Browsing by Author "Dy, Rajany"

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    AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19
    (Wolters Kluwer, 2021) Gupta, Shruti; Coca, Steven G.; Chan, Lili; Melamed, Michal L.; Brenner, Samantha K.; Hayek, Salim S.; Sutherland, Anne; Puri, Sonika; Srivastava, Anand; Leonberg-Yoo, Amanda; Shehata, Alexandre M.; Flythe, Jennifer E.; Rashidi, Arash; Schenck, Edward J.; Goyal, Nitender; Hedayati, S. Susan; Dy, Rajany; Bansal, Anip; Athavale, Ambarish; Nguyen, H. Bryant; Vijayan, Anitha; Charytan, David M.; Schulze, Carl E.; Joo, Min J.; Friedman, Allon N.; Zhang, Jingjing; Sosa, Marie Anne; Judd, Eric; Velez, Juan Carlos Q.; Mallappallil, Mary; Redfern, Roberta E.; Bansal, Amar D.; Neyra, Javier A.; Liu, Kathleen D.; Renaghan, Amanda D.; Christov, Marta; Molnar, Miklos Z.; Sharma, Shreyak; Kamal, Omer; Boateng, Jeffery Owusu; Short, Samuel A.P.; Admon, Andrew J.; Sise, Meghan E.; Wang, Wei; Parikh, Chirag R.; Leaf, David E.; STOP-COVID Investigators; Medicine, School of Medicine
    Background: AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT). Methods: We conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. We used multivariable logistic regression to identify patient-and hospital-level risk factors for AKI-RRT and to examine risk factors for 28-day mortality among such patients. Results: A total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Patient-level risk factors for AKI-RRT included CKD, men, non-White race, hypertension, diabetes mellitus, higher body mass index, higher d-dimer, and greater severity of hypoxemia on ICU admission. Predictors of 28-day mortality in patients with AKI-RRT were older age, severe oliguria, and admission to a hospital with fewer ICU beds or one with greater regional density of COVID-19. At the end of a median follow-up of 17 days (range, 1-123 days), 403 of the 637 patients (63.3%) with AKI-RRT had died, 216 (33.9%) were discharged, and 18 (2.8%) remained hospitalized. Of the 216 patients discharged, 73 (33.8%) remained RRT dependent at discharge, and 39 (18.1%) remained RRT dependent 60 days after ICU admission. Conclusions: AKI-RRT is common among critically ill patients with COVID-19 and is associated with a hospital mortality rate of >60%. Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission.
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    Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19
    (ACP, 2021) Al-Samkari, Hanny; Gupta, Shruti; Leaf, Rebecca Karp; Wang, Wei; Rosovsky, Rachel P.; Brenner, Samantha K.; Hayek, Salim S.; Berlin, Hanna; Kapoor, Rajat; Shaefi, Shahzad; Melamed, Michal L.; Sutherland, Anne; Radbel, Jared; Green, Adam; Garibaldi, Brian T.; Srivastava, Anand; Leonberg-Yoo, Amanda; Shehata, Alexandre M.; Flythe, Jennifer E.; Rashidi, Arash; Goyal, Nitender; Chan, Lili; Mathews, Kusum S.; Hedayati, S. Susan; Dy, Rajany; Toth-Manikowski, Stephanie M.; Zhang, Jingjing; Mallappallil, Mary; Redfern, Roberta E.; Bansal, Amar D.; Short, Samuel A.P.; Vangel, Mark G.; Admon, Andrew J.; Semler, Matthew W.; Bauer, Kenneth A.; Hernán, Miguel A.; Leaf, David E.; Medicine, School of Medicine
    Background: Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19). Objective: To evaluate the incidence of venous thromboembolism (VTE) and major bleeding in critically ill patients with COVID-19 and examine the observational effect of early therapeutic anticoagulation on survival. Design: In a multicenter cohort study of 3239 critically ill adults with COVID-19, the incidence of VTE and major bleeding within 14 days after intensive care unit (ICU) admission was evaluated. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done to examine the observational effect of early therapeutic anticoagulation on survival. A Cox model with inverse probability weighting to adjust for confounding was used. Setting: 67 hospitals in the United States. Participants: Adults with COVID-19 admitted to a participating ICU. Measurements: Time to death, censored at hospital discharge, or date of last follow-up. Results: Among the 3239 patients included, the median age was 61 years (interquartile range, 53 to 71 years), and 2088 (64.5%) were men. A total of 204 patients (6.3%) developed VTE, and 90 patients (2.8%) developed a major bleeding event. Independent predictors of VTE were male sex and higher D-dimer level on ICU admission. Among the 2809 patients included in the target trial emulation, 384 (11.9%) received early therapeutic anticoagulation. In the primary analysis, during a median follow-up of 27 days, patients who received early therapeutic anticoagulation had a similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]). Limitation: Observational design. Conclusion: Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation.