Prospective Multicenter Study on Early Proximal Tubular Injury in COVID-19–Related Acute Respiratory Distress Syndrome
2024
Bobot, Mickaël | Heim, Xavier | Max, Howard | Boucraut, José | Simeone, Pierre | Stein, Claire | Velly, Lionel | Bruder, Nicolas | Forel, Jean-Marie | Hraiech, Sami | Guervilly, Christophe | Carvelli, Julien | Gainnier, Marc | Mège, Jean-Louis | Chopinet, Sophie | Jourde-Chiche, Noémie | Papazian, Laurent | Burtey, Stéphane | Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM] ; Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION) | Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN) ; Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE) | Centre Européen de Recherche en Imagerie médicale (CERIMED) ; Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-École Centrale de Marseille (ECM)-Institut Paoli-Calmettes (IPC) ; Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Centre National de la Recherche Scientifique (CNRS) | Laboratoire d'Immunologie [Hôpital de la Conception - APHM] ; Assistance Publique - Hôpitaux de Marseille (APHM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION)-Centre National de la Recherche Scientifique (CNRS) | Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM] ; Hôpital de la Timone [CHU - APHM] (TIMONE) | Centre de recherche en neurobiologie - neurophysiologie de Marseille (CRN2M) ; Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS) | Institut de Neurosciences de la Timone (INT) ; Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS) | Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS) ; Aix Marseille Université (AMU) | Service Anesthésie et Réanimation [Hôpital Nord - APHM] ; Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital Nord [CHU - APHM] | Service chirurgie générale et transplantation hépatique, APHM, Hôpital La Timone, Marseille, France | Laboratoire d'Imagerie Interventionnelle Expérimentale (LIIE) ; Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)
International audience
Show more [+] Less [-]English. IntroductionDuring COVID-19, renal impairment is associated with poor prognosis in intensive care unit (ICU). We aimed to assess the existence and incidence of early renal dysfunction and its prognostic value in patients with COVID-19–related acute respiratory distress syndrome (ARDS).MethodsIn this prospective multicenter study, patients aged over 18 years with invasive mechanical ventilation (MV) for ARDS were enrolled in 3 ICUs. Precise evaluation of renal dysfunction markers, including urinary protein electrophoresis (UPE) and quantification, was performed within 24 hours after MV onset.ResultsFrom March 2020 to December 2021, 135 patients were enrolled as follows: 100 with COVID-19 ARDS and 35 with non–COVID-19 ARDS. UPE found more tubular dysfunction in patients with COVID-19 (68% vs. 21.4%, P < 0.0001) and more normal profiles in patients without COVID-19 (65.0% vs. 11.2%, P = 0.0003). Patients with COVID-19 significantly displayed early urinary leakage of tubular proteins such as beta-2-microglobulin (ß2m) and free light chains, tended to display acute kidney injury (AKI) more frequently (51.0% vs. 34.3%, P = 0.088), had longer MV (20 vs. 9 days, P < 0.0001) and longer ICU stay (26 vs. 15 days, P < 0.0001). In COVID-19 ARDS, leakage of free lambda light chain was associated with the onset of Kidney Disease: Improving Global Outcomes (KDIGO) ≥2 AKI (odds ratio [OR]: 1.014, 95% confidence interval [CI] 1.003–1.025, P = 0.011).ConclusionPatients with COVID-19–related ARDS display a proximal tubular dysfunction before the onset of AKI, which predicts AKI. Proximal tubular damage seems an important mechanism of COVID-19–induced nephropathy. Analysis of urinary proteins is a reliable noninvasive tool to assess proximal tubular dysfunction in the ICU.
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