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Koch B, Shehata M, Müller-Ruttloff C, Gouda SA, Wetzstein N, Patyna S, Scholz A, Schmid T, Dietrich U, Münch C, Ziebuhr J, Geiger H, Martinez-Sobrido L, Baer PC, Mostafa A, Pleschka S. Influenza A virus replicates productively in primary human kidney cells and induces factors and mechanisms related to regulated cell death and renal pathology observed in virus-infected patients. Front Cell Infect Microbiol 2024; 14:1363407. [PMID: 38590437 PMCID: PMC10999593 DOI: 10.3389/fcimb.2024.1363407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Influenza A virus (IAV) infection can cause the often-lethal acute respiratory distress syndrome (ARDS) of the lung. Concomitantly, acute kidney injury (AKI) is frequently noticed during IAV infection, correlating with an increased mortality. The aim of this study was to elucidate the interaction of IAV with human kidney cells and, thereby, to assess the mechanisms underlying IAV-mediated AKI. Methods To investigate IAV effects on nephron cells we performed infectivity assays with human IAV, as well as with human isolates of either low or highly pathogenic avian IAV. Also, transcriptome and proteome analysis of IAV-infected primary human distal tubular kidney cells (DTC) was performed. Furthermore, the DTC transcriptome was compared to existing transcriptomic data from IAV-infected lung and trachea cells. Results We demonstrate productive replication of all tested IAV strains on primary and immortalized nephron cells. Comparison of our transcriptome and proteome analysis of H1N1-type IAV-infected human primary distal tubular cells (DTC) with existing data from H1N1-type IAV-infected lung and primary trachea cells revealed enrichment of specific factors responsible for regulated cell death in primary DTC, which could be targeted by specific inhibitors. Discussion IAV not only infects, but also productively replicates on different human nephron cells. Importantly, multi-omics analysis revealed regulated cell death as potential contributing factor for the clinically observed kidney pathology in influenza.
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Affiliation(s)
- Benjamin Koch
- Department of Internal Medicine 4, Nephrology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Mahmoud Shehata
- Center of Scientific Excellence for Influenza Viruses, National Research Centre (NRC), Cairo, Egypt
- Institute of Medical Virology, Justus Liebig University Giessen, Giessen, Germany
| | - Christin Müller-Ruttloff
- Institute of Medical Virology, Justus Liebig University Giessen, Giessen, Germany
- German Center for Infection Research (DZIF), Partner Site Giessen, Giessen, Germany
| | - Shady A. Gouda
- Institute for Biochemistry II, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Nils Wetzstein
- Department of Internal Medicine 2, Infectious Diseases, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sammy Patyna
- Department of Internal Medicine 4, Nephrology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Anica Scholz
- Institute of Biochemistry I, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Tobias Schmid
- Institute of Biochemistry I, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ursula Dietrich
- Institute for Tumor Biology and Experimental Therapy, Georg-Speyer-Haus, Frankfurt am Main, Germany
| | - Christian Münch
- Institute for Biochemistry II, Goethe University Frankfurt, Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany
- Cardio-Pulmonary Institute, Frankfurt am Main, Germany
| | - John Ziebuhr
- Institute of Medical Virology, Justus Liebig University Giessen, Giessen, Germany
- German Center for Infection Research (DZIF), Partner Site Giessen, Giessen, Germany
| | - Helmut Geiger
- Department of Internal Medicine 4, Nephrology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Luis Martinez-Sobrido
- Texas Biomedical Research Institute, Disease Intervention & Prevention (DIP) and Host Pathogen Interactions (HPI) Programs, San Antonio, TX, United States
| | - Patrick C. Baer
- Department of Internal Medicine 4, Nephrology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ahmed Mostafa
- Center of Scientific Excellence for Influenza Viruses, National Research Centre (NRC), Cairo, Egypt
- Texas Biomedical Research Institute, Disease Intervention & Prevention (DIP) and Host Pathogen Interactions (HPI) Programs, San Antonio, TX, United States
| | - Stephan Pleschka
- Institute of Medical Virology, Justus Liebig University Giessen, Giessen, Germany
- German Center for Infection Research (DZIF), Partner Site Giessen, Giessen, Germany
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Charkviani M, Truong HH, Nikravangolsefid N, Ninan J, Prokop LJ, Reddy S, Kashani KB, Domecq Garces JP. Temporal Relationship and Clinical Outcomes of Acute Kidney Injury Following Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis. Crit Care Explor 2024; 6:e1054. [PMID: 38352941 PMCID: PMC10863947 DOI: 10.1097/cce.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVES Conduct a systematic review and meta-analysis to assess prevalence and timing of acute kidney injury (AKI) development after acute respiratory distress syndrome (ARDS) and its association with mortality. DATA SOURCES Ovid MEDLINE(R), Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Ovid PsycINFO database, Scopus, and Web of Science thought April 2023. STUDY SELECTION Titles and abstracts were screened independently and in duplicate to identify eligible studies. Randomized controlled trials and prospective or retrospective cohort studies reporting the development of AKI following ARDS were included. DATA EXTRACTION Two reviewers independently extracted data using a pre piloted abstraction form. We used Review Manager 5.4 software (Cochrane Library, Oxford, United Kingdom) and Open Meta software (Brown University, Providence, RI) for statistical analyses. DATA SYNTHESIS Among the 3646 studies identified and screened, 17 studies comprising 9359 ARDS patients met the eligibility criteria and were included in the meta-analysis. AKI developed in 3287 patients (40%) after the diagnosis of ARDS. The incidence of AKI at least 48 hours after ARDS diagnosis was 20% (95% CI, 0.18-0.21%). The pooled risk ratio (RR) for the hospital (or 30-d) mortality among ARDS patients who developed AKI was 1.93 (95% CI, 1.71-2.18). AKI development after ARDS was identified as an independent risk factor for mortality in ARDS patients, with a pooled odds ratio from multivariable analysis of 3.69 (95% CI, 2.24-6.09). Furthermore, two studies comparing mortality between patients with late vs. early AKI initiation after ARDS revealed higher mortality in late AKI patients with RR of 1.46 (95% CI, 1.19-1.8). However, the certainty of evidence for most outcomes was low to very low. CONCLUSIONS While our findings highlight a significant association between ARDS and subsequent development of AKI, the low to very low certainty of evidence underscores the need for cautious interpretation. This systematic review identified a significant knowledge gap, necessitating further research to establish a more definitive understanding of this relationship and its clinical implications.
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Affiliation(s)
| | - Hong Hieu Truong
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Jacob Ninan
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Swetha Reddy
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Juan Pablo Domecq Garces
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
- Division of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN
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Ishiguro T, Kobayashi Y, Shimizu Y, Uemura Y, Toriba R, Takata N, Ueda M, Shimizu Y. Prognostic factors of virus-associated pneumonia other than COVID-19 in adults. Respir Med 2024; 221:107497. [PMID: 38097142 DOI: 10.1016/j.rmed.2023.107497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To determine prognostic factors of virus-associated pneumonia other than coronavirus disease 2019. METHODS We retrospectively studied patients suffering from virus-associated community-acquired pneumonia, and who were admitted to Saitama Cardiovascular and Respiratory Center from 2002 to 2020. Prognostic factors were analyzed by univariable and multivariable regression analysis of patient demographics, laboratory data, chest imaging, severity on admission, and initial treatment. PATIENTS HIV-positive patients, those with non-resected lung cancer or receiving chemotherapy, and those with COVID-19 were excluded. Included were 363 patients diagnosed by nucleic acid amplification method, paired sera, and rapid diagnostic tests. RESULTS A CURB-65 score of ≥3 was significant by univariable analysis for 60-day mortality but was nonsignificant by multivariable analysis. The poor prognostic factors that were significant by multivariable analysis (p < 0.05) included immunosuppressive state due to systemic corticosteroid or immunosuppressant administration, acute kidney injury on admission, and corticosteroid administration initiated within 5 days or 5 days to 2 weeks from onset. CONCLUSION A CURB-65 score of ≥3, which is considered to indicate severe pneumonia, was of limited value for predicting mortality of virus-associated pneumonia. We showed patients' underlying diseases and complications to be independent factors of poor prognosis for 60-day mortality. Timing of the initiation of corticosteroid administration remains to be elucidated.
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Affiliation(s)
- Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan.
| | - Yoichi Kobayashi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yosuke Shimizu
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukari Uemura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Riho Toriba
- Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Naomi Takata
- Department of Radiology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Miyuki Ueda
- Department of Radiology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
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Silva BRS, Jara CP, Sidarta-Oliveira D, Velloso LA, Velander WH, Araújo EP. Downregulation of the Protein C Signaling System Is Associated with COVID-19 Hypercoagulability-A Single-Cell Transcriptomics Analysis. Viruses 2022; 14:2753. [PMID: 36560757 PMCID: PMC9785999 DOI: 10.3390/v14122753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/14/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Because of the interface between coagulation and the immune response, it is expected that COVID-19-associated coagulopathy occurs via activated protein C signaling. The objective was to explore putative changes in the expression of the protein C signaling network in the liver, peripheral blood mononuclear cells, and nasal epithelium of patients with COVID-19. Single-cell RNA-sequencing data from patients with COVID-19 and healthy subjects were obtained from the COVID-19 Cell Atlas database. A functional protein-protein interaction network was constructed for the protein C gene. Patients with COVID-19 showed downregulation of protein C and components of the downstream protein C signaling cascade. The percentage of hepatocytes expressing protein C was lower. Part of the liver cell clusters expressing protein C presented increased expression of ACE2. In PBMC, there was increased ACE2, inflammatory, and pro-coagulation transcripts. In the nasal epithelium, PROC, ACE2, and PROS1 were expressed by the ciliated cell cluster, revealing co-expression of ACE-2 with transcripts encoding proteins belonging to the coagulation and immune system interface. Finally, there was upregulation of coagulation factor 3 transcript in the liver and PBMC. Protein C could play a mechanistic role in the hypercoagulability syndrome affecting patients with severe COVID-19.
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Affiliation(s)
- Bruna Rafaela Santos Silva
- Nursing School, University of Campinas, Tessalia Vieira de Camargo, 126, Campinas 13084-970, Brazil
- Laboratory of Cell Signalling, Obesity and Comorbidities Center, OCRC, University of Campinas, Carl Von Linnaeus, s/n, Campinas 13084-864, Brazil
| | - Carlos Poblete Jara
- Department of Chemical and Biomolecular Engineering, University of Nebraska, Lincoln, NE 68588-0643, USA
| | - Davi Sidarta-Oliveira
- Laboratory of Cell Signalling, Obesity and Comorbidities Center, OCRC, University of Campinas, Carl Von Linnaeus, s/n, Campinas 13084-864, Brazil
- School of Medical Sciences, University of Campinas, Tessalia Vieira de Camargo, 126, Campinas 13083-887, Brazil
| | - Licio A. Velloso
- Laboratory of Cell Signalling, Obesity and Comorbidities Center, OCRC, University of Campinas, Carl Von Linnaeus, s/n, Campinas 13084-864, Brazil
- School of Medical Sciences, University of Campinas, Tessalia Vieira de Camargo, 126, Campinas 13083-887, Brazil
| | - William H. Velander
- Department of Chemical and Biomolecular Engineering, University of Nebraska, Lincoln, NE 68588-0643, USA
| | - Eliana P. Araújo
- Nursing School, University of Campinas, Tessalia Vieira de Camargo, 126, Campinas 13084-970, Brazil
- Laboratory of Cell Signalling, Obesity and Comorbidities Center, OCRC, University of Campinas, Carl Von Linnaeus, s/n, Campinas 13084-864, Brazil
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Huang D, Yang H, Yu H, Wang T, Chen Z, Yao R, Liang Z. A prediction model for major adverse cardiovascular events (MACE) in patients with coronavirus disease 2019 (COVID-19). BMC Pulm Med 2022; 22:343. [PMID: 36096832 PMCID: PMC9466355 DOI: 10.1186/s12890-022-02143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Emerging evidence shows that cardiovascular injuries and events in coronavirus disease 2019 (COVID-19) should be considered. The current study was conducted to develop an early prediction model for major adverse cardiovascular events (MACE) during hospitalizations of COVID-19 patients. Methods This was a retrospective, multicenter, observational study. Hospitalized COVID-19 patients from Wuhan city, Hubei Province and Sichuan Province, China, between January 14 and March 9, 2020, were randomly divided into a training set (70% of patients) and a testing set (30%). All baseline data were recorded at admission or within 24 h after admission to hospitals. The primary outcome was MACE during hospitalization, including nonfatal myocardial infarction, nonfatal stroke and cardiovascular death. The risk factors were selected by LASSO regression and multivariate logistic regression analysis. The nomogram was assessed by calibration curve and decision curve analysis (DCA). Results Ultimately, 1206 adult COVID-19 patients were included. In the training set, 48 (5.7%) patients eventually developed MACE. Six factors associated with MACE were included in the nomogram: age, PaO2/FiO2 under 300, unconsciousness, lymphocyte counts, neutrophil counts and blood urea nitrogen. The C indices were 0.93 (95% CI 0.90, 0.97) in the training set and 0.81 (95% CI 0.70, 0.93) in the testing set. The calibration curve and DCA demonstrated the good performance of the nomogram. Conclusions We developed and validated a nomogram to predict the development of MACE in hospitalized COVID-19 patients. More prospective multicenter studies are needed to confirm our results. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02143-3.
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Affiliation(s)
- Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Huan Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - He Yu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zhu Chen
- Department of Infectional Inpatient Ward Two, Chengdu Public Health Clinical Medical Center, Chengdu, Sichuan, China
| | - Rong Yao
- Department of Emergency Medicine, Emergency Medical Laboratory, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China. .,Disaster Medical Center, Sichuan University, Chengdu, Sichuan, China.
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Trifi A, Abdellatif S, Masseoudi Y, Mehdi A, Benjima O, Seghir E, Cherif F, Touil Y, Jeribi B, Daly F, Abdennebi C, Ammous A, Lakhal SB. COVID-19-induced acute kidney injury in critically ill patients: epidemiology, risk factors, and outcome. Acute Crit Care 2022; 36:308-316. [PMID: 35263826 PMCID: PMC8907460 DOI: 10.4266/acc.2021.00934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/19/2021] [Indexed: 01/08/2023] Open
Abstract
Background The kidney represents a potential target for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data about acute kidney injury (AKI) during SARS-CoV-2 infection are lacking. We aimed to investigate the proportion, risk factors, and prognosis of AKI in critical patients affected with SARS-CoV-2. Methods A case/control study was conducted in two intensive care units of a tertiary teaching hospital. Results Among 109 patients, 75 were male (69%) with median age at 64 years and 48 (44%) developed AKI within 4 days (interquartile range [IQR], 1–9). Of them, 11 (23%), 9 (19%), and 28 (58%) were classified as stage 1, 2, and 3, respectively. AKI patients were older and presented more sepsis, acute respiratory distress syndrome, and rhabdomyolysis; higher initial urea and creatinine; more marked inflammatory syndrome and hematological disorders; and required more mechanical ventilation and vasopressors. An elevated D-dimers level (odds ratio [OR], 12.83; 95% confidence interval [CI], 1.9–85) was an independent factor of AKI. Sepsis was near to significance (OR, 5.22; 95% CI, 0.94–28; P=0.058). AKI was independently related to mortality (OR, 6.8; 95% CI, 1.49–105) and significantly reduced the survival (14.7 days; IQR, 12-17 vs. 19.9 days; IQR, 17-22.7; P=0.011) in AKI and no AKI group respectively. Hypoxemia with the ratio of the arterial partial pressure of oxygen and the inspiratory concentration of oxygen <70, and vasopressors were identified as mortality factors. Conclusions AKI occurred in almost half the studied patients and significantly worsened their prognosis. A high D-dimers level and sepsis contributed significantly to its development.
