1
|
Mayerhöfer T, Perschinka F, Klein SJ, Peer A, Lehner GF, Bellmann R, Gasteiger L, Mittermayr M, Breitkopf R, Eschertzhuber S, Mathis S, Fiala A, Fries D, Ströhle M, Foidl E, Hasibeder W, Helbok R, Kirchmair L, Stögermüller B, Krismer C, Heiner T, Ladner E, Thomé C, Preuß-Hernandez C, Mayr A, Potocnik M, Reitter B, Brunner J, Zagitzer-Hofer S, Ribitsch A, Joannidis M. Incidence, risk factors and outcome of acute kidney injury in critically ill COVID-19 patients in Tyrol, Austria: a prospective multicenter registry study. J Nephrol 2023; 36:2531-2540. [PMID: 37837501 PMCID: PMC10703973 DOI: 10.1007/s40620-023-01760-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/06/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Acute kidney injury is a frequent complication in critically ill patients with and without COVID-19. The aim of this study was to evaluate the incidence of, and risk factors for, acute kidney injury and its effect on clinical outcomes of critically ill COVID-19 patients in Tyrol, Austria. METHODS This multicenter prospective registry study included adult patients with a SARS-CoV-2 infection confirmed by polymerase chain reaction, who were treated in one of the 12 dedicated intensive care units during the COVID-19 pandemic from February 2020 until May 2022. RESULTS In total, 1042 patients were included during the study period. The median age of the overall cohort was 66 years. Of the included patients, 267 (26%) developed acute kidney injury during their intensive care unit stay. In total, 12.3% (n = 126) required renal replacement therapy with a median duration of 9 (IQR 3-18) days. In patients with acute kidney injury the rate of invasive mechanical ventilation was significantly higher with 85% (n = 227) compared to 41% (n = 312) in the no acute kidney injury group (p < 0.001). The most important risk factors for acute kidney injury were invasive mechanical ventilation (OR = 4.19, p < 0.001), vasopressor use (OR = 3.17, p < 0.001) and chronic kidney disease (OR = 2.30, p < 0.001) in a multivariable logistic regression analysis. Hospital and intensive care unit mortality were significantly higher in patients with acute kidney injury compared to patients without acute kidney injury (Hospital mortality: 52.1% vs. 17.2%, p < 0.001, ICU-mortality: 47.2% vs. 14.7%, p < 0.001). CONCLUSION As in non-COVID-19 patients, acute kidney injury is clearly associated with increased mortality in critically ill COVID-19 patients. Among known risk factors, invasive mechanical ventilation has been identified as an independent and strong predictor of acute kidney injury.
Collapse
Affiliation(s)
- Timo Mayerhöfer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Fabian Perschinka
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sebastian J Klein
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Internal Medicine II, Gastroenterology, Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, St. Pölten, Austria
| | - Andreas Peer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Georg F Lehner
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Romuald Bellmann
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Lukas Gasteiger
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Mittermayr
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Robert Breitkopf
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | - Simon Mathis
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Fiala
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Dietmar Fries
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Mathias Ströhle
- Department of Anesthesia and Intensive Care Medicine, Hospital Kufstein, Kufstein, Austria
| | - Eva Foidl
- Department of Anesthesia and Intensive Care Medicine, Hospital Kufstein, Kufstein, Austria
| | - Walter Hasibeder
- Department of Anesthesiology and Critical Care Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
| | - Lukas Kirchmair
- Department of Anesthesia and Critical Care Medicine, Hospital Schwaz, Schwaz, Austria
| | - Birgit Stögermüller
- Department of Anesthesia and Critical Care Medicine, Hospital Schwaz, Schwaz, Austria
| | - Christoph Krismer
- Department of Internal Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Tatjana Heiner
- Department of Anesthesia and Intensive Care Medicine, Hospital Reutte, Reutte, Austria
| | - Eugen Ladner
- Department of Anesthesia and Intensive Care Medicine, Hospital Reutte, Reutte, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | | | - Andreas Mayr
- Department of Anesthesia and Intensive Care Medicine, Hospital Lienz, Lienz, Austria
| | - Miriam Potocnik
- Department of Anesthesia and Intensive Care Medicine, Hospital St. Johann in Tyrol, St. Johann in Tyrol, Austria
| | - Bruno Reitter
- Department of Anesthesia and Intensive Care Medicine, Hospital St. Johann in Tyrol, St. Johann in Tyrol, Austria
| | - Jürgen Brunner
- Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
- Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria
| | | | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| |
Collapse
|
2
|
Mayerhöfer T, Klein SJ, Peer A, Perschinka F, Lehner GF, Hasslacher J, Bellmann R, Gasteiger L, Mittermayr M, Eschertzhuber S, Mathis S, Fiala A, Fries D, Kalenka A, Foidl E, Hasibeder W, Helbok R, Kirchmair L, Stögermüller B, Krismer C, Heiner T, Ladner E, Thomé C, Preuß-Hernandez C, Mayr A, Pechlaner A, Potocnik M, Reitter B, Brunner J, Zagitzer-Hofer S, Ribitsch A, Joannidis M. Changes in characteristics and outcomes of critically ill COVID-19 patients in Tyrol (Austria) over 1 year. Wien Klin Wochenschr 2021; 133:1237-1247. [PMID: 34661740 PMCID: PMC8521508 DOI: 10.1007/s00508-021-01945-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/28/2021] [Accepted: 08/25/2021] [Indexed: 12/15/2022]
Abstract
Background Widely varying mortality rates of critically ill Coronavirus disease 19 (COVID-19) patients in the world highlighted the need for local surveillance of baseline characteristics, treatment strategies and outcome. We compared two periods of the COVID-19 pandemic to identify important differences in characteristics and therapeutic measures and their influence on the outcome of critically ill COVID-19 patients. Methods This multicenter prospective register study included all patients with a SARS-CoV‑2 infection confirmed by polymerase chain reaction, who were treated in 1 of the 12 intensive care units (ICU) from 8 hospitals in Tyrol, Austria during 2 defined periods (1 February 2020 until 17 July: first wave and 18 July 2020 until 22 February 2021: second wave) of the COVID-19 pandemic. Results Overall, 508 patients were analyzed. The majority (n = 401) presented during the second wave, where the median age was significantly higher (64 years, IQR 54–74 years vs. 72 years, IQR 62–78 years, p < 0.001). Invasive mechanical ventilation was less frequent during the second period (50.5% vs 67.3%, p = 0.003), as was the use of vasopressors (50.3% vs. 69.2%, p = 0.001) and renal replacement therapy (12.0% vs. 19.6%, p = 0.061), which resulted in shorter ICU length of stay (10 days, IQR 5–18 days vs. 18 days, IQR 5–31 days, p < 0.001). Nonetheless, ICU mortality did not change (28.9% vs. 21.5%, p = 0.159) and hospital mortality even increased (22.4% vs. 33.4%, p = 0.039) in the second period. Age, frailty and the number of comorbidities were significant predictors of hospital mortality in a multivariate logistic regression analysis of the overall cohort. Conclusion Advanced treatment strategies and learning effects over time resulted in reduced rates of mechanical ventilation and vasopressor use in the second wave associated with shorter ICU length of stay. Despite these improvements, age appears to be a dominant factor for hospital mortality in critically ill COVID-19 patients. Supplementary Information The online version of this article (10.1007/s00508-021-01945-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Timo Mayerhöfer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Sebastian J Klein
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.,Doctoral College Medical Law and Healthcare, Faculty of Law, University Innsbruck, Innsbruck, Austria
| | - Andreas Peer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Fabian Perschinka
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Georg F Lehner
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Julia Hasslacher
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Romuald Bellmann
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Lukas Gasteiger
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Mittermayr
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | - Simon Mathis
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Fiala
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Dietmar Fries
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Armin Kalenka
- Department of Anesthesia and Intensive Care Medicine, Hospital Kufstein, Kufstein, Austria
| | - Eva Foidl
- Department of Anesthesia and Intensive Care Medicine, Hospital Kufstein, Kufstein, Austria
| | - Walter Hasibeder
- Department of Anesthesiology and Critical Care Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Lukas Kirchmair
- Department of Anesthesia and Critical Care Medicine, Hospital Schwaz, Schwaz, Austria
| | - Birgit Stögermüller
- Department of Anesthesia and Critical Care Medicine, Hospital Schwaz, Schwaz, Austria
| | - Christoph Krismer
- Department of Internal Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Tatjana Heiner
- Department of Anesthesia and Intensive Care Medicine, Hospital Reutte, Reutte, Austria
| | - Eugen Ladner
- Department of Anesthesia and Intensive Care Medicine, Hospital Reutte, Reutte, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | | | - Andreas Mayr
- Department of Anesthesia and Intensive Care Medicine, Hospital Lienz, Lienz, Austria
| | - Agnes Pechlaner
