Category Archives: AoP

Prediction of acute kidney injury in mechanically ventilated patients with COVID-19-related septic shock: An exploratory analysis of non-renal organ dysfunction markers

Jose J. Zaragoza1, Jonathan S. Chávez-Iñiguez2,3, Armando Vazquez-Rangel4

1 Critical Care Department, Hospital H+ Queretaro, Mexico
2 Nephrology Department, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
3 Centro Uniersitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
4 Nephrology Department, Instituto Nacional de Cardiologia, Mexico City, Mexico

DOI: 10.2478/jccm-2026-0013

Background: Acute kidney injury (AKI) is a common and serious complication in critically ill patients with non-kidney organ dysfunction. Early prediction of AKI is crucial for timely intervention and improved outcomes. This study aimed to identify readily available non-renal predictors of AKI and to develop an exploratory prediction model in a specific cohort of critically ill patients with COVID-19-related septic shock requiring mechanical ventilation.
Materials and methods: This was a single-center, observational, retrospective cohort study conducted in the respiratory ICU of Hospital H+ Querétaro between April and December 2020. The study included 42 mechanically ventilated patients with septic shock secondary to SARS-CoV-2 infection and non-kidney organ dysfunction. AKI was defined using the KDIGO criteria. Trend analysis, bivariate and multivariate linear regression, were used to identify predictors of AKI and severe AKI.
Results: AKI occurred in 23 (54.8%) patients, with 6 (14.3%) developing severe AKI. Trend analysis revealed differences in norepinephrine dose, hemoglobin, and lactate trends between groups. A simplified logistic regression model, validated internally with bootstrapping to prevent overfitting, identified a protective trend associated with higher hemoglobin levels on admission. Quantitative analysis of a forecasting model for daily renal function showed moderate predictive accuracy.
Conclusions: This study identified several readily available non-kidney organ dysfunction variables that can predict AKI and its severity in critically ill patients with COVID-19-related septic shock. These findings may help in the early identification of at-risk patients and facilitate timely interventions to potentially improve outcomes. Further validation in larger and more diverse populations is warranted.

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Efficacy of gabapentin versus trospium chloride for prevention of catheter-related bladder discomfort inside the surgical intensive care unit: A prospective, randomised, controlled clinical study

Ahmed Moustafa Mohamed, Wessam Zaher Selima

Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt

DOI: 10.2478/jccm-2026-0015

Introduction: Catheter-related bladder discomfort (CRBD) after perioperative catheterisation of the urinary bladder (COUB) is not uncommon.
Aim of the study: We evaluated the efficacy of both oral gabapentin and trospium in preventing CRBD during the early postoperative period in patients admitted to the surgical intensive care unit (S-ICU).
Material and Methods: 120 patients aged 20–65 years, ASA I, II or III who were admitted to S-ICU after undergoing elective spinal surgery (ESS) with COUB were included. They were randomly assigned to be administered either an oral 400 mg gabapentin capsule (Group G) or an oral 60 mg slow-release trospium chloride capsule (Group T) or nothing (Group C). The primary goal was the occurrence of CRBD and its severity at 1, 2, 6, 12, and 24 hours after the study drug administration (SDA).
Results: Group G and group T had a statistically significant lower incidence of CRBD than group C at 1, 2, 6, 12, and 24 hours after SDA, respectively. Both had considerably lower severity than group C in the first two hours only (P= 0.001 and 0.001, respectively). Group T had non-significantly lower incidence and severity of CRBD than group G. Group G had significantly lower mean total fentanyl requirements for up to 24 hours after SDA than group T and group C (P < 0.001).
Conclusion: Both oral gabapentin capsules and slow release trospium chloride capsules administered postoperatively, significantly decreased both the incidence of CRBD and its severity in the early postoperative period amongst S-ICU patients, without significant differences between the two drugs.

