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Lukowsky LR, Der-Martirosian C, Northcraft H, Kalantar-Zadeh K, Goldfarb DS, Dobalian A. Predictors of Acute Kidney Injury (AKI) among COVID-19 Patients at the US Department of Veterans Affairs: The Important Role of COVID-19 Vaccinations. Vaccines (Basel) 2024; 12:146. [PMID: 38400130 PMCID: PMC10892207 DOI: 10.3390/vaccines12020146] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND There are knowledge gaps about factors associated with acute kidney injury (AKI) among COVID-19 patients. To examine AKI predictors among COVID-19 patients, a retrospective longitudinal cohort study was conducted between January 2020 and December 2022. Logistic regression models were used to examine predictors of AKI, and survival analysis was performed to examine mortality in COVID-19 patients. RESULTS A total of 742,799 veterans diagnosed with COVID-19 were included and 95,573 were hospitalized within 60 days following COVID-19 diagnosis. A total of 45,754 developed AKI and 28,573 AKI patients were hospitalized. Use of vasopressors (OR = 14.73; 95% CL 13.96-15.53), history of AKI (OR = 2.22; CL 2.15-2.29), male gender (OR = 1.90; CL 1.75-2.05), Black race (OR = 1.62; CL 1.57-1.65), and age 65+ (OR = 1.57; CL 1.50-1.63) were associated with AKI. Patients who were vaccinated twice and boosted were least likely to develop AKI (OR = 0.51; CL 0.49-0.53) compared to unvaccinated COVID-19 patients. Patients receiving two doses (OR = 0.77; CL = 0.72-0.81), or a single dose (OR = 0.88; CL = 0.81-0.95) were also less likely to develop AKI compared to the unvaccinated. AKI patients exhibited four times higher mortality compared to those without AKI (HR = 4.35; CL 4.23-4.50). Vaccinated and boosted patients had the lowest mortality risk compared to the unvaccinated (HR = 0.30; CL 0.28-0.31). CONCLUSION Use of vasopressors, being unvaccinated, older age, male gender, and Black race were associated with post COVID-19 AKI. Whether COVID-19 vaccination, including boosters, decreases the risk of developing AKI warrants additional studies.
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Affiliation(s)
- Lilia R. Lukowsky
- Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA 91343, USA; (C.D.-M.); (H.N.); (A.D.)
| | - Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA 91343, USA; (C.D.-M.); (H.N.); (A.D.)
| | - Heather Northcraft
- Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA 91343, USA; (C.D.-M.); (H.N.); (A.D.)
| | - Kamyar Kalantar-Zadeh
- The Lundquist Institute for Biomedical Innovation, Harbor UCLA Medical Center, Torrance, CA 90502, USA;
- Tibor Rubin VA Medical Center, Long Beach VA Healthcare System, Long Beach, CA 90822, USA
| | - David S. Goldfarb
- New York Harbor VA Healthcare System (NYHHS), US Department of Veterans Affairs, New York, NY 10010, USA;
- NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, CA 91343, USA; (C.D.-M.); (H.N.); (A.D.)