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Affiliation(s)
- Ahlem Trifi
- Medical Intensive Care Unit, University Hospital Center La Rabta, Tunis, Tunisia.,Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia
| | - Sami Abdellatif
- Medical Intensive Care Unit, University Hospital Center La Rabta, Tunis, Tunisia.,Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia
| | - Yosri Masseoudi
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia.,Department of Anesthesia, University Hospital Center La Rabta, Tunis, Tunisia
| | - Asma Mehdi
- Medical Intensive Care Unit, University Hospital Center La Rabta, Tunis, Tunisia.,Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia
| | - Oussama Benjima
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia.,Department of Anesthesia, University Hospital Center La Rabta, Tunis, Tunisia
| | - Eya Seghir
- Medical Intensive Care Unit, University Hospital Center La Rabta, Tunis, Tunisia.,Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia
| | - Fatma Cherif
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia.,Department of Anesthesia, University Hospital Center La Rabta, Tunis, Tunisia
| | - Yosr Touil
- Medical Intensive Care Unit, University Hospital Center La Rabta, Tunis, Tunisia.,Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia
| | - Bedis Jeribi
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia.,Department of Anesthesia, University Hospital Center La Rabta, Tunis, Tunisia
| | - Foued Daly
- Medical Intensive Care Unit, University Hospital Center La Rabta, Tunis, Tunisia.,Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia
| | - Cyrine Abdennebi
- Medical Intensive Care Unit, University Hospital Center La Rabta, Tunis, Tunisia.,Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia
| | - Adel Ammous
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia.,Department of Anesthesia, University Hospital Center La Rabta, Tunis, Tunisia
| | - Salah Ben Lakhal
- Medical Intensive Care Unit, University Hospital Center La Rabta, Tunis, Tunisia.,Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia
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Kumar P, Tiwari K, Pendyala SK, Jaiswal RK, Chacko NL, Srivastava E, Tiwari RVC. Cardiovascular Complications and its Impact on outcomes in COVID-19: An Original Research. J Pharm Bioallied Sci 2021; 13:S1333-S1337. [PMID: 35017983 PMCID: PMC8687031 DOI: 10.4103/jpbs.jpbs_143_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/06/2021] [Accepted: 05/06/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The viral infection COVID-19 is highly infectious and has claimed many lives till date and is still continuing to consume lives. In the COVID-19, along with pulmonary symptoms, cardiovascular (CV) events were also recorded that have known to significantly contribute to the mortality. In our study, we designed and validated a new risk score that can predict CV events, and also evaluated the effect of these complications on the prognosis in COVID-19 patients. MATERIALS AND METHODS A retrospective, multicenter, observational study was done among 1000 laboratory-confirmed COVID-19 patients between June 2020 and December 2020. All the data of the clinical and laboratory parameters were collected. Patients were randomly divided into two groups for testing and validating the hypothesis. The identification of the independent risk factors was done by the logistic regression analysis method. RESULTS Of all the types of the clinical and laboratory parameters, ten "independent risk factors" were identified associated with CV events in Group A: male gender, older age, chronic heart disease, cough, lymphocyte count <1.1 × 109/L at admission, blood urea nitrogen >7 mmol/L at admission, estimated glomerular filtration rate <90 ml/min/1.73 m2 at admission, activated partial thromboplastin time >37 S, D-dimer, and procalcitonin >0.5 mg/L. In our study, we found that CV events were significantly related with inferior prognosis (P < 0.001). CONCLUSIONS A new risk scoring system was designed in our study, which may be used as a predictive tool for CV complications among the patients with COVID-19 infection.
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Affiliation(s)
- Prashant Kumar
- Department of Cardiology, Rajendra Institute of Medical Science, Ranchi, Jharkhand, India
| | - Kaousthubh Tiwari
- General Physician, Rollz India Waste Management Pvt. Ltd, Ghaziabad, Uttar Pradesh, India
| | - Siva Kumar Pendyala
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, AIMST University, Kedah, Malaysia
| | - Ratnesh Kumar Jaiswal
- Department of Periodontics, RUHS College of Dental Sciences, Jaipur, Rajasthan, India
| | - Neelathil Lisa Chacko
- Department of Periodontics, SMBT Dental College and Postgraduate Centre, Sangamner, Maharashtra, India
| | - Ekta Srivastava
- Department of Pediatric and Preventive Dentistry, SMBT Dental College and Hospital, Sangamner, Maharashtra, India
| | - Rahul V. C. Tiwari
- Department of OMFS, Narsinbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat, India,Address for correspondence: Dr. Rahul V. C. Tiwari, Department of OMFS, Narsinbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar - 384 315, Gujarat, India. E-mail:
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8
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Cau A, Cheng MP, Lee T, Levin A, Lee TC, Vinh DC, Lamontagne F, Singer J, Walley KR, Murthy S, Patrick D, Rewa O, Winston B, Marshall J, Boyd J, Russell JA. Acute Kidney Injury and Renal Replacement Therapy in COVID-19 Versus Other Respiratory Viruses: A Systematic Review and Meta-Analysis. Can J Kidney Health Dis 2021; 8:20543581211052185. [PMID: 34733538 PMCID: PMC8558598 DOI: 10.1177/20543581211052185] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 09/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a potentially fatal complication of Coronavirus Disease-2019 (COVID-19). Binding of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, to its viral receptor, angiotensin converting enzyme 2 (ACE2), results in viral entry and may cause AKI. OBJECTIVES We performed a systematic review and meta-analysis of the frequencies of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients and compared those frequencies with patients who were infected by respiratory viruses that bind or downregulate ACE2 (ACE2-associated viruses) and viruses that do not bind nor downregulate ACE2 (non-ACE2-associated viruses). DESIGN Systematic review and meta-analysis. SETTING Observational studies on COVID-19 and other respiratory viral infections reporting AKI and RRT were included. The exclusion criteria were non-English articles, non-peer-reviewed articles, review articles, studies that included patients under the age of 18, studies including fewer than 10 patients, and studies not reporting AKI and RRT rates. PATIENTS Adult COVID-19, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and influenza patients. MEASUREMENTS We extracted the following data from the included studies: author, year, study location, age, sex, race, diabetes mellitus, hypertension, chronic kidney disease, shock, vasopressor use, mortality, intensive care unit (ICU) admission, ICU mortality, AKI, and RRT. METHODS We systematically searched PubMed and EMBASE for articles reporting AKI or RRT. AKI was defined by authors of included studies. Critical illness was defined by ICU admission. We performed a random effects meta-analysis to calculate pooled estimates for the AKI and RRT rate within each virus group using a random intercept logistic regression model. RESULTS Of 23 655 hospitalized, critically ill COVID-19 patients, AKI frequencies were not significantly different between COVID-19 patients (51%, 95% confidence interval [CI]: 44%-57%) and critically ill patients infected with ACE2-associated (56%, 95% CI: 37%-74%, P = .610) or non-ACE2-associated viruses (63%, 95% CI: 43%-79%, P = .255). Pooled RRT rates were also not significantly different between critically ill, hospitalized patients with COVID-19 (20%, 95% CI: 16%-24%) and ACE2-associated viruses (18%, 95% CI: 8%-33%, P = .747). RRT rates for both COVID-19 and ACE2-associated viruses were significantly different (P < .001 for both) from non-ACE2-associated viruses (49%, 95% CI: 44%-54%). After adjusting for shock or vasopressor use, AKI and RRT rates were not significantly different between groups. LIMITATIONS Limitations of this study include the heterogeneity of definitions of AKI that were used across different virus studies. We could not match severity of infection or do propensity matching across studies. Most of the included studies were conducted in retrospective fashion. Last, we did not include non-English publications. CONCLUSIONS Our findings suggest that viral ACE2 association does not significantly alter the rates of AKI and RRT among critically ill patients admitted to the ICU. However, the rate of RRT is lower in patients with COVID-19 or ACE2-associated viruses when compared with patients infected with non-ACE2-binding viruses, which might partly be due to the lower frequencies of shock and use of vasopressors in these two virus groups. Prospective studies are necessary to demonstrate whether modulation of the ACE2 axis with Renin-Angiotensin System inhibitors impacts the rates of AKI and whether they are beneficial or harmful in COVID-19 patients.