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Positive fluid balance is associated with earlier acute kidney injury in COVID-19 patients

Rezwan Munshi1, Sandra Gomez-Paz2, Salman Bhutta3, Joshua Fogel4, James Pellegrini1, Narois Nehru1, Eric Lam5, Sofia Rubinstein1

1 Nassau University Medical Center, East Meadow, NY, USA
2 Brody School of Medicine, East Carolina University, Greenville, NC, USA
3 Northwell Health, New Hyde Park, NY, USA
4 Brooklyn College, Brooklyn, NY, USA
5 Rutgers New Jersey Medical School, Newark, NJ, USA

DOI: 10.2478/jccm-2026-0016

Introduction: Managing fluid balance in COVID-19 patients can be challenging, particularly if acute kidney injury (AKI) develops.
Aim of the study: We study the relationship between fluid net input and output (FNIO) in COVID-19 patients with development of AKI, time to development of AKI, in-hospital length of stay (LOS), and in-hospital mortality.
Material and Methods: Retrospective study of 403 patients with COVID-19. Data for FNIO were from day 1 through day 10 or earlier if AKI occurred.
Results: AKI occurred in 22.8%, in-hospital mortality occurred in 26.3%, mean days to AKI were 7.7 (SD=6.3), and mean LOS was 11.5 (SD=13.2) days. In the multivariate logistic regression analyses, increased FNIO mean was significantly associated with slightly increased odds for mortality (OR=1.001, 95% CI:1.0001, 1.0011, p=0.02) but was not significantly associated with AKI. In the multivariate linear regression analyses, increased FNIO mean was significantly associated with lesser days to AKI (B=-6.63*10-5, SE=<0.001, p=0.003) in the whole sample, greater days to AKI in the subset of those with ICU treatment (B=<0.001, SE=<0.001, p<0.001), while FNIO mean was not significantly associated with LOS.
Conclusions: Positive fluid balance was associated with faster onset of AKI and increased mortality. Fluid administration in patients with COVID-19 should be guided by routinely measuring FNIO. A restrictive fluid management regimen rather than usual care should be practiced.

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Admission biomarkers and COVID-19 mortality: A retrospective study during Vietnam’s pandemic peak

Uyen Thi Bich Nguyen1, Hau Phuc Le2,3, Vu Hoang Anh Nguyen4, Ai-Thanh Tran-Nguyen4,5

1 Department of Nephrology and Hemodialysis, Le Van Viet Hospital, Ho Chi Minh City, Vietnam
2 Outpatient Clinic for HIV-AIDS Patients, Chau Thanh District Medical Center, Tra Vinh Province, Vietnam
3 Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
4 Department of Psychosomatic Medicine, Thu Duc City Hospital, Ho Chi Minh City, Vietnam
5 Thu Duc City Hospital, Ho Chi Minh City, Vietnam

DOI: 10.2478/jccm-2026-0012

Background: This study aimed to evaluate the prognostic value of key admission biomarkers in predicting mortality among hospitalized COVID-19 patients and to establish optimal cut-off thresholds for clinical decision-making.
Methods: Retrospective cohort study included 269 COVID-19 patients treated at Thu Duc City Hospital, Vietnam, during the peak of the fourth pandemic wave in 2021. Logistic regression identified independent predictors of mortality, and receiver operating characteristic (ROC) curve analysis assessed the diagnostic performance of biomarkers. The area under the ROC curve (AUROC), Sensitivity, Specificity and Accuracy Index were used to determine optimal cut-off values.
Results: Among the 269 patients, 53 (19.7%) died and 216 (80.3%) survived. Non-survivors exhibited elevated D-dimer (4.48 μg/mL vs 0.93 μg/mL, p < 0.0001), neutrophil counts (6.8 × 10⁹/L vs 3.5 × 10⁹/L, p < 0.0001) and white blood cell counts (11.68 × 10⁹/L vs. 7.87 × 10⁹/L, p < 0.0001). Lymphocyte counts and fibrinogen levels were significantly lower in non-survivors (p < 0.05). Logistic regression identified D-dimer (OR = 1.05, 95% CI: 1.02–1.09, p = 0.001), neutrophil counts (OR = 1.32, 95% CI: 1.10–1.63, p = 0.005) and lymphocyte counts (OR = 0.51, 95% CI: 0.26–0.92, p = 0.033) as significant predictors of mortality. ROC analysis revealed that D-dimer (AUROC = 0.809) and neutrophil counts (AUROC = 0.726) demonstrated strong discriminatory power, with cut-off values of ≥1.126 μg/mL (sensitivity = 90.57%, specificity = 60.19%) and ≥6.715 × 10⁹/L (sensitivity = 52.83%, specificity = 82.87%), respectively.
Conclusion: These findings support the use of admission biomarkers to guide early interventions and improve patient outcomes in severe COVID-19 cases. Further studies are warranted to validate these results and explore their applicability in other settings.

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