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Mechanical ventilation in acute respiratory distress syndrome during SARS-COV2 pneumonitis is responsible for pro-inflammatory and hemodynamic phenomena favoring the development of acute renal failure (AKI). The incidence of AKI varies between 20 to 40% of cases for COVID-19 patients admitted to the intensive care unit, with a very high mortality, but heterogeneous according to the different epidemic waves probably due to the phenomenon of genetic variant of the Virus. The objective of this study was to compare the mortality of COVID-19 patents admitted with ARI admitted to intensive care according to waves and variants.
Descriptive and analytical cross-sectional study conducted with COVID-19 patients with AKI admitted to intensive care covering the period from March 2020 to December 2021, in the multipurpose intensive care unit, site of the Grand Est Francilien hospital, Meaux site. The statistical analysis was performed with SPSS software version 23.0. The square Khi test or Fischer's exact used to compare proportions, the student's T-test to compare averages. The search for associated factors was carried out in logistic regression. The value of p≤ 0.05 was set as the significance level
A total of 86 patients were included in the study, the average age was 65 years and elderly patients (≥ 65 years) were the most represented (58%), the sex ratio M/F was 1.8, they were mostly Caucasian at 82%. Most patients had hypertension (50%), diabetes (39.5%), heart disease (37.2%), dyslipidemia (20.9%), arrhythmia disorder (20.9%). The average duration of admission to intensive care is 21.24 ± 13.59 days, diuresis was normal at admission and decreases with length of hospitalization, average blood pressure is 57.33 mmHg, most of our patients were overweight or obese. A large proportion of patients were included in the 2nd wave compared to other epidemic waves. The beta variant was the majority of 36 patients (41.9%), alpha 26 patients (30.3%), Delta 16 patients (18.6%) and Omicron eight patients (9.3%).46.5% of patients had severe lung involvement with acute respiratory distress syndrome according to the Berlin 2012 classification and received a mean Fi02 of 91.22 ± 9.11 and a PEEP of 12.65 ± 1.76. Urea and creatinine levels at admission were normal and increased over time to mean averages of 22.78 ± 13.64 and 260 ± 162.74, respectively. We noted 35% of deaths and when we go back according to the stages of KDIGO, we note 50% in stage III, 33% in stage II and 32% in stage I. the second wave had the highest death rate, however there is a higher case fatality rate in the fourth wave
AKI is common in patients admitted to intensive care for SARS-COV2 infection, it has a significant mortality and lethality depending on the severity of the KDIGO stage of the AKI as well as the associated lung lesions and whose variability has been punctuated by the different epidemic waves and genetic variants of the virus associated with it.