Prevalencia de lesión renal aguda y mortalidad asociada de los pacientes críticamente enfermos que cursan con una infección por SARS-CoV2 versus un SDRA severo: una revisión sistemática de la literatura y meta anális

INTRODUCCIÓN: La enfermedad crítica por SARS-CoV2 ha representado un determinante relevante de mortalidad dentro de las causas de ingreso a una unidad de cuidado crítico, se ha descrito que estos pacientes tienen mayor prevalencia de lesión renal comparado a otras causas de enfermedad crítica (38)....

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Autores:
Restrepo Bastidas, Andrés Alirio
Tipo de recurso:
Tesis
Fecha de publicación:
2022
Institución:
Universidad Tecnológica de Pereira
Repositorio:
Repositorio Institucional UTP
Idioma:
spa
OAI Identifier:
oai:repositorio.utp.edu.co:11059/14616
Acceso en línea:
https://hdl.handle.net/11059/14616
https://repositorio.utp.edu.co/home
Palabra clave:
610 - Medicina y salud::616 - Enfermedades
Meta-Analysis
Epidemiology of Infectious Diseases
SARS-CoV-2 Infection
Covid 19
ARDS
Acute Kidney Failure
Mortality
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openAccess
License
Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)
id UTP2_2b3a06dd160258835bcd80e0542b5c24
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network_acronym_str UTP2
network_name_str Repositorio Institucional UTP
repository_id_str
dc.title.spa.fl_str_mv Prevalencia de lesión renal aguda y mortalidad asociada de los pacientes críticamente enfermos que cursan con una infección por SARS-CoV2 versus un SDRA severo: una revisión sistemática de la literatura y meta anális
title Prevalencia de lesión renal aguda y mortalidad asociada de los pacientes críticamente enfermos que cursan con una infección por SARS-CoV2 versus un SDRA severo: una revisión sistemática de la literatura y meta anális
spellingShingle Prevalencia de lesión renal aguda y mortalidad asociada de los pacientes críticamente enfermos que cursan con una infección por SARS-CoV2 versus un SDRA severo: una revisión sistemática de la literatura y meta anális
610 - Medicina y salud::616 - Enfermedades
Meta-Analysis
Epidemiology of Infectious Diseases
SARS-CoV-2 Infection
Covid 19
ARDS
Acute Kidney Failure
Mortality
title_short Prevalencia de lesión renal aguda y mortalidad asociada de los pacientes críticamente enfermos que cursan con una infección por SARS-CoV2 versus un SDRA severo: una revisión sistemática de la literatura y meta anális
title_full Prevalencia de lesión renal aguda y mortalidad asociada de los pacientes críticamente enfermos que cursan con una infección por SARS-CoV2 versus un SDRA severo: una revisión sistemática de la literatura y meta anális
title_fullStr Prevalencia de lesión renal aguda y mortalidad asociada de los pacientes críticamente enfermos que cursan con una infección por SARS-CoV2 versus un SDRA severo: una revisión sistemática de la literatura y meta anális
title_full_unstemmed Prevalencia de lesión renal aguda y mortalidad asociada de los pacientes críticamente enfermos que cursan con una infección por SARS-CoV2 versus un SDRA severo: una revisión sistemática de la literatura y meta anális
title_sort Prevalencia de lesión renal aguda y mortalidad asociada de los pacientes críticamente enfermos que cursan con una infección por SARS-CoV2 versus un SDRA severo: una revisión sistemática de la literatura y meta anális
dc.creator.fl_str_mv Restrepo Bastidas, Andrés Alirio
dc.contributor.advisor.none.fl_str_mv Echeverry Piedrahita, David Ricardo
dc.contributor.author.none.fl_str_mv Restrepo Bastidas, Andrés Alirio
dc.subject.ddc.none.fl_str_mv 610 - Medicina y salud::616 - Enfermedades
topic 610 - Medicina y salud::616 - Enfermedades
Meta-Analysis
Epidemiology of Infectious Diseases
SARS-CoV-2 Infection
Covid 19
ARDS
Acute Kidney Failure
Mortality
dc.subject.mesh.none.fl_str_mv Meta-Analysis
Epidemiology of Infectious Diseases
SARS-CoV-2 Infection
dc.subject.proposal.other.fl_str_mv Covid 19
ARDS
dc.subject.proposal.eng.fl_str_mv Acute Kidney Failure
Mortality
description INTRODUCCIÓN: La enfermedad crítica por SARS-CoV2 ha representado un determinante relevante de mortalidad dentro de las causas de ingreso a una unidad de cuidado crítico, se ha descrito que estos pacientes tienen mayor prevalencia de lesión renal comparado a otras causas de enfermedad crítica (38). Dada la similitud entre los mecanismos fisiopatológicos descritos para SARS-CoV2 y el Síndrome de Dificultad Respiratoria Aguda (SDRA), el objetivo del presente trabajo es determinar la relación entre la enfermedad crítica por SARS-CoV2 respecto a la prevalencia de lesión renal aguda, necesidad de terapia de reemplazo renal (TRR) y mortalidad en comparación con los pacientes críticos con SDRA severo. MÉTODOS: Hasta el 1 de junio de 2021, se realizó una revisión sistemática de la literatura en las bases de datos PubMed/Scopus/Cochrane/EMBASE/Google Scholar. Para identificar artículos de interés, se utilizó las siguientes palabras claves como estrategias de búsqueda “renal complications” o “acute kidney injury” o “kidney complications” o “renal replacement therapy” o “Y” seguido por “SARS-COV2” o “COVID-19” o “Y” “critically ill” para los estudios de SARS-COV2; mientras que para los escritos relacionados con SDRA se usó “renal complications” o “acute kidney injury” o “kidney complications” o “renal replacement therapy” o “Y” seguido por “Acute respiratory distress syndrome” o “Y” “Not COVID-19”. Se analizaron los estudios y se consolidó la información recolectada, luego se establecieron el Riesgo Relativo (RR), Diferencias de Riesgo (DR) y los Odds Ratio (OR) y medidas de frecuencia de eventos para lesión renal aguda, necesidad de Terapia de Reemplazo Renal (TRR) y para mortalidad asociada a la presencia de daño renal.