- Department of Internal Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Miriam Potocnik
- Department of Anesthesia and Intensive Care Medicine, Hospital St. Johann in Tyrol, St. Johann in Tyrol, Austria
| | - Bruno Reitter
- Department of Anesthesia and Intensive Care Medicine, Hospital St. Johann in Tyrol, St. Johann in Tyrol, Austria
| | - Jürgen Brunner
- Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| |
Collapse
|
3
|
Klein SJ, Bellmann R, Dejaco H, Eschertzhuber S, Fries D, Furtwängler W, Gasteiger L, Hasibeder W, Helbok R, Hochhold C, Hofer S, Kirchmair L, Krismer C, Ladner E, Lehner GF, Mathis S, Mayr A, Mittermayr M, Peer A, Preuß Hernández C, Reitter B, Ströhle M, Swoboda M, Thomé C, Joannidis M. Structured ICU resource management in a pandemic is associated with favorable outcome in critically ill COVID‑19 patients. Wien Klin Wochenschr 2020; 132:653-663. [PMID: 33170333 PMCID: PMC7653454 DOI: 10.1007/s00508-020-01764-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022]
Abstract
Introduction On February 25, 2020, the first 2 patients were tested positive for severe acute respiratory syndrome coronavirus‑2 (SARS-CoV-2) in Tyrol, Austria. Rapid measures were taken to ensure adequate intensive care unit (ICU) preparedness for a surge of critically ill coronavirus disease-2019 (COVID-19) patients. Methods This cohort study included all COVID-19 patients admitted to an ICU with confirmed or strongly suspected COVID-19 in the State of Tyrol, Austria. Patients were recorded in the Tyrolean COVID-19 intensive care registry. Date of final follow-up was July 17, 2020. Results A total of 106 critically ill patients with COVID-19 were admitted to 1 of 13 ICUs in Tyrol from March 9 to July 17, 2020. Median age was 64 years (interquartile range, IQR 54–74 years) and the majority of patients were male (76 patients, 71.7%). Median simplified acute physiology score III (SAPS III) was 56 points (IQR 49–64 points). The median duration from appearance of first symptoms to ICU admission was 8 days (IQR 5–11 days). Invasive mechanical ventilation was required in 72 patients (67.9%) and 6 patients (5.6%) required extracorporeal membrane oxygenation treatment. Renal replacement therapy was necessary in 21 patients (19.8%). Median ICU length of stay (LOS) was 18 days (IQR 5–31 days), median hospital LOS was 27 days (IQR 13–49 days). The ICU mortality was 21.7% (23 patients), hospital mortality was 22.6%. There was no significant difference in ICU mortality in patients receiving invasive mechanical ventilation and in those not receiving it (18.1% vs. 29.4%, p = 0.284). As of July 17th, 2020, two patients are still hospitalized, one in an ICU, one on a general ward. Conclusion Critically ill COVID-19 patients in Tyrol showed high severity of disease often requiring complex treatment with increased lengths of ICU and hospital stay. Nevertheless, the mortality was found to be remarkably low, which may be attributed to our adaptive surge response providing sufficient ICU resources. Electronic supplementary material The online version of this article (10.1007/s00508-020-01764-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sebastian J Klein
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
- Doctoral College Medical Law and Healthcare, Faculty of Law, University Innsbruck, Innsbruck, Austria
| | - Romuald Bellmann
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Hannes Dejaco
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | - Dietmar Fries
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Wilhelm Furtwängler
- Department of Anesthesia and Intensive Care Medicine, Hospital Kufstein, Kufstein, Austria
| | - Lukas Gasteiger
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Walter Hasibeder
- Department of Anesthesiology and Critical Care Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Hochhold
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Stefanie Hofer
- Department of Internal Medicine, Hospital Hall, Hall, Austria
| | - Lukas Kirchmair
- Department of Anesthesia and Critical Care Medicine, Hospital Schwaz, Schwaz, Austria
| | - Christoph Krismer
- Department of Internal Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Eugen Ladner
- Department of Anesthesia and Intensive Care Medicine, Hospital Reutte, Reutte, Austria
| | - Georg F Lehner
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Simon Mathis
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Mayr
- Department of Anesthesia and Intensive Care Medicine, Hospital Lienz, Lienz, Austria
| | - Markus Mittermayr
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Peer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | | | - Bruno Reitter
- Department of Anesthesia and Intensive Care Medicine, Hospital St. Johann in Tyrol, St. Johann in Tyrol, Austria
| | - Mathias Ströhle
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Swoboda
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| |
Collapse
|