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Affiliation(s)
- A. Cau
- The University of British Columbia, Vancouver, BC, Canada
| | - M. P. Cheng
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Terry Lee
- Centre for Health Evaluation & Outcomes Science, The University of British Columbia, Vancouver, BC, Canada
| | - A. Levin
- Division of Nephrology, St. Paul’s Hospital, Vancouver, BC, Canada
| | - T. C. Lee
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - D. C. Vinh
- Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - J. Singer
- Centre for Health Evaluation & Outcomes Science, The University of British Columbia, Vancouver, BC, Canada
| | - K. R. Walley
- Centre for Heart Lung Innovation, St. Paul’s Hospital and The University of British Columbia, Vancouver, BC, Canada
| | - S. Murthy
- BC Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - D. Patrick
- British Columbia Centre for Disease Control and The University of British Columbia, Vancouver, BC, Canada
| | - O. Rewa
- University of Alberta, Edmonton, AB, Canada
| | - B. Winston
- University of Calgary, Calgary, AB, Canada
| | - J. Marshall
- St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - J. Boyd
- Centre for Heart Lung Innovation, St. Paul’s Hospital and The University of British Columbia, Vancouver, BC, Canada
| | - JA Russell
- Centre for Heart Lung Innovation, St. Paul’s Hospital and The University of British Columbia, Vancouver, BC, Canada
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Chang KW, Leu SW, Lin SW, Liang SJ, Yang KY, Chan MC, Chen WC, Hu HC, Fang WF, Chen YM, Sheu CC, Tsai MJ, Wang HC, Chien YC, Peng CK, Wu CL, Kao KC. Renal Replacement Therapy in Patients with Influenza Pneumonia Related Acute Respiratory Distress Syndrome. J Clin Med 2021; 10:jcm10091837. [PMID: 33922592 PMCID: PMC8122892 DOI: 10.3390/jcm10091837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Acute kidney injury (AKI) requiring renal replacement therapy (RRT) increases the mortality of acute respiratory distress syndrome (ARDS) patients. The aim of this study was to investigate the outcomes and predictors of RRT in patients with influenza pneumonia-related ARDS. This retrospective cohort study includes patients from eight tertiary referral centers in Taiwan between January and March 2016, and all 282 patients with influenza pneumonia-related ARDS were enrolled. Thirty-four patients suffered from AKI requiring RRT, while 16 patients had underlying end stage renal disease (ESRD). The 30- and 60-day mortality rates were significantly higher in patients with AKI requiring RRT compared with those not requiring RRT (50.0% vs. 19.8%, p value < 0.001; 58.8% vs. 27.2%, p value = 0.001, respectively), but the patients with ESRD had no significant difference in mortality (12.5% vs. 19.8%, p value = 0.744; 31.3% vs. 27.2%, p value = 0.773, respectively). The predictors for AKI requiring RRT included underlying chronic liver disease and C-reactive protein. The mortality predictors for patients with AKI requiring RRT included the pneumonia severity index, tidal volume, and continuous renal replacement therapy. In this study, patients with influenza pneumonia-related ARDS with AKI requiring RRT had significantly higher mortality compared with other patients.
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Affiliation(s)
- Ko-Wei Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-W.C.); (S.-W.L.); (S.-W.L.); (H.-C.H.)
| | - Shaw-Woei Leu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-W.C.); (S.-W.L.); (S.-W.L.); (H.-C.H.)
| | - Shih-Wei Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-W.C.); (S.-W.L.); (S.-W.L.); (H.-C.H.)
| | - Shinn-Jye Liang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan;
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 122, Taiwan; (K.-Y.Y.); (W.-C.C.)
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei 122, Taiwan
| | - Ming-Cheng Chan
- Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan;
- College of Science, Tunghai University, Taichung 407, Taiwan
| | - Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 122, Taiwan; (K.-Y.Y.); (W.-C.C.)
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei 122, Taiwan
| | - Han-Chung Hu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-W.C.); (S.-W.L.); (S.-W.L.); (H.-C.H.)
- Department of Respiratory Therapy, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
| | - Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (W.-F.F.); (Y.-M.C.)
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
| | - Yu-Mu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (W.-F.F.); (Y.-M.C.)
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (C.-C.S.); (M.-J.T.)
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (C.-C.S.); (M.-J.T.)
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hao-Chien Wang
- Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (H.-C.W.); (Y.-C.C.)
| | - Ying-Chun Chien
- Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (H.-C.W.); (Y.-C.C.)
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Chieh-Liang Wu
- Center for Quality Management, Taichung Veterans General Hospital, Taichung 407, Taiwan;
- Office of Medical Administration, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Kuo-Chin Kao
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-W.C.); (S.-W.L.); (S.-W.L.); (H.-C.H.)
- Department of Respiratory Therapy, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
- Correspondence:
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10
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Cheng MP, Cau A, Lee TC, Brodie D, Slutsky A, Marshall J, Murthy S, Lee T, Singer J, Demir KK, Boyd J, Ohm H, Maslove D, Goffi A, Bogoch II, Sweet DD, Walley KR, Russell JA; Angiotensin Receptor Blocker Coronavirus Study (ARBs) CORONA I. Acute Cardiac Injury in Coronavirus Disease 2019 and Other Viral Infections-A Systematic Review and Meta-Analysis. Crit Care Med 2021. [PMID: 33870918 DOI: 10.1097/CCM.0000000000005026] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Severe acute respiratory syndrome-related coronavirus-2 binds and inhibits angiotensin-converting enzyme-2. The frequency of acute cardiac injury in patients with coronavirus disease 2019 is unknown. The objective was to compare the rates of cardiac injury by angiotensin-converting enzyme-2-binding viruses from viruses that do not bind to angiotensin-converting enzyme-2. DATA SOURCES We performed a systematic review of coronavirus disease 2019 literature on PubMed and EMBASE. STUDY SELECTION We included studies with ten or more hospitalized adults with confirmed coronavirus disease 2019 or other viral pathogens that described the occurrence of acute cardiac injury. This was defined by the original publication authors or by: 1) myocardial ischemia, 2) new cardiac arrhythmia on echocardiogram, or 3) new or worsening heart failure on echocardiogram. DATA EXTRACTION We compared the rates of cardiac injury among patients with respiratory infections with viruses that down-regulate angiotensin-converting enzyme-2, including H1N1, H5N1, H7N9, and severe acute respiratory syndrome-related coronavirus-1, to those with respiratory infections from other influenza viruses that do not bind angiotensin-converting enzyme-2, including Influenza H3N2 and influenza B. DATA SYNTHESIS Of 57 studies including 34,072 patients, acute cardiac injury occurred in 50% (95% CI, 44-57%) of critically ill patients with coronavirus disease 2019. The overall risk of acute cardiac injury was 21% (95% CI, 18-26%) among hospitalized patients with coronavirus disease 2019. In comparison, 37% (95% CI, 26-49%) of critically ill patients with other respiratory viruses that bind angiotensin-converting enzyme-2 (p = 0.061) and 12% (95% CI, 7-22%) of critically ill patients with other respiratory viruses that do not bind angiotensin-converting enzyme-2 (p < 0.001) experienced a cardiac injury. CONCLUSIONS Acute cardiac injury may be associated with whether the virus binds angiotensin-converting enzyme-2. Acute cardiac injury occurs in half of critically ill coronavirus disease 2019 patients, but only 12% of patients infected by viruses that do not bind to angiotensin-converting enzyme-2.
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11
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Sang L, Chen S, Zheng X, Guan W, Zhang Z, Liang W, Zhong M, Jiang L, Pan C, Zhang W, Xia J, Chen N, Wu W, Wu H, Xu Y, Liu X, Liu X, He J, Li S, Zhang D, Zhong N, Li Y. The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study. BMC Pulm Med 2020; 20:290. [PMID: 33167955 PMCID: PMC7649893 DOI: 10.1186/s12890-020-01305-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/01/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The clinical correlates, prognosis and determinants of acute kidney injury (AKI) in patients with coronavirus disease 2019 (Covid-19) remain largely unclear. METHODS We retrospectively reviewed medical records of all adult patients with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. RESULTS Among 210 patients, 131 were males (62.4%). The median Age was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) were classified as being at stage 1, 2 and 3, respectively. 54 patients (58.7%) received continuous renal replacement therapy. Age, sepsis, nephrotoxic drug, invasive mechanical ventilation and elevated baseline serum creatinine levels were associated with the occurrence of AKI. Renal recovery during hospitalization was identified among 16 patients with AKI (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure and higher ratio of partial pressure of oxygen to the fraction of inspired oxygen. Of 210 patients, 93 deceased within 28 days of ICU admission. AKI stage 3, critical disease, greater Age and the lowest ratio of partial pressure of oxygen to the fraction of inspired oxygen being < 150 mmHg were independently associated with death. CONCLUSIONS Among patients with Covid-19, the incidence of AKI was high. Our findings of the risk factors of the development of AKI and factors associated with renal function recovery may inform clinical management of patients with critical illness of Covid-19.
