Introduction:
Diastolic dysfunction (DD) has been reported as a risk factor for acute kidney injury (AKI). Although the use of point-of-care ultrasound (PoCUS) in the management of critically ill patients is increasing in Africa, data on cardiac parameters in AKI are scarce. The aim of this study was to assess the association between diastolic dysfunction and AKI in severe COVID-19 patients.
Methods:
A single-centre, retrospective, case-control study of severe COVID-19 patients aged 18 years or older between March 2020 and January 2022. Patients with end-stage renal disease (ESRD) or on dialysis were excluded. Each COVID-19 patient enrolled in the study underwent a cardiac ultrasound within 48 hours of admission. AKI was diagnosed according to KDIGO guidelines. E/e' indicated diastolic function and DD was defined as the mean of septal and lateral measurements of E/e' ≥ 13. Logistic regression was used to determine factors associated with AKI. P value was considered significant at p ˂ 0.05 level.
Results:
Eighty-two patients were included in the present study, with a mean age of 62.6 ± 12.2 years, a predominantly male population (75.6%), and hypertension (61.0%) as the main comorbidity. Heart failure was present in only 8 of the 82 patients (9.8%). Patients with AKI (32.9%) were more likely to be obese (40.7% versus 16.4%, p=0.016) and diabetic (37.0% versus 12.7%, p=0.011). These patients had lower peripheral oxygen saturation (88.7% ± 10.6% vs. 92.7±6.6%, p=0.023), oxygen partial pressure (62.1±17.2 vs. 76.9±35.5, p=0.024), urine pH (5.4±0.6 vs. 6.0±1.0, p=0.01) and total cholesterol (5. 1±1.1 vs. 4.4±0.9, p=0.011), neutrophil/lymphocyte ratio (6.6±5.5 vs. 4.9±2.3, p=0.03), E/e' ratio (10.5±2.9 vs. 8.5±2.2, p=0.001) and inferior vena cava diameter (16.7±4.7 vs. 13.8±3.6, p=0.002). Multivariate logistic regression analysis showed that E/e' (aOR 1.3;95% CI, 1.02-1.62, p=0.033) was a significant risk factor for AKI in severe COVID-19 patients with a high risk if there was a DD (aOR 6.7;95% CI, 1.2-37.9, p=0.033).
Conclusions:
Diastolic dysfunction increases the risk of AKI in patients with severe COVID-19. Using PoCUS to assess left ventricular diastolic function in the ICU may be a useful parameter to stratify AKI risk.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.