- Division of Health Services Management and Policy in the College of Public Health, The Ohio State University, Columbus, OH 43210, USA
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McAdams MC, Xu P, Li M, Gregg LP, Saleh SN, Ostrosky-Frid M, Willett DL, Velasco F, Lehmann CU, Hedayati SS. Validation of a predictive model for hospital-acquired acute kidney injury with emergence of SARS-CoV-2 variants. J Investig Med 2023; 71:459-464. [PMID: 36786195 PMCID: PMC9929183 DOI: 10.1177/10815589221140592] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 02/15/2023]
Abstract
We previously developed and validated a model to predict acute kidney injury (AKI) in hospitalized coronavirus disease 2019 (COVID-19) patients and found that the variables with the highest importance included a history of chronic kidney disease and markers of inflammation. Here, we assessed model performance during periods when COVID-19 cases were attributable almost exclusively to individual variants. Electronic Health Record data were obtained from patients admitted to 19 hospitals. The outcome was hospital-acquired AKI. The model, previously built in an Inception Cohort, was evaluated in Delta and Omicron cohorts using model discrimination and calibration methods. A total of 9104 patients were included, with 5676 in the Inception Cohort, 2461 in the Delta cohort, and 967 in the Omicron cohort. The Delta Cohort was younger with fewer comorbidities, while Omicron patients had lower rates of intensive care compared with the other cohorts. AKI occurred in 13.7% of the Inception Cohort, compared with 13.8% of Delta and 14.4% of Omicron (Omnibus p = 0.84). Compared with the Inception Cohort (area under the curve (AUC): 0.78, 95% confidence interval (CI): 0.76-0.80), the model showed stable discrimination in the Delta (AUC: 0.78, 95% CI: 0.75-0.80, p = 0.89) and Omicron (AUC: 0.74, 95% CI: 0.70-0.79, p = 0.37) cohorts. Estimated calibration index values were 0.02 (95% CI: 0.01-0.07) for Inception, 0.08 (95% CI: 0.05-0.17) for Delta, and 0.12 (95% CI: 0.04-0.47) for Omicron cohorts, p = 0.10 for both Delta and Omicron vs Inception. Our model for predicting hospital-acquired AKI remained accurate in different COVID-19 variants, suggesting that risk factors for AKI have not substantially evolved across variants.
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Affiliation(s)
- Meredith C McAdams
- Division of Nephrology, Department of
Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Renal Section, Medical Service,
Veterans Affairs North Texas Health Care System, Dallas, TX, USA
| | - Pin Xu
- Division of Nephrology, Department of
Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael Li
- University of Texas Southwestern
College of Medicine, Dallas, TX, USA
| | - L Parker Gregg
- Section of Nephrology, Department of
Medicine, Baylor College of Medicine, Selzman Institute for Kidney Health, Houston,
TX, USA
- Section of Nephrology, Michael E.
DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Veterans Affairs Health Services
Research and Development Center for Innovations in Quality, Effectiveness, and
Safety, Houston, TX, USA
| | - Sameh N Saleh
- Clinical Informatics Center, University
of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mauricio Ostrosky-Frid
- Department of Internal Medicine,
University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Duwayne L Willett
- Division of Cardiology, Department of
Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Christoph U Lehmann
- Clinical Informatics Center, University
of Texas Southwestern Medical Center, Dallas, TX, USA
| | - S Susan Hedayati
- Division of Nephrology, Department of
Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Palomba H, Cubos D, Bozza F, Zampieri FG, Romano TG. Development of a Risk Score for AKI onset in COVID-19 Patients: COV-AKI Score. BMC Nephrol 2023; 24:46. [PMID: 36859175 PMCID: PMC9977632 DOI: 10.1186/s12882-023-03095-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
PURPOSE Acute Kidney Injury (AKI) in COVID-19 patients is associated with increased morbidity and mortality. In the present study, we aimed to develop a prognostic score to predict AKI development in these patients. MATERIALS AND METHODS This was a retrospective observational study of 2334 COVID 19 patients admitted to 23 different hospitals in Brazil, between January 10th and August 30rd, 2020. The primary outcome of AKI was defined as any increase in serum creatinine (SCr) by 0.3 mg/dL within 48 h or a change in SCr by ≥ 1.5 times of baseline within 1 week, based on Kidney Disease Improving Global Outcomes (KDIGO) guidelines. All patients aged ≥ 18 y/o admitted with confirmed SARS-COV-2 infection were included. Discrimination of variables was calculated by the Receiver Operator Characteristic Curve (ROC curve) utilizing area under curve. Some continuous variables were categorized through ROC curve. The cutoff points were calculated using the value with the best sensitivity and specificity. RESULTS A total of 1131 patients with COVID-19 admitted to the ICU were included. Patients mean age was 52 ± 15,8 y/o., with a prevalence of males 60% (n = 678). The risk of AKI was 33% (n = 376), 78% (n = 293) of which did not require dialysis. Overall mortality was 11% (n = 127), while for AKI patients, mortality rate was 21% (n = 80). Variables selected for the logistic regression model and inclusion in the final prognostic score were the following: age, diabetes, ACEis, ARBs, chronic kidney disease and hypertension. CONCLUSION AKI development in COVID 19 patients is accurately predicted by common clinical variables, allowing early interventions to attenuate the impact of AKI in these patients.
