marseille, France
| | - Bénédicte Gaborit
- C2VN, INRAE, INSERM, Aix Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France; (A.L.); (A.D.); (B.G.)
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, AP-HM, 13915 Marseille, France
| | - Alexis Jacquier
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
- CRMBM—UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France;
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