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Affiliation(s)
- Ling Sang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sibei Chen
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Zhejiang, Hangzhou, China
| | - Weijie Guan
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhihui Zhang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thorax Surgery, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chun Pan
- Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Wei Zhang
- Emergency Department, the 900th Hospital of Joint Service Corps of Chinese PLA, FuZhou, China
| | - Jiaan Xia
- Department of tuberculosis, Wuhan Jinyintan Hospital, Wuhan, China
| | - Nanshan Chen
- Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China
| | - Wenjuan Wu
- Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China
| | - Hongkai Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yonghao Xu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuesong Liu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- Department of Thorax Surgery, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dingyu Zhang
- Research Center for Translational Medicine, Wuhan Jinyintan Hospital, Wuhan, China
- Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, China
| | - Nanshan Zhong
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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12
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Li J, Zhang D, Sun Z, Bai C, Zhao L. Influenza in hospitalised patients with malignancy: a propensity score matching analysis. ESMO Open 2020; 5:e000968. [PMID: 33093022 PMCID: PMC7583803 DOI: 10.1136/esmoopen-2020-000968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 01/22/2023] Open
Abstract
Background Patients with malignancy are vulnerable to influenza viruses and are at high risk of developing serious complications. However, few studies have investigated the impact of influenza infection among hospitalised patients with malignancy. Methods Cancer-related hospitalisations were identified by using data from National Inpatient Sample in the USA between 2012 and 2014. We conducted a 1:1 propensity score matching analysis to compare the in-hospital outcomes between cancer patients with and without influenza. Multivariate logistic regression analyses were also performed to identify independent prognosis predictors of mortality. Results We identified 13 186 849 weighted cancer-related hospitalisations during the study period, and 47 850 of them (0.36%) had a concomitant diagnosis of influenza. After propensity score matching, cancer patients with concomitant influenza had a higher mortality (5.4% vs 4.2%; OR, 1.30; 95% CI, 1.13 to 1.49; p<0.001), longer length of stay (6.3 days vs 5.6 days; p<0.001) but lower costs (US$14 605.9 vs US$14 625.5; p<0.001) in hospital than those without influenza. In addition, cancer patients with influenza had a higher incidence of complications, including pneumonia (18.4% vs 13.2%; OR, 1.49; 95% CI, 1.37 to 1.62; p<0.001), neutropenia (7.1% vs 3.4%; OR, 2.18; 95% CI, 1.91 to 2.50; p<0.001), sepsis (19.5% vs 9.3%; OR, 2.36; 95% CI, 2.16 to 2.58; p<0.001), dehydration (14.8% vs 8.8%; OR, 1.80; 95% CI, 1.65 to 1.97; p<0.001) and acute kidney injury (19.9% vs 17.6%; OR, 1.16; 95% CI, 1.08 to 1.25; p<0.001) than those without influenza. Older age, no insurance, more comorbidities, lung cancer and haematological malignancy were independently associated with higher mortality. Conclusion Influenza is associated with worse in-hospital clinical outcomes among hospitalised patients with malignancy. Annual influenza vaccination and early initiation of antiviral therapy are recommended in this high-risk population.
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Affiliation(s)
- Jiarui Li
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dingding Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhao Sun
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunmei Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Zhao
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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13
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Huang D, Yang H, Yu H, Wang T, Yao R, Liang Z. A novel risk score to predict cardiovascular complications in patients with coronavirus disease 2019 (COVID-19): A retrospective, multicenter, observational study. Immun Inflamm Dis 2020; 8:638-649. [PMID: 32969605 PMCID: PMC7537545 DOI: 10.1002/iid3.353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/11/2020] [Indexed: 02/05/2023]
Abstract
Background We conducted this study to explore a novel risk score to predict cardiovascular complications in patients with coronavirus disease 2019 (COVID‐19). Methods The current study was a retrospective, multicenter, observational study. The clinical data of COVID‐19 patients at admission were collected. Patients were randomly divided into training set and testing set (70% vs. 30% of patients). Independent risk factors were identified via logistic regression analysis. Results Finally, 1207 patients were included. Ten independent risk factors associated with cardiovascular complications were identified in training set: male (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.18, 2.85), age ≥ 60 years old (OR: 2.01; 95% CI: 1.3, 3.2), cough (OR: 1.86; 95% CI: 1.16, 3), chronic heart disease (OR: 2.3; 95% CI: 1.19, 4.46), lymphocyte count ≤1.1 × 109/L at admission (OR: 1.60; 95% CI: 1.03, 2.47), blood urea nitrogen ≥7 mmol/L at admission (OR: 2.14; 95% CI: 1.27, 3.62), estimated glomerular filtration rate ≤90 ml/min/1.73 m2 at admission (OR: 2.08; 95% CI: 1.13, 3.83), activated partial thromboplastin time ≥37 s (OR: 3.07; 95% CI: 1.37, 6.86), D‐dimer ≥ 0.5 mg/L (OR: 2.12; 95% CI: 1.33, 3.36) and procalcitonin ≥0.5 μg/L (OR: 3.58; 95% CI: 1.40, 9.14). The area under curve of ROC curve was 0.773 (95% CI: 0.723, 0.822; p < .01). The risk score had robustness and generalizability after validation. Cardiovascular complications were significantly associated with poorer survivals (log‐rank test: p < .001). Conclusions We developed and validated a novel risk score, which has a promising predictive capacity for cardiovascular complications in COVID‐19 patients.
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Affiliation(s)
- Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huan Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - He Yu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rong Yao
- Emergency Medical Laboratory, Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Disaster Medical Center, Sichuan University, Chengdu, Sichuan, China
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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14
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Cui X, Yu X, Wu X, Huang L, Tian Y, Huang X, Zhang Z, Cheng Z, Guo Q, Zhang Y, Cai Y, Zhan Q. Acute Kidney Injury in Patients with the Coronavirus Disease 2019: A Multicenter Study. Kidney Blood Press Res 2020; 45:612-622. [PMID: 32712607 PMCID: PMC7445371 DOI: 10.1159/000509517] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/18/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Severe acute respiratory viral infections are frequency accompanied by multiple organ dysfunction, including acute kidney injury (AKI). In December 2019, the coronavirus disease 2019 (COVID-19) outbreak began in Wuhan, Hubei Province, China, and rapidly spread worldwide. While diffuse alveolar damage and acute respiratory failure are the main features of COVID-19, other organs may be involved, and the incidence of AKI is not well described. We assessed the incidence and clinical characteristics of AKI in patients with laboratory-confirmed COVID-19 and its effects on clinical outcomes. Methods We conducted a multicenter, retrospective, observational study of patients with COVID-19 admitted to two general hospitals in Wuhan from 5 January 2020 to 21 March 2020. Demographic data and information on organ dysfunction were collected daily. AKI was defined according to the KDIGO clinical practice guidelines. Early and late AKI were defined as AKI occurring within 72 h after admission or after 72 h, respectively. Results Of the 116 patients, AKI developed in 21 (18.1%) patients. Among them, early and late AKI were found in 13 (11.2%) and 8 (6.9%) patients, respectively. Compared with patients without AKI, patients with AKI had more severe organ dysfunction, as indicated by a higher level of disease severity status, higher sequential organ failure assessment (SOFA) score on admission, an increased prevalence of shock, and a higher level of respiratory support. Patients with AKI had a higher SOFA score on admission (4.5 ± 2.1 vs. 2.8 ± 1.4, OR 1.498, 95% CI 1.047–2.143) and greater hospital mortality (57.1% vs. 12.6%, OR 3.998, 95% CI 1.088–14.613) than patients without AKI in both the univariate and multivariate analyses. Patients with late AKI, but not those with early AKI, had a significantly prolonged length of stay (19.6 vs. 9.6 days, p = 0.015). Conclusion Our findings show that admission SOFA score was an independent risk factor for AKI in COVID-19 patients, and patients with AKI had higher in-hospital mortality. Moreover, AKI development after 72 h of admission was related to prolonged hospitalization time.
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Affiliation(s)
- Xiaoyang Cui
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xin Yu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xiaojing Wu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Linna Huang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ye Tian
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xu Huang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zeyu Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhenshun Cheng
- Department of Pulmonary and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiang Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Cai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qingyuan Zhan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China,
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15
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Gu X, Zhou F, Wang Y, Fan G, Cao B. Respiratory viral sepsis: epidemiology, pathophysiology, diagnosis and treatment. Eur Respir Rev 2020; 29:29/157/200038. [PMID: 32699026 DOI: 10.1183/16000617.0038-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/04/2020] [Indexed: 12/11/2022] Open
Abstract
According to the Third International Consensus Definition for Sepsis and Septic Shock, sepsis is a life-threatening organ dysfunction resulting from dysregulated host responses to infection. Epidemiological data about sepsis from the 2017 Global Burden of Diseases, Injuries and Risk Factor Study showed that the global burden of sepsis was greater than previously estimated. Bacteria have been shown to be the predominant pathogen of sepsis among patients with pathogens detected, while sepsis caused by viruses is underdiagnosed worldwide. The coronavirus disease that emerged in 2019 in China and now in many other countries has brought viral sepsis back into the vision of physicians and researchers worldwide. Although the current understanding of the pathophysiology of sepsis has improved, the differences between viral and bacterial sepsis at the level of pathophysiology are not well understood. Diagnosis methods that can broadly differentiate between bacterial and viral sepsis at the initial stage after the development of sepsis are limited. New treatments that can be applied at clinics for sepsis are scarce and this situation is not consistent with the growing understanding of pathophysiology. This review aims to give a brief summary of current knowledge of the epidemiology, pathophysiology, diagnosis and treatment of viral sepsis.
