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

Background

For the coronavirus disease 2019 (COVID-19), critically ill patients had a high mortality rate. We aimed to assess the association between prolonged intermittent renal replacement therapy (PIRRT) and mortality in patients with COVID-19 undergoing invasive mechanical ventilation.

Methods

In this retrospective cohort study, we included all patients with COVID-19 undergoing invasive mechanical ventilation from February 12 nd to March 2 nd , 2020. All patients were followed until death or March 28 th , and all survivors were followed for at least 30 days.

Results

For 36 hospitalized COVID-19 patients with 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 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 (P = 0.042). The association between PIRRT and a reduced risk of mortality remained significant in three different models, with adjusted hazard ratios varying from 0.332 to 0.398. Higher levels of IL-2 receptor, TNF-α, procalcitonin, prothrombin time, and NT-proBNP were significantly associated with an increased risk of mortality in patients with PIRRT.

Conclusion

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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