Association between Prolonged Intermittent Renal Replacement Therapy and All-Cause Mortality in COVID-19 Patients Undergoing Invasive Mechanical Ventilation: A Retrospective Cohort Study

  1. Yi Yang
  2. Jia Shi
  3. Shuwang Ge
  4. Shuiming Guo
  5. Xue Xing
  6. Yanan Wang
  7. Anying Cheng
  8. Qingquan Liu
  9. Junhua Li
  10. Yong Ning
  11. Fan He
  12. Gang Xu

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Abstract

<b><i>Background:</i></b> The mortality rate of critically ill patients with coronavirus disease 2019 (COVID-19) was high. We aimed to assess the association between prolonged intermittent renal replacement therapy (PIRRT) and mortality in patients with COVID-19 undergoing invasive mechanical ventilation. <b><i>Methods:</i></b> This retrospective cohort study included all COVID-19 patients receiving invasive mechanical ventilation between February 12 and March 2, 2020. All patients were followed until death or March 28, and all survivors were followed for at least 30 days. <b><i>Results:</i></b> For 36 hospitalized COVID-19 patients receiving invasive mechanical ventilation, the mean age was 69.4 (±10.8) years, and 30 patients (83.3%) were men. Twenty-two (61.1%) patients received PIRRT (PIRRT group), and 14 cases (38.9%) were managed with conventional strategy (non-PIRRT group). There were no differences in age, sex, comorbidities, complications, treatments, and most of the laboratory findings. During the median follow-up period of 9.5 (interquartile range 4.3–33.5) days, 13 of 22 (59.1%) patients in the PIRRT group and 11 of 14 (78.6%) patients in the non-PIRRT group died. Kaplan-Meier analysis demonstrated prolonged survival in patients in the PIRRT group compared with that in the non-PIRRT group (<i>p</i> = 0.042). The association between PIRRT and a reduced risk of mortality remained significant in 3 different models, with adjusted hazard ratios varying from 0.332 to 0.398. Increased IL-2 receptor, TNF-α, procalcitonin, prothrombin time, and NT-proBNP levels were significantly associated with an increased risk of mortality in patients with PIRRT. <b><i>Conclusion:</i></b> PIRRT may be beneficial for the treatment of COVID-19 patients with invasive mechanical ventilation. Further prospective multicenter studies with larger sample sizes are required.

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  1. Version published to 10.1159/000512099
  2. Version published to 10.1101/2020.03.16.20036780v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.03.16.20036780: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    SPSS 23.0 (IBM Corporation, Armonk, NY) statistical software was used for statistical analysis.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    GraphPad Prism 6 (GraphPad Software, USA) was used for statistical analysis and visualization.
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    ADE can elicit sustained inflammation, lymphopenia, and/or cytokine storm, which is a possible explanation for the geographic limitation of severe cases. Third, combined infections may lead to a more severe systemic inflammatory response. Indeed, in our study, some patients had infections in other organs (e.g. urinary tract and blood) caused by other pathogens (e.g., influenza virus and fungi). Fourth, shock, hypoxemia and coagulation pathway abnormalities in critical patients could aggravate the systemic inflammatory response, which lead to a vicious cycle that is life-threatening (37, 38). In our study, PIRRT was associated with prolonged survival in COVID-19 patients with invasive mechanical ventilation. The primary goal of RRT is to compensate for the loss of renal function and associated sequelae, including uremic toxicity, electrolyte disturbances, metabolic acidosis, and volume overload (22, 39). In addition, RRT can also remove cytokines from the bloodstream. Emerging evidence has shown that RRT was associated with significantly lower mortality in patients with severe sepsis (17, 18, 40). Besides, in patients with acute respiratory distress syndrome, RRT could remove inflammatory mediators, modulate immune function, and regulate oxygenation, thus improving patient prognosis (41-43). PIRRT is a widely used blood purification therapy, that achieves a high solute clearance rate through diffusion and convection (44). PIRRT has shown to encompass the benefits of both conti...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  4. Version published to 10.1101/2020.03.16.20036780v1 on medRxiv