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2022, Number 5

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Med Crit 2022; 36 (5)

CO2 Delta as a predictor of acute kidney injury (AKI) in patients diagnosed with adult respiratory distress syndrome (ARDS) by COVID-19 and septic shock

Villalobos ÁVH, Sánchez CA, Arcos ZM, Varela SLE, Aguirre SJS, Chaires GR

Language: Spanish
References: 36
Page: 265-271
PDF size: 283.86 Kb.


ABSTRACT

Introduction: The SARS-CoV-2 virus is capable of affecting various organs, leading to dysfunction. The main organs of shock are the lung, kidney and cardiovascular system. Patients who develop ARDS usually present with sepsis and septic shock, being more prone to developing acute kidney injury (AKI) either due to hypovolemia or myocardial dysfunction. Invasive monitoring in these patients has been a challenge, due to health protocols and the large number of patients, so the arterial-venous CO2 differential (DCO2), is an easy parameter to measure, can help us determine indirectly cardiac output (CO) and perfusion in patients with shock. Objective: To assess the use of DCO2 as a predictor of AKI in patients with septic shock and COVID-19. Material and methods: An observational, cross-sectional and retrolective study was carried out in patients with septic shock and ARDS due to COVID-19, admitted to the respiratory intensive care unit (ICU) of the ABC Medical Center. DCO2 and its association with LRA were determined. The data was summarized using measures of central tendency, Student's t test to determine the difference in means, and the risk of developing AKI was estimated by calculating the Odds Ratio (OR). The study was approved by the ethics committee of Centro Médico ABC, Mexico City (Folio: ABC-21-36). Results: From March 13 to July 13, 2020, 527 patients (p) diagnosed with COVID-19 were admitted, 107 (20.3%) presented ARDS with the requirement of invasive mechanical ventilation (IMV) and 99 (18.78%) septic shock, 74.4% were men, 61% developed some degree of AKI, especially in the group with DCO2 less than 6mmHg (44 vs 17 p ≤ 0.001) with OR 2.108, 95% CI = 1.23-3.36. There was no significant difference in the severity scales. Conclusion: DCO2 greater than 6 mmHg was not a good predictor for AKI, however, a DCO2 less than 6mmHg increased the risk of AKI.


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