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Affiliation(s)
- Xiaoying Gu
- Dept of Pulmonary and Critical Care Medicine, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.,Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Fei Zhou
- Dept of Pulmonary and Critical Care Medicine, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Yeming Wang
- Dept of Pulmonary and Critical Care Medicine, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Guohui Fan
- Dept of Pulmonary and Critical Care Medicine, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.,Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Bin Cao
- Dept of Pulmonary and Critical Care Medicine, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China .,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.,Dept of Respiratory Medicine, Capital Medical University, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
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Abstract
Purpose: This study aimed to investigate the occurrence and risk factors of acute kidney injury (AKI) in ventilated newborns. Methods: In total, 139 newborns receiving mechanical ventilation (MV) were reviewed in this retrospective study. The demographic and clinical data were collected. Then, the independent risk factors for AKI were evaluated using univariate and multivariate logistic regression analyses. Results: The incidence rate of AKI was 15.11% (21/139) in ventilated newborns. Univariate analysis showed significant differences in gestational age, birth weight, Apagar scores, the highest oxygen concentration, serum creatinine levels at admission and 48 h after MV, history of asphyxia, urine output at 48 h after MV, invasive MV, noninvasive MV, and outcomes between AKI and non-AKI groups (all p < .05). The lower gestational age (odd ratio (OR): 1.194, 95% confidence interval (CI): 1.013–1.407, p = .035), the increased use of invasive mechanical ventilation (IMV) (OR: 4.790, 95% CI: 1.115–20.575, p = .035), and lower birth weight (OR: 0.377, 95% CI: 0.178–0.801, p = .011) were independent risk factors for the occurrence of AKI. Additionally, higher stage of AKI was significantly associated with poor prognosis of AKI (p = .018). Conclusion: In this retrospective study, it was found that lower gestational age, birth weight, and increased use of IMV were independent risk factors for AKI in ventilated newborns. The poor prognosis might be indicated by the higher AKI stage.
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Affiliation(s)
- Yuanyuan Fan
- Department of Pediatrics, Zhongda Affiliated Hospital of Southeast University, Nanjing, China
| | - Jinkun Ye
- Department of Pediatrics, Nanjing Maternal and Child Health Hospital, Nanjing, China
| | - Lijuan Qian
- Department of Pediatrics, Zhongda Affiliated Hospital of Southeast University, Nanjing, China
| | - Ruibin Zhao
- Department of Pediatrics, Tian Kang Hospital, Tianchang, China
| | - Ning Zhang
- Department of Pediatrics, Zhongda Affiliated Hospital of Southeast University, Nanjing, China
| | - Liwen Xue
- Department of Pediatrics, The First Hospital of Changzhou, Changzhou, China
| | - Lixing Qiao
- Department of Pediatrics, Zhongda Affiliated Hospital of Southeast University, Nanjing, China
| | - Li Jiang
- Department of Pediatrics, Zhongda Affiliated Hospital of Southeast University, Nanjing, China
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Keilich SR, Bartley JM, Haynes L. Diminished immune responses with aging predispose older adults to common and uncommon influenza complications. Cell Immunol 2019; 345:103992. [PMID: 31627841 PMCID: PMC6939636 DOI: 10.1016/j.cellimm.2019.103992] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023]
Abstract
Influenza (flu) is a serious disease for older adults, with increased severity of infection and greater risk for hospitalization and death. Flu infection is limited to pulmonary epithelial cells, yet there are many systemic symptoms and older adults are more susceptible to flu-related complications. In older adults, flu rarely comes without additional complications and there is a perfect storm for enhanced disease due to multiple factors including existing co-morbidities, plus impaired lung function and dysregulated immune responses that occur with even healthy aging. Commonly, opportunistic secondary bacterial infections prosper in damaged lungs. Intensified systemic inflammation with aging can cause dysfunction in extra-pulmonary organs and tissues such as cardiovascular, musculoskeletal, neuropathologic, hepatic, and renal complications. Often overlooked is the underappreciated connections between many of these conditions, which exacerbate one another when in parallel. This review focuses on flu infection and the numerous complications in older adults associated with diminished immune responses.
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Affiliation(s)
- Spencer R Keilich
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
| | - Jenna M Bartley
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT 06030, USA; Department of Immunology, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
| | - Laura Haynes
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT 06030, USA; Department of Immunology, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
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Dalbhi SA, Alshahrani HA, Almadi A, Busaleh H, Alotaibi M, Almutairi W, Almukhrq Z. Prevalence and mortality due to acute kidney injuries in patients with influenza A (H1N1) viral infection: A systemic narrative review. Int J Health Sci (Qassim) 2019; 13:56-62. [PMID: 31341456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There is limited evidence of studying the associated factors of acute kidney injury (AKI) among patients with influenza A (H1N1) virus infection pandemic in 2009. AKI is one of the most prevalent complications in the intensive care unit. Its incidence is associated with high mortality and negative impacts on long-term survival. The aim of this narrative review was to determine the prevalence and mortality due to AKI, among patients admitted with the H1N1 virus. MATERIALS AND METHODS A narrative review of studies reporting about treatment measures and mortality associated with AKI during the H1N1 pandemic over a 10-year period (from September 2009 to August 2018), was performed. We searched the following databases; EMBASE, Medline/PubMed, NHS evidence, Google Scholar, and the Cochrane Library. Our inclusion revealed 20 studies of patients (n = 3579) who were admitted with H1N1 infection and developed AKI. RESULTS In this study, 33% of patients (n = 1164) who were admitted with H1N1 infection had developed AKI. Within the first 5 years (2009 to 2013), 36% of patients (n = 1013) developed AKI. Within the next 5 years (2014-2018), 812 patients were admitted with the H1N1 infection and 18% of patients (n = 150) had developed AKI. Over the 10 years, there was a 50% reduction in the number of patients who developed AKI (2009 and 2018) (P < 0.0001). CONCLUSION Patients showed varied responses to treatment measures, depending on their geographical location, comorbidities, and other characteristics. Despite a reasonable prevalence of AKI among patients with the H1N1 virus infection, the mortality over the last 10 years was reduced, with renal replacement therapy as a common therapy in most studies.
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Lombardi R, Nin N, Peñuelas O, Ferreiro A, Rios F, Marin MC, Raymondos K, Lorente JA, Koh Y, Hurtado J, Gonzalez M, Abroug F, Jibaja M, Arabi Y, Moreno R, Matamis D, Anzueto A, Esteban A; VENTILA Group. Acute Kidney Injury in Mechanically Ventilated Patients: The Risk Factor Profile Depends on the Timing of Aki Onset. Shock 2017; 48:411-7. [PMID: 28379920 DOI: 10.1097/SHK.0000000000000871] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent complication in patients under mechanical ventilation (MV). We aimed to assess the risk factors for AKI with particular emphasis on those potentially preventable. STUDY DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of a large, multinational database of MV patients with >24 h of MV and normal renal function at admission. AKI was defined according to creatinine-based KDIGO criteria. Risk factors were analyzed according to the time point at which AKI occurred: early (≤48 h after ICU admission, AKIE) and late (day 3 to day 7 of ICU stay, AKIL). A conditional logistic regression model was used to identify variables independently associated with AKI. RESULTS Three thousand two hundred six patients were included. Seven hundred patients had AKI (22%), the majority of them AKIE (547/704). The risk factor profile was highly dependent upon the timing of AKI onset. In AKIE risk factors were older age; SAPS II score; postoperative and cardiac arrest as the reasons for MV; worse cardiovascular SOFA, pH, serum creatinine, and platelet count; higher level of peak pressure and Vt/kg; and fluid overload at admission. In contrast, AKIL was linked mostly to events that occurred after admission (lower platelet count and pH; ICU-acquired sepsis; and fluid overload). None ventilation-associated parameters were identify as risk factors for AKIL. CONCLUSIONS In the first 48 h, risk factors are associated with the primary disease and the patient's condition at admission. Subsequently, emergent events like sepsis and organ dysfunction appear to be predictive factors making prevention a challenge.
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Sellers SA, Hagan RS, Hayden FG, Fischer WA. The hidden burden of influenza: A review of the extra-pulmonary complications of influenza infection. Influenza Other Respir Viruses 2018; 11:372-393. [PMID: 28745014 PMCID: PMC5596521 DOI: 10.1111/irv.12470] [Citation(s) in RCA: 239] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 12/13/2022] Open
Abstract
Severe influenza infection represents a leading cause of global morbidity and mortality. Although influenza is primarily considered a viral infection that results in pathology limited to the respiratory system, clinical reports suggest that influenza infection is frequently associated with a number of clinical syndromes that involve organ systems outside the respiratory tract. A comprehensive MEDLINE literature review of articles pertaining to extra‐pulmonary complications of influenza infection, using organ‐specific search terms, yielded 218 articles including case reports, epidemiologic investigations, and autopsy studies that were reviewed to determine the clinical involvement of other organs. The most frequently described clinical entities were viral myocarditis and viral encephalitis. Recognition of these extra‐pulmonary complications is critical to determining the true burden of influenza infection and initiating organ‐specific supportive care.
