einstein (São Paulo). 30/Aug/2023;21:eAO0119.

COVID-19-associated coagulopathy and acute kidney injury in critically ill patients

Bruno Caldin da , Ricardo Luiz , Bento Fortunato Cardoso dos , João Carlos de Campos , Roseny dos Reis , Guilherme Martins de , Carolina , Thais Dias , Niklas Söderberg , Bárbara Vieira , Flávia Nunes Dias , Hélio Penna , Gustavo Faissol Janot de , Valdir Fernandes de , Leonardo José Rolim , Thiago Domingos

DOI: 10.31744/einstein_journal/2023AO0119

Highlights

43.4% of the cohort developed acute kidney injury.

D-dimer and fibrinogen levels were high in both groups.

Rotational thromboelastometry data were similar between groups.

Serum levels of antithrombin activity and protein C were lower in patients who developed acute kidney injury.

Objective

The incidence of thrombotic events and acute kidney injury is high in critically ill patients with COVID-19. We aimed to evaluate and compare the coagulation profiles of patients with COVID-19 developing acute kidney injury versus those who did not, during their intensive care unit stay.

Methods

Conventional coagulation and platelet function tests, fibrinolysis, endogenous inhibitors of coagulation tests, and rotational thromboelastometry were conducted on days 0, 1, 3, 7, and 14 following intensive care unit admission.

Results

Out of 30 patients included, 13 (43.4%) met the criteria for acute kidney injury. Comparing both groups, patients with acute kidney injury were older: 73 (60-84) versus 54 (47-64) years, p=0.027, and had a lower baseline glomerular filtration rate: 70 (51-81) versus 93 (83-106) mL/min/1.73m², p=0.004. On day 1, D-dimer and fibrinogen levels were elevated but similar between groups: 1780 (1319-5517) versus 1794 (726-2324) ng/mL, p=0.145 and 608 (550-700) versus 642 (469-722) g/dL, p=0.95, respectively. Rotational thromboelastometry data were also similar between groups. However, antithrombin activity and protein C levels were lower in patients who developed acute kidney injury: 82 (75-92) versus 98 (90-116), p=0.028 and 70 (52-82) versus 88 (78-101) μ/mL, p=0.038, respectively. Mean protein C levels were lower in the group with acute kidney injury across multiple time points during their stay in the intensive care unit.

Conclusion

Critically ill patients experiencing acute kidney injury exhibited lower endogenous anticoagulant levels. Further studies are needed to understand the role of natural anticoagulants in the pathophysiology of acute kidney injury within this population.

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COVID-19-associated coagulopathy and acute kidney injury in critically ill patients
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