The spectrum of biochemical alterations associated with organ dysfunction and inflammatory status and their association with disease outcomes in severe COVID-19: A longitudinal cohort and time-series design study.
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
09
06
2020
revised:
02
09
2020
accepted:
07
09
2020
pubmed:
29
9
2020
medline:
29
9
2020
entrez:
28
9
2020
Statut:
ppublish
Résumé
In patients with severe COVID-19, no data are available on the longitudinal evolution of biochemical abnormalities and their ability to predict disease outcomes. Using a retrospective, longitudinal cohort study design on consecutive patients with severe COVID-19, we used an extensive biochemical dataset of serial data and time-series design to estimate the occurrence of organ dysfunction and the severity of the inflammatory reaction and their association with acute respiratory failure (ARF) and death. On the 162 studied patients, 1151 biochemical explorations were carried out for up to 59 biochemical markers, totaling 15,260 biochemical values. The spectrum of biochemical abnormalities and their kinetics were consistent with a multi-organ involvement, including lung, kidney, heart, liver, muscle, and pancreas, along with a severe inflammatory syndrome. The proportion of patients who developed an acute kidney injury (AKI) stage 3, increased significantly during follow-up (0·9%, day 0; 21·4%, day 14; Our results point out the lack of the association between the inflammatory markers and the risk of death but rather highlight a significant association between renal dysfunction and the risk of COVID-19 related acute respiratory failure and death.
Sections du résumé
BACKGROUND
BACKGROUND
In patients with severe COVID-19, no data are available on the longitudinal evolution of biochemical abnormalities and their ability to predict disease outcomes.
METHODS
METHODS
Using a retrospective, longitudinal cohort study design on consecutive patients with severe COVID-19, we used an extensive biochemical dataset of serial data and time-series design to estimate the occurrence of organ dysfunction and the severity of the inflammatory reaction and their association with acute respiratory failure (ARF) and death.
FINDINGS
RESULTS
On the 162 studied patients, 1151 biochemical explorations were carried out for up to 59 biochemical markers, totaling 15,260 biochemical values. The spectrum of biochemical abnormalities and their kinetics were consistent with a multi-organ involvement, including lung, kidney, heart, liver, muscle, and pancreas, along with a severe inflammatory syndrome. The proportion of patients who developed an acute kidney injury (AKI) stage 3, increased significantly during follow-up (0·9%, day 0; 21·4%, day 14;
INTERPRETATION
CONCLUSIONS
Our results point out the lack of the association between the inflammatory markers and the risk of death but rather highlight a significant association between renal dysfunction and the risk of COVID-19 related acute respiratory failure and death.
Identifiants
pubmed: 32984786
doi: 10.1016/j.eclinm.2020.100554
pii: S2589-5370(20)30298-4
pmc: PMC7502281
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100554Informations de copyright
© 2020 The Author(s).
Déclaration de conflit d'intérêts
The authors who have taken part in this study declare that they do not have anything to disclose regarding conflicts of interest concerning this manuscript.
Références
JAMA. 2020 Apr 28;323(16):1574-1581
pubmed: 32250385
Stat Med. 2010 Feb 20;29(4):504-20
pubmed: 20013937
BMJ. 2020 Feb 19;368:m606
pubmed: 32075786
Gut. 2020 Jun;69(6):1002-1009
pubmed: 32213556
Am J Physiol Heart Circ Physiol. 2020 May 1;318(5):H1084-H1090
pubmed: 32228252
Lancet Infect Dis. 2020 May;20(5):533-534
pubmed: 32087114
J Clin Transl Hepatol. 2020 Mar 28;8(1):13-17
pubmed: 32274341
JAMA. 2020 Apr 21;323(15):1488-1494
pubmed: 32125362
N Engl J Med. 2020 Jun 11;382(24):2327-2336
pubmed: 32275812
Biometrics. 1988 Sep;44(3):837-45
pubmed: 3203132
Am J Kidney Dis. 2020 Jul;76(1):4-6
pubmed: 32276031
Biometrics. 2000 Sep;56(3):909-14
pubmed: 10985236
J Clin Invest. 2020 May 1;130(5):2620-2629
pubmed: 32217835
Nature. 2020 Mar;579(7798):270-273
pubmed: 32015507
Euro Surveill. 2020 Feb;25(6):
pubmed: 32070465
Lancet. 2020 Feb 22;395(10224):565-574
pubmed: 32007145
BMJ. 1990 Jan 27;300(6719):230-5
pubmed: 2106931
Cardiovasc Res. 2020 May 1;116(6):1097-1100
pubmed: 32227090
Science. 2015 Jan 23;347(6220):1260419
pubmed: 25613900
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
JAMA Cardiol. 2020 Jul 1;5(7):811-818
pubmed: 32219356
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
J Allergy Clin Immunol. 2020 Jul;146(1):119-127.e4
pubmed: 32360286
Clin Kidney J. 2020 Jun 08;13(3):362-370
pubmed: 32695327
Lancet Respir Med. 2020 May;8(5):430-432
pubmed: 32272081
Kidney Int. 2020 May;97(5):829-838
pubmed: 32247631
Nat Rev Immunol. 2020 May;20(5):277
pubmed: 32249847
Health Econ. 1997 Nov-Dec;6(6):561-75
pubmed: 9466139
Chest. 2004 Sep;126(3):845-50
pubmed: 15364765
Crit Care. 2007;11(2):R31
pubmed: 17331245
Lancet Infect Dis. 2020 Jun;20(6):689-696
pubmed: 32220650
BMJ. 2020 Mar 26;368:m1091
pubmed: 32217556
Medicine (Baltimore). 2015 Nov;94(44):e1774
pubmed: 26554775
Lancet Respir Med. 2020 Jun;8(6):538-539
pubmed: 32278367
Eur Respir J. 2020 May 21;55(5):
pubmed: 32265307
Clin Infect Dis. 2020 Sep 12;71(6):1393-1399
pubmed: 32271369
Lancet. 2020 Feb 15;395(10223):497-506
pubmed: 31986264
Science. 2020 Mar 27;367(6485):1444-1448
pubmed: 32132184
Lancet. 2020 Mar 28;395(10229):1033-1034
pubmed: 32192578
Lancet. 2020 Feb 15;395(10223):507-513
pubmed: 32007143