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Affiliation(s)
- Henrique Palomba
- Hospital Vila Nova Star - ICU and Critical Care Nephrology Department, Rua Dr. Alceu de Campos Rodrigues 126, São Paulo, Brazil.
| | - Daniel Cubos
- Hospital Vila Nova Star - ICU and Critical Care Nephrology Department, Rua Dr. Alceu de Campos Rodrigues 126, São Paulo, Brazil.,Instituto D'Or de Pesquisa e Ensino, Avenida República do Líbano 611, São Paulo, Brazil
| | - Fernando Bozza
- Instituto D'Or de Pesquisa e Ensino, Avenida República do Líbano 611, São Paulo, Brazil.,Instituto Nacional de Infectologia Evandro Chagas Fundação Oswaldo Cruz FIOCRUZ, Avenida Brasil 4365 , Rio de Janeiro, Brazil
| | - Fernando Godinho Zampieri
- Hospital Vila Nova Star - ICU and Critical Care Nephrology Department, Rua Dr. Alceu de Campos Rodrigues 126, São Paulo, Brazil
| | - Thiago Gomes Romano
- Hospital Vila Nova Star - ICU and Critical Care Nephrology Department, Rua Dr. Alceu de Campos Rodrigues 126, São Paulo, Brazil.,Instituto D'Or de Pesquisa e Ensino, Avenida República do Líbano 611, São Paulo, Brazil.,Hospital São Luiz Itaim - Oncologic Critical Care Department, Rua Dr. Alceu de Campos Rodrigues 95, São Paulo, Brazil.,ABC Medical School Nephrology Department Assistant Professor, Avenida Príncipe de Gales 821, Santo André, Brazil
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Masica AL, Velasco F, Nelson TL, Medford RJ, Hughes AE, Pandey A, Peterson ED, Lehmann CU. The Texas Health Resources Clinical Scholars Program: Learning healthcare system workforce development through embedded translational research. Learn Health Syst 2022; 6:e10332. [PMID: 36263262 PMCID: PMC9576247 DOI: 10.1002/lrh2.10332] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Texas Health Resources (THR), a large, nonprofit health care system based in the Dallas-Fort Worth area, has collaborated with the University of Texas Southwestern Medical Center (UTSW) to develop and operate a unique, integrated approach for Learning Health System (LHS) workforce development. This training model centers on academic health system faculty members conducting later-stage translational research within a partnering regional care delivery organization. Methods The THR Clinical Scholars Program engages early career UTSW faculty members to conduct studies that are likely to have an impact on care delivery at the health system level. Interested candidates submit formal applications to the program. A joint committee comprised of senior research faculty from UTSW and THR clinical leadership reviews proposals with a focus on the shared LHS needs of both institutions-developing high quality research output that can be applied to enhance care delivery. A key prioritization criterion for funding is the degree to which the research addresses a question relevant to THR as a high-volume network with multiple channels for consumers to access care. The program emphasis is on supporting embedded research initiatives using health system data to generate knowledge that will improve the quality and efficiency of care for the patient populations served by the participant organizations. Results We discuss specific strategic and tactical components of the THR Clinical Scholars Program including an overview of the academic affiliation agreement between the collaborating organizations, criteria for successful program applications, data sharing, and funding. We also share project summaries from selected clinical scholars as examples of the LHS research done in the program to date. Conclusion This experience report provides an implementation framework for other academic health systems interested in adopting similar LHS workforce training models with community partners.
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Affiliation(s)
| | | | | | - Richard J. Medford
- Division of Infectious Diseases, Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA,Clinical Informatics CenterUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Amy E. Hughes
- Department of Population and Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Eric D. Peterson
- Division of Cardiology, Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Christoph U. Lehmann
- Clinical Informatics CenterUniversity of Texas Southwestern Medical CenterDallasTexasUSA,Department of PediatricsUniversity of Texas Southwestern Medical CenterDallasTexasUSA
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