The effect of renal replacement therapy application on mortality and hematological and inflammatory markers of COVID-19 intensive care patients

OBJECTIVE: The main purpose of our study, which was designed retrospectively, is to determine the effect of renal replacement therapy on mortality in patients hospitalized in the intensive care unit with the diagnosis of COVID 19, and to show the effect on intensive care unit length of stay, vasopressor requirement and duration, mechanical ventilation needs, hematological and inflammatory laboratory parameters. METHODS: A total of 274 patients, 208 of whom did not receive RRT and 66 of whom received RRT, who were hospitalized in the COVID-19 intensive care unit of Istanbul Medical Faculty between 18/03/2020 and 05/03/2021 were included in this retrospective study. In our study, mortality, prognostic laboratory parameters, survival analyzes, the effect of RRT application on hematological and inflammatory laboratory parameters and whether these parameters have a statistically significant relationship with mortality were compared between the groups with and without RRT. RESULTS: It was determined that the conditions of the patients who were followed up in the intensive care unit with the diagnosis of COVID-19 and who needed RRT were more serious (more mechanical ventilation and vasopressor needs, higher APACHE and SOFA scores and procalcitonin value). Mortality was found to be higher in patients who underwent RRT. In addition, it was observed that the patients who underwent RRT had high D-dimer values after RRT. When the gender distribution of the patients was examined, it was seen that males received more RRT statistically.(54(28.3%)-12(14.3%)) (p:0.014). In the group receiving RRT mortality (50(34.5%)- 95(65.5%) p<0.001), need for mechanical ventilation (61(31.4%)- 133(68.6%) p<0.001) vasopressor requirement (61(34.4%)- 117(65.7%) p<0.01), intensive care unit length of stay (11(2-55)- 8(1-29) p:0.001) were found to be statistically significantly higher. CRP values of renal replacement therapy before and after 3rd-6th days of RRT(143(0.7-460)-86.5(2-385)-111.5(1.4-20.5) p:0.03) the effect on the trend was found to be statistically significant. The effect of renal replacement therapy on the trend of D-dimer values before and after 3rd-6th days of RRT(1970(103-20000)-3900(870-2550)-4560(1180-20000) p:0.02) was found to be statistically significant. The decrease effect of renal replacement therapy on the trend of Fibrinogen values (641.6+198.2) - (520.6+185.2)- (-) p: 0.002) before and after 3rd-6th days of RRT was found to be statistically significant. When the survival analysis table of the patients who received renal replacement therapy was examined according to the initiation of early and late renal replacement therapy, it was determined that the survival rate was higher in patients who were started on late renal replacement therapy compared to those who started early renal replacement therapy. (Kaplan-Meier survival analysis (log rank test, x2:3,87) ) p:0.049 ). The CRP value on the 3rd day after the start of renal replacement therapy was found to be statistically significant in terms of being a mortality risk factor.(1005(1000-1011) p:0.048) CONCLUSION: Renal replacement therapy is a frequently used treatment strategy in COVID-19 intensive care patients. As our study shows, RRT is a risk factor for mortality, long intensive care stays, mechanical ventilation need, and vasopressor requirement. In addition, it was observed that the course of some hematological and inflammatory laboratory parameters changed after RRT. The result that late RRT increases survival in starting early and late RRT also reveals how careful and selective we should be when starting this treatment.