Compromiso renal en pacientes con COVID-19 severa y crítica
Resumen
Introducción: la injuria renal aguda fue una complicación observada en forma frecuente en los pacientes críticos durante la pandemia por COVID-19. Objetivos: 1) determinar la incidencia de injuria renal aguda asociada a COVID-19 severa y crítica; 2) determinar la implicancia pronóstica en términos de morbimortalidad del compromiso renal.
Materiales y métodos: estudio prospectivo, observacional y analítico de una cohorte de pacientes con COVID-19 severa y crítica ingresados a la Unidad de Medicina Intensiva del Hospital Español. Se realizó un análisis descriptivo y analítico (univariado y mutivariado) y se empleo un nivel estadístico de significación menor a 0,05.
Resultados: n=233 pacientes con COVID-19 severa y crítica ingresados a la Unidad de Medicina Intensiva del Hospital Español entre 9/20 y 5/21. Injuria renal aguda asociada a COVID-19: 47,9% (107/233), injuria renal aguda severa (estadios KDIGO 2 y 3): 79,4% (85/107), injuria renal aguda nosocomial: 47,7% (52/107), enfermedad renal aguda: 41,1% (44/107), requerimiento de técnica de reemplazo renal: 29,9% (32/107).
La mortalidad al alta de medicina intensiva en pacientes con injuria renal aguda: 72,9% (78/107) versus sin injuria renal aguda: 48,4% (61/126) (p=0,000). El análisis multivariado mostró como factor predictivo protectivo de riesgo de muerte al alta de medicina intensiva a la función renal normal al egreso (OR 0,055, IC 95%: 0,014-0,213, p= 0,000).
Conclusiones: la incidencia de injuria renal aguda asociada a COVID-19 en medicina intensiva fue elevada, con un predominio de estadios 2-3 y se asoció con una mortalidad significativamente mayor. La normalización de la función renal se comportó como un factor predictivo protectivo de riesgo de muerte. El grado de soporte multiorgánico se asoció con un aumento progresivo de la mortalidad.
Citas
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