{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:29Z","timestamp":1787028629491,"version":"build-2736575974"},"reference-count":16,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T00:00:00Z","timestamp":1666051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Acute kidney injury (AKI) is the second most frequent condition after acute respiratory distress syndrome (ARDS) in critically ill patients with severe COVID-19 and is strongly associated with mortality. The aim of this multicentric study was to assess the impact of the specific treatments of COVID-19 and ARDS on the risk of severe AKI in critically ill COVID-19 patients. Methods: In this cohort study, data from consecutive patients older than 18 years admitted to 6 ICUs for COVID-19-related ARDS requiring invasive mechanical ventilation were included. The incidence and severity of AKI, defined according to the 2012 KDIGO definition, were monitored during the entire ICU stay until day 90. Patients older than 18 years admitted to the ICU for COVID-19-related ARDS requiring invasive mechanical ventilation were included. Results: 164 patients were included in the final analysis; 97 (59.1%) displayed AKI, of which 39 (23.8%) had severe stage 3 AKI, and 21 (12.8%) required renal replacement therapy (RRT). In univariate analysis, severe AKI was associated with angiotensin-converting enzyme inhibitors (ACEI) exposure (p = 0.016), arterial hypertension (p = 0.029), APACHE-II score (p = 0.004) and mortality at D28 (p = 0.008), D60 (p &lt; 0.001) and D90 (p &lt; 0.001). In multivariate analysis, the factors associated with the onset of stage 3 AKI were: exposure to ACEI (OR: 4.238 (1.307\u201313.736), p = 0.016), APACHE II score (without age) (OR: 1.138 (1.044\u20131.241), p = 0.003) and iNO (OR: 5.694 (1.953\u201316.606), p = 0.001). Prone positioning (OR: 0.234 (0.057\u20130.967), p = 0.045) and dexamethasone (OR: 0.194 (0.053\u20130.713), p = 0.014) were associated with a decreased risk of severe AKI. Conclusions: Dexamethasone was associated with the prevention of the risk of severe AKI and RRT, and iNO was associated with severe AKI and RRT in critically ill patients with COVID-19. iNO should be used with caution in COVID-19-related ARDS.<\/jats:p>","DOI":"10.3390\/jcm11206130","type":"journal-article","created":{"date-parts":[[2022,10,19]],"date-time":"2022-10-19T00:58:51Z","timestamp":1666141131000},"page":"6130","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically Ill Patients with COVID-19"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9451-0372","authenticated-orcid":false,"given":"Micka\u00ebl","family":"Bobot","sequence":"first","affiliation":[{"name":"Centre de N\u00e9phrologie et Transplantation R\u00e9nale, H\u00f4pital de la Conception, AP-HM, 13005 Marseille, France"},{"name":"Aix Marseille University, INSERM 1263, INRAE 1260, C2VN, European Center for Medical Imaging Research (CERIMED), Campus Sant\u00e9 Timone, 13005 Marseille, France"},{"name":"Assistance Publique\u2014H\u00f4pitaux de Marseille, H\u00f4pital Nord, M\u00e9decine Intensive R\u00e9animation, Centre d\u2019Etudes et de Recherches sur les Services de Sant\u00e9 et Qualit\u00e9 de vie EA 3279, Aix-Marseille University, 13015 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8800-9856","authenticated-orcid":false,"given":"David","family":"Tonon","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019Anesth\u00e9sie-R\u00e9animation, Aix-Marseille University, CHU Conception, AP-HM, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"No\u00e9mie","family":"Peres","sequence":"additional","affiliation":[{"name":"Assistance Publique\u2014H\u00f4pitaux de Marseille, H\u00f4pital Nord, M\u00e9decine Intensive R\u00e9animation, Centre d\u2019Etudes et de Recherches sur les Services de Sant\u00e9 et Qualit\u00e9 de vie EA 3279, Aix-Marseille University, 13015 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9066-6591","authenticated-orcid":false,"given":"Christophe","family":"Guervilly","sequence":"additional","affiliation":[{"name":"Assistance Publique\u2014H\u00f4pitaux de Marseille, H\u00f4pital Nord, M\u00e9decine Intensive R\u00e9animation, Centre d\u2019Etudes et de Recherches sur les Services de Sant\u00e9 et Qualit\u00e9 de vie EA 3279, Aix-Marseille University, 13015 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flora","family":"Lef\u00e8vre","sequence":"additional","affiliation":[{"name":"Centre de N\u00e9phrologie et Transplantation R\u00e9nale, H\u00f4pital de la Conception, AP-HM, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Max","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019Anesth\u00e9sie-R\u00e9animation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youri","family":"Bommel","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019Anesth\u00e9sie-R\u00e9animation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Volff","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019Anesth\u00e9sie-R\u00e9animation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3097-758X","authenticated-orcid":false,"given":"Marc","family":"Leone","sequence":"additional","affiliation":[{"name":"Service d\u2019Anesth\u00e9sie-R\u00e9animation, H\u00f4pital Nord, AP-HM, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Lopez","sequence":"additional","affiliation":[{"name":"Service d\u2019Anesth\u00e9sie-R\u00e9animation, H\u00f4pital Nord, AP-HM, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0682-9405","authenticated-orcid":false,"given":"Pierre","family":"Simeone","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019Anesth\u00e9sie-R\u00e9animation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France"},{"name":"CNRS, Institut des Neurosciences de la Timone, UMR7289, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1305-9805","authenticated-orcid":false,"given":"Julien","family":"Carvelli","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation et Surveillance Continue, H\u00f4pital de la Timone, AP-HM, Aix-Marseille University, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Chopinet","sequence":"additional","affiliation":[{"name":"Department of Digestive Surgery and Liver Transplantation, H\u00f4pital la Timone, AP-HM, 13005 Marseille, France"},{"name":"European Center for Medical Imaging Research CERIMED, Laboratoire d\u2019imagerie Interventionnelle Ex-p\u00e9rimentale (LIIE), Aix-Marseille Universit\u00e9, Campus Sant\u00e9 Timone, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Hraiech","sequence":"additional","affiliation":[{"name":"Assistance Publique\u2014H\u00f4pitaux de Marseille, H\u00f4pital Nord, M\u00e9decine Intensive R\u00e9animation, Centre d\u2019Etudes et de Recherches sur les Services de Sant\u00e9 et Qualit\u00e9 de vie EA 3279, Aix-Marseille University, 13015 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Papazian","sequence":"additional","affiliation":[{"name":"Assistance Publique\u2014H\u00f4pitaux de Marseille, H\u00f4pital Nord, M\u00e9decine Intensive R\u00e9animation, Centre d\u2019Etudes et de Recherches sur les Services de Sant\u00e9 et Qualit\u00e9 de vie EA 3279, Aix-Marseille University, 13015 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lionel","family":"Velly","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019Anesth\u00e9sie-R\u00e9animation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France"},{"name":"CNRS, Institut des Neurosciences de la Timone, UMR7289, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00e9my","family":"Bourenne","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation et Surveillance Continue, H\u00f4pital de la Timone, AP-HM, Aix-Marseille University, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Marie","family":"Forel","sequence":"additional","affiliation":[{"name":"Assistance Publique\u2014H\u00f4pitaux de Marseille, H\u00f4pital Nord, M\u00e9decine Intensive R\u00e9animation, Centre d\u2019Etudes et de Recherches sur les Services de Sant\u00e9 et Qualit\u00e9 de vie EA 3279, Aix-Marseille University, 13015 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1007\/s00134-020-06153-9","article-title":"Acute kidney injury in critically ill patients with COVID-19","volume":"46","author":"Gabarre","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1681\/ASN.2020030276","article-title":"Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia","volume":"31","author":"Pei","year":"2020","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.nephro.2021.06.002","article-title":"Kidney damage in COVID-19","volume":"17","author":"Burtey","year":"2021","journal-title":"Nephrol. Ther."},{"key":"ref_5","first-page":"1253","article-title":"The spectrum of kidney biopsies in hospitalized patients with COVID-19, acute kidney injury, and\/or proteinuria","volume":"36","author":"Ferlicot","year":"2021","journal-title":"Nephrol. Dial. Transplant. Off. Publ. Eur. Dial. Transpl. Assoc.\u2014Eur. Ren. Assoc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.bjae.2018.01.005","article-title":"Steroid use in critical care","volume":"18","author":"Young","year":"2018","journal-title":"BJA Educ."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"The Recovery Collaborative Group (2021). Dexamethasone in Hospitalized Patients with COVID-19. N. Engl. J. Med., 384, 693\u2013704.","DOI":"10.1056\/NEJMoa2021436"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Volff, M., Tonon, D., Bommel, Y., Peres, N., Lagier, D., Agard, G., Jacquier, A., Bartoli, A., Carvelli, J., and Max, H. (2021). Factors Associated with 90-Day Mortality in Invasively Ventilated Patients with COVID-19 in Marseille, France. J. Clin. Med., 10.","DOI":"10.3390\/jcm10235650"},{"key":"ref_9","unstructured":"ARDS Definition Task Force, Ranieri, V.M., Rubenfeld, G.D., Thompson, B.T., Ferguson, N.D., Caldwell, E., Fan, E., Camporota, L., and Slutsky, A.S. (2012). Acute respiratory distress syndrome: The Berlin Definition. JAMA, 307, 2526\u20132533."},{"key":"ref_10","unstructured":"Kdigo Aki Working Group (2012). KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int. Suppl., 2, 1."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1164\/rccm.201602-0420CP","article-title":"Lung-Kidney Cross-Talk in the Critically Ill Patient","volume":"194","author":"Slutsky","year":"2016","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"R144","DOI":"10.1186\/cc7123","article-title":"Riyadh ICU Program Users Group Correlation between the AKI classification and outcome","volume":"12","author":"Ostermann","year":"2008","journal-title":"Crit. Care Lond. Engl."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s13054-015-0880-2","article-title":"Inhaled nitric oxide therapy and risk of renal dysfunction: A systematic review and meta-analysis of randomized trials","volume":"19","author":"Ruan","year":"2015","journal-title":"Crit. Care"},{"key":"ref_14","first-page":"CD002787","article-title":"Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) in children and adults","volume":"2016","author":"Gebistorf","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"18","DOI":"10.2741\/s43","article-title":"The role of nitric oxide and reactive nitrogen species in experimental ARDS","volume":"2","author":"Rehberg","year":"2010","journal-title":"Front. Biosci. Sch. Ed."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1186\/s13054-021-03666-7","article-title":"Impact of dexamethasone use to prevent from severe COVID-19-induced acute kidney injury","volume":"25","author":"Orieux","year":"2021","journal-title":"Crit. Care Lond. Engl."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/20\/6130\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:56:20Z","timestamp":1760144180000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/20\/6130"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,18]]},"references-count":16,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["jcm11206130"],"URL":"https:\/\/doi.org\/10.3390\/jcm11206130","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,18]]}}}