Impact of dexamethasone in severe COVID-19-induced acute kidney injury: a multicenter cohort study - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Annals of Intensive Care Année : 2024

Impact of dexamethasone in severe COVID-19-induced acute kidney injury: a multicenter cohort study

Résumé

BACKGROUND: Acute kidney injury (AKI) in intensive care unit (ICU) patients with severe COVID-19 is common (> 50%). A specific inflammatory process has been suggested in the pathogenesis of AKI, which could be improved by dexamethasone (DXM). In a small monocenter study (n = 100 patients), we reported a potential protective effect of DXM on the risk of AKI. This study aimed to investigate the preventive impact of DXM on AKI in a multicenter study of patients with severe COVID-19. METHODS: We conducted a multicenter study in three French ICUs from March 2020 to August 2021. All patients admitted to ICU for severe COVID-19 were included. Individuals with preexistent AKI or DXM administration before admission to ICU were excluded. While never used during the first wave, DXM was used subsequently at ICU entry, providing two treatment groups. Multivariate Cause-specific Cox models taking into account changes in ICU practices over time, were utilized to determine the association between DXM and occurrence of AKI. RESULTS: Seven hundred and ninety-eight patients were included. Mean age was 62.6 +/- 12.1 years, 402/798 (50%) patients had hypertension, and 46/798 (6%) had previous chronic kidney disease. Median SOFA was 4 [3-6] and 420/798 (53%) required invasive mechanical ventilation. ICU mortality was 208/798 (26%). AKI was present in 598/798 (75%) patients: 266/598 (38%), 163/598 (27%), and 210/598 (35%) had, respectively, AKI KDIGO 1, 2, 3, and 61/598 (10%) patients required renal replacement therapy. Patients receiving DXM had a significantly decreased hazard of AKI occurrence compared to patients without DXM (HR 0.67; 95CI 0.55-0.81). These results were consistent in analyses that (1) excluded patients with DXM administration to AKI onset delay of less than 12 h, (2) incorporating the different 'waves' of the COVID-19 pandemic. CONCLUSIONS: DXM was associated with a decrease in the risk of AKI in severe COVID-19 patients admitted to ICU. This supports the hypothesis that the inflammatory injury of AKI may be preventable.
Fichier principal
Vignette du fichier
BPH_AnnIntensiveCare_2024_Rubin.pdf (1012.33 Ko) Télécharger le fichier
Origine : Fichiers éditeurs autorisés sur une archive ouverte

Dates et versions

hal-04502801 , version 1 (13-03-2024)

Licence

Paternité

Identifiants

Citer

Sebastien Rubin, Arthur Orieux, Mathilde Prezelin-Reydit, Antoine Garric, Yoann Picard, et al.. Impact of dexamethasone in severe COVID-19-induced acute kidney injury: a multicenter cohort study. Annals of Intensive Care, 2024, 14 (1), pp.26. ⟨10.1186/s13613-024-01258-6⟩. ⟨hal-04502801⟩

Collections

CNRS U1219 U1034
1 Consultations
1 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More