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Affiliation(s)
- Subhashini A Sellers
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert S Hagan
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Frederick G Hayden
- Division of Infectious Diseases, The University of Virginia, Charlottesville, VA, USA
| | - William A Fischer
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Cruz-Lagunas A, Jiménez-Alvarez L, Ramírez G, Mendoza-Milla C, García-Sancho MC, Avila-Moreno F, Zamudio P, Urrea F, Ortiz-Quintero B, Campos-Toscuento VL, Morán J, Barrera AA, Martínez-Briseño D, Fernández-Plata R, Sierra-Vargas MP, Muñoz-Perea C, Illescas-Flores S, Bautista E, Suratt BT, Pérez-Padilla JR, Zuñiga J. Obesity and pro-inflammatory mediators are associated with acute kidney injury in patients with A/H1N1 influenza and acute respiratory distress syndrome. Exp Mol Pathol 2014; 97:453-7. [PMID: 25305354 DOI: 10.1016/j.yexmp.2014.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/07/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The obesity has been shown to increase the severity of A/H1N1 infection and the development of acute respiratory distress syndrome (ARDS) and organ involvement. METHODS Circulating levels of C-peptide, insulin, glucagon, leptin, acute phase reactants (procalcitonin, C-reactive protein, tissue plasminogen activator, and serum amyloids A and P), were measured in samples from 32 critically ill patients with A/H1N1 virus infection, 17 of whom had ARDS complicated by acute kidney injury (AKI) and 15 of whom had ARDS but did not develop AKI. RESULTS Patients with ARDS and AKI (ARDS/AKI) had higher BMI and higher levels of C-peptide, insulin, leptin, procalcitonin and serum amyloid A compared to those ARDS patient who did not develop AKI. Adjusting for confounding variables using logistic regression analysis, higher levels of C-peptide (>0.75 ng/mL) (OR=64.8, 95% CI = 2.1-1980, p = 0.0006) and BMI>30 Kg/m(2) (OR = 42.0, 95% CI = 1.2-1478, p = 0.04) were significantly associated with the development of AKI in ARDS patients. CONCLUSION High levels of C-peptide and BMI>30 kg/m(2) were associated with the development of AKI in ARDS patients due to A/H1N1 infection. These metabolic/obesity indicators, together with the profiles of pro-inflammatory acute phase proteins, may be important links between obesity and poor outcomes in A/H1N1 09 infection.
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22
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Otero A, Cardinal-Fernández P, Rojas Y, Nin N, Martínez-Caro L, Esteban A, Lorente JA. On the minute by minute variations of urine output: a study in a porcine model. J Nephrol 2014; 27:45-50. [PMID: 24424719 DOI: 10.1007/s40620-013-0019-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/11/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Urine output (UO) is usually measured hourly in acutely ill patients. Devices capable of more continuous (minute by minute urine output, UOm) measurements have become available recently. This paper aims to (1) analyze the minute by minute variations of UO, (2) analyze the impact of sepsis on those variations and (3) test if UO measured over periods shorter than 60 min provides information not available in hourly measurements. METHODS Fifteen male pigs were anesthetized, tracheostomized and mechanically ventilated. Sepsis was induced by the administration of live Escherichia coli. Three groups were studied: nonseptic (n = 7) and septic (n = 4), both receiving sodium chloride (NaCl) 0.9 % at 4 ml kg(-1) h(-1); and septic (n = 4) receiving NaCl 0.9 % at 17 ml kg(-1) h(-1). UOm was measured during 6 h. RESULTS There was a significant variation of UOm over time, as assessed by the coefficient of variation of the root-mean-squared error (CV(RMSE)), which was significantly more pronounced under conditions of sepsis than under control conditions. A UO production pattern in sepsis was identified, characterized by low UO production compared to baseline levels for approximately 30 min, followed by high UO production for approximately 30 min after initiation of the septic challenge. This pattern was noticeable if UO was measured every 10 min but not over longer periods of time. CONCLUSIONS UOm provides information not conveyed by hourly measurements, especially under the cardiovascular alterations associated to sepsis. This information could enable an early identification of sepsis.
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Larsen TR, Kinni V, Zaks J, David S, McCullough PA. A lethal case of influenza and type 5 cardiorenal syndrome. Blood Purif 2013; 36:112-5. [PMID: 24192807 DOI: 10.1159/000355398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 08/30/2013] [Indexed: 12/17/2022]
Abstract
Interactions between the heart and kidneys have been labeled as the cardiorenal syndrome (CRS). Type-5 CRS describes a disease that simultaneously damages both organs. With severe infection, systemic inflammatory mediators (TNF-α and IL-1β) cause wide-spread endothelial dysfunction, cellular apoptosis, and depressed organ function. Impaired myocardial function promotes worsening renal function and vice versa, leading to a dangerous positive feedback loop. Influenza viruses cause both myocardial and kidney injury, presumably through an immune-mediated mechanism. Herein we present a lethal case of influenza, resulting in acute type V cardiorenal syndrome.
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Affiliation(s)
- Timothy R Larsen
- Department of Internal Medicine, Section of Cardiology, Providence Hospitals and Medical Centers, Southfield, Mich., USA
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Bagshaw SM, Sood MM, Long J, Fowler RA, Adhikari NKJ. Acute kidney injury among critically ill patients with pandemic H1N1 influenza A in Canada: cohort study. BMC Nephrol 2013; 14:123. [PMID: 23763900 PMCID: PMC3694036 DOI: 10.1186/1471-2369-14-123] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 06/03/2013] [Indexed: 01/30/2023] Open
Abstract
Background Canada’s pandemic H1N1 influenza A (pH1N1) outbreak led to a high burden of critical illness. Our objective was to describe the incidence of AKI (acute kidney injury) in these patients and risk factors for AKI, renal replacement therapy (RRT), and mortality. Methods From a prospective cohort of critically ill adults with confirmed or probable pH1N1 (16 April 2009–12 April 2010), we abstracted data on demographics, co-morbidities, acute physiology, AKI (defined by RIFLE criteria for Injury or Failure), treatments in the intensive care unit, and clinical outcomes. Univariable and multivariable logistic regression analyses were used to evaluate the associations between clinical characteristics and the outcomes of AKI, RRT, and hospital mortality. Results We included 562 patients with pH1N1-related critical illness (479 [85.2%] confirmed, 83 [14.8%] probable]: mean age 48.0 years, 53.4% female, and 13.3% aboriginal. Common co-morbidities included obesity, diabetes, and chronic obstructive pulmonary disease. AKI occurred in 60.9%, with RIFLE categories of Injury (23.0%) and Failure (37.9%). Independent predictors of AKI included obesity (OR 2.94; 95%CI, 1.75-4.91), chronic kidney disease (OR 4.50; 95%CI, 1.46-13.82), APACHE II score (OR per 1-unit increase 1.06; 95%CI, 1.03-1.09), and PaO2/FiO2 ratio (OR per 10-unit increase 0.98; 95%CI, 0.95-1.00). Of patients with AKI, 24.9% (85/342) received RRT and 25.8% (85/329) died. Independent predictors of RRT were obesity (OR 2.25; 95% CI, 1.14-4.44), day 1 mechanical ventilation (OR 4.09; 95% CI, 1.21-13.84), APACHE II score (OR per 1-unit increase 1.07; 95% CI, 1.03-1.12), and day 1 creatinine (OR per 10 μmol/L increase, 1.06; 95%CI, 1.03-1.10). Development of AKI was not independently associated with hospital mortality. Conclusion The incidence of AKI and RRT utilization were high among Canadian patients with critical illness due to pH1N1.
