Relationship between PEEP levels, central venous pressure, systemic inflammation and AKI in critically ill ventilated COVID-19 patients. A monocenter retrospective study

Abstract Introduction: The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute renal failure (AKI) have been poorly described in mechanically ventilated patient secondary to Sars-Cov-2 infection (Covid-19). Methods This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical ICU between Mars 2020 et July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the five days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end pressure (PEEP), CVP, and leukocytes count. Results 57 patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median 12 [IQR, 11–13] mmHg vs 10 [9–12] mmHg, p = 0.03). Multivariate models with adjustment on leukocytes and SAPS II confirmed the association between CVP value and risk of WRF, odd ratio: 1.97 (IC95: 1.12–4.33). Leukocytes count was also associated with occurrence of WRF (14.3 [11.3–17.5]) G/L in the WRF group vs 9.2 [8.1–11.1] G/L in the no-WRF group) (p = 0,002). Conclusion In Mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF.