Abstract
Background and study aim: : Several reports showed that some Covid-19 patients tend to have serious and fatal complications related to the kidney and heart. Rationale and mechanisms inducing this pathogenesis is unclear, but it’s more common to happen in patients with hemodynamic instability and refractory severe hypotension related to cytokine storm. It represents an irreversible stage of a sepsis-like illness that induces simultaneous damage to various organs as the myocardium and renal tubules alike the cardio-renal syndrome. The predictors for this injurious effect of COVID-19 on both myocardium and renal tissues might be related to the co-morbidities, late presentation and other factors which need further evaluation.The aim of this article is to study the predictors of cardio-renal syndrome in COVID-19 patients Patients and Methods: Our study is a prospective observational study conducted upon confirmed 160 COVID-19 ICU patients admitted from 15th March till 20th May 2020. All patients were subjected to clinical assessment, full laboratory evaluation including PCR for COVID-19 from nasopharyngeal swab and full radiological evaluation.. Results: As regards the predictors for cardio-renal syndrome [15-17]; Age showed high statistically significance (P <0.0004). Furthermore, serum creatinine and serum K were statistically significant in patients with cardio-renal affection (P= 0.015, 0.021) whereas GFR, D-dimer, need for mechanical ventilation and vasopressors were highly statistically significant with cardio-renal affected patients (P <0.001). Conclusion: Cardio-renal syndrome was common in COVID-19 ICU patients. Hypokalemia, lower GFR on admission, mechanical ventilation, vasopressors, age and D-dimer were significant independent predictors for CRS. Moreover,CRS during hospitalization was associated with an increased risk of in-hospital death.
Highlights
COVID-19 infection has exhibited a heterogeneous clinical course, ranging from asymptomatic carrier scenario to a lethal one with multi-organ failure with a wide variation of case fatality rates ranging from 0.7 to 67% [2,3,4]
Assuming an incidence rate of Cardio-renal syndromes (CRS) of around 7% in COVID-19 patients as observed from the incidence recorded at our unit, we calculated that a sample size of 157 patients would estimate this incidence rate with a precision of ± 4%, i.e., with 95% confidence limits ranging from 3% to 11%
In our study evaluating 160 COVID 19 ICU patients the acute cardiac injury was reported in 36 patients out of 160 (22.5%), whereas acute kidney injury (AKI) was reported in 18 patients (11.25%), whilst CRS developed in 8 patients representing 5%
Summary
COVID-19 infection has exhibited a heterogeneous clinical course, ranging from asymptomatic carrier scenario to a lethal one with multi-organ failure with a wide variation of case fatality rates ranging from 0.7 to 67% [2,3,4]. Rationale and mechanisms inducing this pathogenesis is unclear, but it’s more common to happen in patients with hemodynamic instability and refractory severe hypotension related to cytokine storm. It represents an irreversible stage of a sepsis-like illness that induces simultaneous damage to various organs as the myocardium and renal tubules alike the cardio-renal syndrome. The predictors for this injurious effect of COVID-19 on both myocardium and renal tissues might be related to the co-morbidities, late presentation and other factors which need further evaluation.The aim of this article is to study the predictors of cardio-renal syndrome in COVID-19 patients
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