Kritik hastalarda COVID-19 ilişkili akut böbrek hasarı
COVID-19 related acute kidney injury in critically ill patients
Yazar: SENA BELPINAR
Danışman: PROF. DR. İSMAİL HAKKI CİNEL ; DOÇ. DR. BELİZ BİLGİLİ
Marmara Üniversitesi / Tıp Fakültesi / Anesteziyoloji Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2021
Konu: Anestezi ve Reanimasyon = Anesthesiology and Reanimation

Özet:
Amaç: Kritik hastalığı olan COVID-19 hastalarında akut böbrek hasarı (ABH) insidansını ve
risk faktörlerini tanımlamak ve COVID-19 ile ilişkili ABH' nin mortalite üzerindeki etkisini belirlemek.
Gereç ve Yöntem: Bu retrospektif kohort çalışması, kritik hastalığı olan COVID-19 hastalarından oluşmaktadır. Hastaların demografik özellikleri (yaş, cinsiyet, yandaş hastalıklar ), APACHE II ve SOFA skorları, hemodinamik parametreler, kan testi analizi, organ disfonksiyonları, sekonder enfeksiyonlar, septik şok, vazopresör kullanımı ve solunum desteği türleri kaydedildi. ABH, KDIGO' ya göre evrelendi. Hastalar ABH' nin şiddetine göre gruplandırıldı. Akut böbrek hasarının risk faktörleri lojistik regresyon analizi ile analiz edildi.
Bulgular: 217 hasta tarandı, 20 hasta kronik böbrek yetmezliği nedeniyle dışlandı. Çalışmaya 197 hasta dahil edildi. ABH görülme sıklığı% 46.9 olarak belirlendi. Genel mortalite %47.4 ve ABH' li hastaların mortalitesi% 73.4 idi. Ortalama APACHE II ve SOFA skorları sırasıyla 14.88 ve 6.96 idi. Tek değişkenli analizde COVID-19 ilişkili ABH hastalarında invaziv mekanik ventilasyon, ağır ARDS, sekonder enfeksiyonlar, septik şok, miyokardiyal disfonksiyon anlamlı olarak yüksek olmasına rağmen, çok değişkenli lojistik regresyon analizinde hiçbiri bağımsız risk faktörü olarak tespit edilmedi. Çok değişkenli lojistik regresyon analizi ile; COVID-19 ile ilişkili ABH gelişimi için bağımsız risk faktörleri olarak artan yaş, yüksek SOFA skoru, düşük sistolik kan basıncı, KKY (konjestif kalp yetmezliği), pnömotoraks, DİK, vazopresör kullanımı belirlendi (sırasıyla; p = 0,019, p = 0,027 , p = 0,008, p = 0,028, p = 0,047, p = 0,020, p = 0,005). COVID-19 ilişkili ABH 10.9 kat artmış mortalite ile ilişkilidir [OR (%95 GA): 10.909 (5.597, 21.262), p<0.001].
Sonuç: Kritik hastalığı olan COVID-19 hastalarında mortalite yüksektir ve ABH bu hastalarda mortaliteyi artırmaktadır. COVID-19 ilişkili ABH' de çeşitli risk faktörleri rol oynar, bu risk faktörlerinden bazıları hastaların yaş ve KKY gibi özellikleriyle ilgilidir, bazıları da DİK ve pnömotoraks gibi COVID-19'da yaygın olarak görülen durumlardır. Gelişen organ disfonksiyonları, COVID-19 ilişkili ABH riskini artırır. COVID-19 ilişkili ABH şiddeti arttıkça mortalite artar.
Anahtar kelimeler: COVID-19 pandemisi, Akut böbrek hasarı, İnsidans, Risk faktörleri, Mortalite, COVID-19 ilişkili akut böbrek hasarı

Abstract:
Aim: To describe the incidence and risk factors of acute kidney injury (AKI) in critically ill COVID-19 patients and to determine the impact of COVID-19 related AKI on mortality.
Materials and Method: This retrospective cohort study consists of critically ill COVID-19 patients. Demographic characteristics of the patients (age, gender, comorbidities), APACHE II and SOFA scores, hemodynamic parameters, blood test analysis, organ dysfunctions, secondary infections, septic shock, use of vasopressors, and types of respiratory support were recorded. AKI was staged according to KDIGO. Patients were grouped according to the severity of AKI. Risk factors of acute kidney injury were analyzed by logistic regression analysis.
Findings: 217 patients were screened, 20 were excluded due to chronic renal failure. 197 patients were included in the study. The incidence of AKI was determined as 46.9%. Overall mortality was 47.4%, and the mortality of patients with AKI was 73.4%. Mean APACHE II and SOFA scores were 14.88 and 6.96, respectively. Even though invasive mechanical ventilation, severe ARDS, secondary infections, septic shock, myocardial dysfunction were significantly higher in COVID-19 related AKI patients in univariate analysis, none of them were detected as independent risk factors in multivariate logistic regression analysis. By multivariate logistic regression analysis; increasing age, high SOFA score, low systolic blood pressure, CHF (congestive heart failure), pneumothorax, DIC, vasopressor usage were determined as independent risk factors for the development of COVID-19 related AKI (respectively;p=0.019,p=0.027,p=0.008,p=0.028,p=0.047,p=0.020,p=0.005). The development of COVID-19 related AKI increases mortality 10.9 times [OR (%95 GA): 10.909 (5.597, 21.262), p<0.001].
Conclusion: Mortality in critically ill COVID-19 patients is high and AKI increases mortality in these patients. Several risk factors play a role in COVID-19 related AKI, some of these risk factors are related to patients' characteristics such as age and CHF and some of them are the conditions that are commonly seen in COVID-19 such as DIC and pneumothorax. Additional organ dysfunctions increase the risk of COVID-19 related AKI. Mortality increases with increasing AKI severity.
Key words: COVID-19 pandemic, Acute kidney injury, Incidence, Risk factors, Mortality, COVID-19 related acute kidney injury