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Affiliation(s)
- Sean M Bagshaw
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter C Mackenzie Centre, 8440-112 St NW, Edmonton, AB T6G 2B7, Canada
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van den Akker JPC, Egal M, Groeneveld ABJ. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Crit Care 2013; 17:R98. [PMID: 23710662 PMCID: PMC3706893 DOI: 10.1186/cc12743] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 05/27/2013] [Indexed: 01/22/2023]
Abstract
Introduction Mechanical ventilation (MV) is commonly regarded as a risk factor for acute kidney injury (AKI) in the critically ill. We investigated the strength of this association and whether settings of tidal volume (Vt) and positive end-expiratory pressure (PEEP) affect the risk for AKI. Methods We performed a systematic review and meta-analysis using studies found by searching MEDLINE, EMBASE, and references in relevant reviews and articles. We included studies reporting on a relation between the use of invasive MV and subsequent onset of AKI, or comparing higher with lower Vt or PEEP and subsequent onset of AKI. All studies clearly stating that MV was initiated after onset of AKI were excluded. We extracted the proportion with and without MV and AKI. We included 31 studies on invasive MV. Results The pooled odds ratio (OR) for the overall effect of MV on AKI was 3.16 (95% CI 2.32 to 4.28, P <0.001). Nearly all subgroups showed that MV increases the risk for AKI. The pooled OR for studies with a multivariate analysis including MV as a risk factor for AKI was 3.58 (95% CI 1.85 to 6.92; P <0.001). Different settings of Vt and PEEP showed no effect. Conclusions Invasive MV is associated with a threefold increase in the odds of developing AKI and various Vt or PEEP settings do not modify this risk. The latter argues in favour of a haemodynamic origin of AKI during MV.
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Ho YL, Yoshino A, Tonacio AC, Latif AZA, Caiaffa Filho HH, De Sousa dos Santos S. Detection of pandemic influenza-A(H1N1)-2009 virus in urine. Intensive Care Med 2013; 39:1168-9. [PMID: 23604135 DOI: 10.1007/s00134-013-2921-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2013] [Indexed: 11/28/2022]
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Bautista E, Arcos M, Jimenez-Alvarez L, García-Sancho MC, Vázquez ME, Peña E, Higuera A, Ramírez G, Fernández-Plata R, Cruz-Lagunas A, García-Moreno SA, Urrea F, Ramírez R, Correa-Rotter R, Pérez-Padilla JR, Zúñiga J. Angiogenic and inflammatory markers in acute respiratory distress syndrome and renal injury associated to A/H1N1 virus infection. Exp Mol Pathol 2013; 94:486-92. [PMID: 23542734 DOI: 10.1016/j.yexmp.2013.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 03/20/2013] [Indexed: 12/11/2022]
Abstract
Acute kidney injury (AKI) is often associated to acute respiratory distress syndrome (ARDS) due to influenza A/H1N1 virus infection. The profile of angiogenic and inflammatory factors in ARDS patients may be relevant for AKI. We analyzed the serum levels of several angiogenic factors, cytokines, and chemokines in 32 patients with A/H1N1 virus infection (17 with ARDS/AKI and 15 ARDS patients who did not developed AKI) and in 18 healthy controls. Significantly higher levels of VEGF, MCP-1, IL-6, IL-8 and IP-10 in ARDS/AKI patients were detected. Adjusting by confusing variables, levels of MCP-1 ≥150 pg/mL (OR=12.0, p=0.04) and VEGF ≥225 pg/mL (OR=6.4, p=0.03) were associated with the development of AKI in ARDS patients. Higher levels of MCP-1 and IP-10 were significantly associated with a higher risk of death in patients with ARDS (hazard ratio (HR)=10.0, p=0.02; HR=25.5, p=0.03, respectively) even taking into account AKI. Patients with influenza A/H1N1 infection and ARDS/AKI have an over-production of MCP-1, VEGF and IP-10 possibly contributing to kidney injury and are associated to a higher risk of death.
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Affiliation(s)
- Edgar Bautista
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Tlalpan 4502, Tlalpan, 14080, Mexico City, Mexico.
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Case J, Khan S, Khalid R, Khan A. Epidemiology of acute kidney injury in the intensive care unit. Crit Care Res Pract 2013; 2013:479730. [PMID: 23573420 DOI: 10.1155/2013/479730] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 01/31/2013] [Indexed: 12/14/2022] Open
Abstract
The incidence of acute kidney injury (AKI) in the intensive care unit (ICU) has increased during the past decade due to increased acuity as well as increased recognition. Early epidemiology studies were confounded by erratic definitions of AKI until recent consensus guidelines (RIFLE and AKIN) standardized its definition. This paper discusses the incidence of AKI in the ICU with focuses on specific patient populations. The overall incidence of AKI in ICU patients ranges from 20% to 50% with lower incidence seen in elective surgical patients and higher incidence in sepsis patients. The incidence of contrast-induced AKI is less (11.5%–19% of all admissions) than seen in the ICU population at large. AKI represents a significant risk factor for mortality and can be associated with mortality greater than 50%.
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Abstract
Renal complications of influenza A virus infections are uncommon but can contribute to a deterioration in the patient's condition, which include acute kidney injury (AKI) in critically ill patients, rhabdomyolysis, hemolytic uremic syndrome (HUS), acute glomerulonephritis (AGN), disseminated intravascular coagulation (DIC), Goodpasture's syndrome, and acute tubulointerstitial nephritis (TIN). The clinical characteristics of AKI in critically ill patients with pandemic influenza A(H1N1) 2009 virus (A(H1N1)pdm09) infection are similar to uninfected patients. Underlying conditions associated with AKI include older age, diabetes mellitus, obesity, pregnancy, history of asthma, and chronic kidney disease. Histologic examination of the kidneys from patients with A(H1N1)pdm09 infection who died include acute tubular necrosis (ATN), myoglobin pigment, and DIC. A(H1N1)pdm09 is present in the kidneys of some patients. The clinical characteristics of patients with rhabdomyolysis associated with influenza A include younger age and the frequent occurrence of muscle symptoms. AKI occurs in approximately one third of patients with rhabdomyolysis due to influenza A. HUS is associated with A(H1N1)pdm09 as follows: Streptococcus pneumoniae-associated HUS following A(H1N1)pdm09 infection, HUS triggered by A(H1N1)pdm09 in patients with genetic complement dysregulation, and HUS associated with A(H1N1)pdm09 without known underlying disorder. AGN, Goodpasture's syndrome, and acute TIN are extremely rare complications of influenza A virus infection. Although the pathogenesis underlying renal injuries due to influenza A virus has not been delineated, some hypotheses have been advanced, including ATN due to renal hypoperfusion or rhabdomyolysis, glomerular microthrombosis due to DIC, direct viral injury to the kidney, and an altered immune system with systemic mononuclear cell activation following influenza A virus infections.
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Affiliation(s)
- Toru Watanabe
- Department of Pediatrics, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City 950-1197, Japan.
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Antonelli M, Bonten M, Chastre J, Citerio G, Conti G, Curtis JR, De Backer D, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Rocco P, Timsit JF, Wernerman J, Zhang H. Year in review in Intensive Care Medicine 2011: I. Nephrology, epidemiology, nutrition and therapeutics, neurology, ethical and legal issues, experimentals. Intensive Care Med 2012; 38:192-209. [PMID: 22215044 PMCID: PMC3291847 DOI: 10.1007/s00134-011-2447-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 12/14/2011] [Indexed: 12/29/2022]
Affiliation(s)
- Massimo Antonelli
- Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy.
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Ashtiani N, Mulder MF, van Wijk JAE, Bokenkamp A. A case of tubulointerstitial nephritis in a patient with an influenza H1N1 infection. Pediatr Nephrol 2012; 27:1985-7. [PMID: 22707215 PMCID: PMC3422450 DOI: 10.1007/s00467-012-2201-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 04/16/2012] [Accepted: 04/17/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients suffering from an H1N1 infection mainly suffer from respiratory symptoms but may also develop symptoms in other organ systems, such as the kidneys. CASE-DIAGNOSIS/TREATMENT A 4 ½ year-old boy was admitted with relatively mild respiratory symptoms of H1N1 infection, but developed severe generalized proximal tubular dysfunction with sterile leucocyturia and a reversible rise in serum creatinine. He made a full recovery with supportive therapy. CONCLUSION Influenza H1N1 may be associated with acute tubulointerstitial nephritis.
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Affiliation(s)
- Niloufar Ashtiani
- Department of Pediatrics, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Margot F. Mulder
- Department of Metabolic Disorders, VU University Medical Center, Amsterdam, the Netherlands
| | - Joanna A. E. van Wijk
- Department of Pediatric Nephrology, VU University Medical Center, Amsterdam, the Netherlands
| | - Arend Bokenkamp
- Department of Pediatric Nephrology, VU University Medical Center, Amsterdam, the Netherlands
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Affiliation(s)
- Michael Joannidis
- Medical Intensive Care Unit, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Lui G. Forni
- Department of Critical Care, Western Sussex Hospitals Trust Honorary Senior Lecturer, Brighton & Sussex Medical Schools, Brighton, UK
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