Type-H, and Type-L COVID-19: are they different subtypes or the same?

OBJECTIVE

SARS-CoV-2 infection, which causes severe pneumonia, caused an epidemic that started in Wuhan, China in December 2019 and spread to the whole world. COVID-19 mainly affects the respiratory system and causes the development of severe pneumonia and related acute respiratory distress syndrome (ARDS) in some patients. We aimed to investigate whether COVID-19 pneumonia cases can be evaluated in different categories in clinical and radiological terms.

PATIENTS AND METHODS

COVID-19 associated ARDS cases being treated with the diagnosis of severe pneumonia between March 21, 2020 and June 15, 2020 in Anesthesia Intensive Care Unit were examined and divided into 2 groups (type-L and type-H, total 29 cases) according to their clinical findings (according to whether they benefited from high PEEP and their lung compliance) and lung computed tomography findings (according to the severity of the ground glass appearance). The groups were compared with each other in terms of inflammatory markers [CRP (C reactive protein), ferritin, D Dimer, PCT (procalcitonin), white blood cell, lymphocyte count, arterial blood gas analysis] and imaging findings.

RESULTS

It was observed that the prone position was beneficial in improving oxygenation in both H-type and L-type patients. 7 of 22 L-type patients were intubated and 5 of these patients died. There was no statistical difference between the two groups in terms of intubation times, hospital stays, cytokine levels, prone position application responses and mortality rates.

CONCLUSIONS

Are there two separate forms of COVID-19 pneumonia, such as h-type and l-type, or are they intertwined and describe the early and late stages of the disease? This question needs to be discussed. In addition, we believe that subtyping COVID-19 pneumonia patients does not make a difference in the treatments to be applied.

Are we aware of COVID-19-related acute kidney injury in intensive care units?

OBJECTIVE

Coronavirus disease-19 (COVID-19) primarily affects the respiratory system. In some cases, the heart, kidney, liver, circulatory system, and nervous system are also affected. COVID-19-related acute kidney injury (AKI) occurs in more than 20% of hospitalized patients and more than 50% of patients in the intensive care unit (ICU). In this study, we aimed to review the prevalence of COVID-19-related acute kidney injury, risk factors, hospital and ICU length of stay, the need for renal replacement therapy. We also examined the effect of AKI on mortality in patients in the ICU that we treated during a 1-year period.

PATIENTS AND METHODS

The files of patients with COVID-19 (n=220) who were treated in our ICU between March 21st, 2020, and June 1st, 2021, were analyzed retrospectively. Demographic data of the patients, laboratory data, and treatments were examined. Patients were divided into two groups, group I patients without AKI and, group II patients with AKI. The patients with AKI were evaluated according to the theKidney Disease Improving Global Outcomes (KDIGO) classification and were graded.

RESULTS

Of the 220 patients included in the study, 89 were female and 131 were male. The mean age of patients with AKI (70.92±11.28 years) was statistically significantly higher than among those without AKI (58.87±13.63 years) (p<0.001). In patients with AKI, ICU length of stay, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, initial lactate levels, need for mechanical ventilation, duration of mechanical ventilation, and secondary infection rates were found to be statistically significantly higher. Discharge rates from the ICU in patients without AKI were statistically higher (75.3% vs. 26.6%), and mortality rates were significantly higher in patients with AKI (67.8% vs. 14.3%).

CONCLUSIONS

Various studies conducted have shown that patients with COVID-19 are at risk for AKI, and this is closely related to age, sex, and disease severity. The presence of AKI in patients with COVID-19 increases mortality, and this is more evident in patients hospitalized in the ICU. In our study, the prevalence of AKI was higher in older patients with high APACHE II scores and initial lactate levels. Comorbidities such as hypertension, chronic kidney disease, and coronary artery disease in patients with AKI were higher than in those without AKI.