Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically Ill Patients with COVID-19

Mickaël Bobot (1, 2, 3, 4, 5) , David Tonon (6, 7) , Noémie Peres (5, 4) , Christophe Guervilly (5, 4) , Flora Lefèvre (2) , Howard Max (8, 7) , Youri Bommel (8, 7) , Maxime Volff (8, 7) , Marc Leone (9) , Alexandre Lopez (9) , Pierre Simeone (8, 10) , Julien Carvelli (8) , Sophie Chopinet (11, 3, 12) , Sami Hraiech (5, 4) , Laurent Papazian (5, 4) , Lionel Velly (8, 10) , Jérémy Bourenne (9, 7) , Jean-Marie Forel (5, 4)

1 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
2 Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM]
3 CERIMED - Centre Européen de Recherche en Imagerie médicale
4 Hôpital Nord [CHU - APHM]
5 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
6 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
7 AMU - Aix Marseille Université
8 Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM]
9 Service Anesthésie et Réanimation [Hôpital Nord - APHM]
10 INT - Institut de Neurosciences de la Timone
11 LIIE - Laboratoire d'Imagerie Interventionnelle Expérimentale
12 TIMONE - Hôpital de la Timone [CHU - APHM]

Background: Acute kidney injury (AKI) is the second most frequent condition after acute respiratory distress syndrome (ARDS) in critically ill patients with severe COVID-19 and is strongly associated with mortality. The aim of this multicentric study was to assess the impact of the specific treatments of COVID-19 and ARDS on the risk of severe AKI in critically ill COVID-19 patients. Methods: In this cohort study, data from consecutive patients older than 18 years admitted to 6 ICUs for COVID-19-related ARDS requiring invasive mechanical ventilation were included. The incidence and severity of AKI, defined according to the 2012 KDIGO definition, were monitored during the entire ICU stay until day 90. Patients older than 18 years admitted to the ICU for COVID-19-related ARDS requiring invasive mechanical ventilation were included. Results: 164 patients were included in the final analysis; 97 (59.1%) displayed AKI, of which 39 (23.8%) had severe stage 3 AKI, and 21 (12.8%) required renal replacement therapy (RRT). In univariate analysis, severe AKI was associated with angiotensin-converting enzyme inhibitors (ACEI) exposure (p = 0.016), arterial hypertension (p = 0.029), APACHE-II score (p = 0.004) and mortality at D28 (p = 0.008), D60 (p < 0.001) and D90 (p < 0.001). In multivariate analysis, the factors associated with the onset of stage 3 AKI were: exposure to ACEI (OR: 4.238 (1.307–13.736), p = 0.016), APACHE II score (without age) (OR: 1.138 (1.044–1.241), p = 0.003) and iNO (OR: 5.694 (1.953–16.606), p = 0.001). Prone positioning (OR: 0.234 (0.057–0.967), p = 0.045) and dexamethasone (OR: 0.194 (0.053–0.713), p = 0.014) were associated with a decreased risk of severe AKI. Conclusions: Dexamethasone was associated with the prevention of the risk of severe AKI and RRT, and iNO was associated with severe AKI and RRT in critically ill patients with COVID-19. iNO should be used with caution in COVID-19-related ARDS.

Mots clés: ARDS; acute kidney injury; intensive care; dexamethasone; inhaled nitric oxide; COVID-19

Domaines: Sciences du Vivant [q-bio]

Mickaël Bobot, David Tonon, Noémie Peres, Christophe Guervilly, Flora Lefèvre, et al.. Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically Ill Patients with COVID-19. Journal of Clinical Medicine, 2022, 11 (20), pp.6130. ⟨10.3390/jcm11206130⟩. ⟨hal-03922618⟩