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Combined effect of Controlling Nutritional Status and Acute Kidney Injury on severe COVID-19 short-term outcomes - 28/05/21

Effet combiné du l’état nutritionnel et de l’insuffisance rénale aiguë sur le pronostic à court terme des formes sévères de la COVID-19

Doi : 10.1016/j.nupar.2021.03.001 
Salam Bennouar a, , Abdelghani Bachir Cherif b , Amel Kessira c , Djamel-Eddine Bennouar c , Samia Abdi a
a Central Laboratory of clinical biology, University Hospital center of Blida, 9000 Blida, Algeria 
b Department of Internal Medicine and Cardiology, University Hospital Center of Blida, 9000 Blida, Algeria 
c Department of hemobiology and blood transfusion, University Hospital Center of Annaba, 23000 Annaba. Algeria 

Corresponding author. Central laboratory of clinical biology. Frantz Fanon Hospital, University Hospital Center of Blida, 9000 Blida, Algeria.Central laboratory of clinical biology. Frantz Fanon Hospital, University Hospital Center of BlidaBlida9000Algeria

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Abstract

Introduction/Objectives

Acute kidney injury (AKI) and malnutrition are two complications commonly reported in severe forms of COVID-19, their combined effect on short-term mortality is, however, not yet investigated. The objective of this study is to determine both their individual and combined effects on short-term prognosis.

Materials and methods

This is a prospective, uni-centric study, including 247 severe COVID-19 patients, admitted between April 25th and June 20th, 2020, at the University Hospital of Blida. AKI was defined according to the KDIGO-2012 guidelines. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. The association with in-hospital mortality was assessed using the Kaplan-Meier method and proportional Cox regression.

Results

Among the 247 severely affected COVID-19 patients included in this study, 34.4% developed AKI, 30.4 and 1.2%, respectively, had moderate and severe CONUT scores, 17.7% worsened and progressed to a critical state and 26.7% did not survive. Both AKI and CONUT score were significantly associated with mortality in a dose-response manner (pLog-Rank<0.0001). Their relative risks are respectively (HR=3.25 CI 95% [1.99–5.3] and HR=2.42 CI 95% [1.5–3.9], p<0.0001). In multivariate analysis, the highest risk was observed for the AKI-CONUT-high combination (HR=3.0, 95% CI [1.5–6.1], p=0.002).

Conclusion

A possible synergistic interaction between AKI and CONUT score for COVID-19 short-term mortality has been highlighted. Monitoring of renal function associated with assessment of nutritional status should be performed routinely and systematically from the early stages of admission.

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Résumé

Introduction/objectifs

L’insuffisance rénale aiguë (AKI) et la dénutrition sont deux complications fréquemment retrouvées dans les formes sévères de la Covid-19. L’objectif de cette étude est de déterminer leurs impacts individuels et combinés sur le pronostic à court terme.

Matériel et méthodes

Il s’agit d’une étude prospective, uni-centrique, incluant 247 cas sévères de Covid-19, admis entre le 25 avril et le 20 juin 2020, au niveau de l’hôpital universitaire de Blida. L’AKI a été définie en suivant les recommandations de la KDIGO-2012. L’état nutritionnel a été évalué en utilisant le score « Controlling Nutritional Status » (CONUT). L’association avec la mortalité en milieu hospitalier a été évaluée par la méthode de Kaplan-Meier et la régression proportionnelle de Cox.

Résultats

L’incidence de l’AKI était de 34,4 %, 50% avaient une dénutrition modérée à sévère. L’AKI et le score CONUT étaient significativement associés à la mortalité d’une manière dose à effet (pLog-Rank<0,0001). Leurs risques relatifs étaient respectivement (HR=3,25 CI 95 % [1,99–5,3] et HR=2,42 CI 95 % [1,5–3,9], p<0,0001). En analyse multivariée, le risque le plus élevé est observé pour la combinaison AKI-CONUT-high (HR=3,0, CI 95% [1,5–6,1], p=0,002).

Conclusion

Une interaction de type synergétique a été mise en évidence entre l’AKI et le score CONUT pour la mortalité à court terme due à la Covid-19. La surveillance de la fonction rénale associée à l’évaluation de l’état nutritionnel devrait être effectuée systématiquement dès les premiers stades d’admission.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : COVID-19, Acute Kidney Injury, Malnutrition, CONUT score, Mortality

Mots clés : COVID-19, Acute Kidney Injury, CONUT score, Mortalité à court terme


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© 2021  Société francophone nutrition clinique et métabolisme (SFNCM). Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 35 - N° 2

P. 144-151 - Maggio 2021 Ritorno al numero
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