publishDate 2022
dc.date.issued.none.fl_str_mv 2022
dc.date.accessioned.none.fl_str_mv 2023-03-24T19:07:24Z
dc.date.available.none.fl_str_mv 2023-03-24T19:07:24Z
dc.type.none.fl_str_mv Trabajo de grado - Especialización
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_93fc
dc.type.version.none.fl_str_mv info:eu-repo/semantics/acceptedVersion
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dc.type.content.none.fl_str_mv Text
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dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/11059/14616
dc.identifier.instname.none.fl_str_mv Universidad Tecnológica de Pereira
dc.identifier.reponame.none.fl_str_mv Repositorio Institucional Universidad Tecnológica de Pereira
dc.identifier.repourl.none.fl_str_mv https://repositorio.utp.edu.co/home
url https://hdl.handle.net/11059/14616
https://repositorio.utp.edu.co/home
identifier_str_mv Universidad Tecnológica de Pereira
Repositorio Institucional Universidad Tecnológica de Pereira
dc.language.iso.none.fl_str_mv spa
language spa
dc.relation.references.none.fl_str_mv 1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England). 2020;395(10223):497-506.
2. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet (London, England). 2020;395(10224):565-74.
3. Bedford J, Enria D, Giesecke J, Heymann DL, Ihekweazu C, Kobinger G, et al. COVID-19: towards controlling of a pandemic. Lancet (London, England). 2020;395(10229):1015-8.
4. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. The New England journal of medicine. 2020;382(8):727-33.
5. Anthony SJ, Johnson CK, Greig DJ, Kramer S, Che X, Wells H, et al. Global patterns in coronavirus diversity. Virus Evolution. 2017;3(1).
6. Chan JFW, Lau SKP, To KKW, Cheng VCC, Woo PCY, Yuen K-Y. Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease. Clin Microbiol Rev. 2015;28(2):465-522.
7. Stringhini S, Wisniak A, Piumatti G, Azman AS, Lauer SA, Baysson H, et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study. Lancet (London, England). 2020;396(10247):313-9
8. Havers FP, Reed C, Lim T, Montgomery JM, Klena JD, Hall AJ, et al. Seroprevalence of Antibodies to SARS-CoV-2 in 10 Sites in the United States, March 23-May 12, 2020. JAMA Internal Medicine. 2020
9. Oran DP, Topol EJ. Prevalence of Asymptomatic SARS-CoV-2 Infection : A Narrative Review. Annals of internal medicine. 2020;173(5):362-
10. Lavezzo E, Franchin E, Ciavarella C, Cuomo-Dannenburg G, Barzon L, Del Vecchio C, et al. Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo'. Nature. 2020;584(7821):425-9.
11. Bajema KL, Oster AM, McGovern OL, Lindstrom S, Stenger MR, Anderson TC, et al. Persons Evaluated for 2019 Novel Coronavirus - United States, January 2020. MMWR Morbidity and mortality weekly report. 2020;69(6):166-70
12. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet (London, England). 2020;395(10223):514-23.
13. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. Jama. 2020;323(13):1239-42
14. Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. Jama. 2020;323(15):1499-500.
15. Kant S, Menez SP, Hanouneh M, Fine DM, Crews DC, Brennan DC, et al. The COVID-19 nephrology compendium: AKI, CKD, ESKD and transplantation. BMC nephrology. 2020;21(1):449.
16. Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney international. 2020;98(1):209-18.
17. Ronco C, Reis T. Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nature reviews Nephrology. 2020;16(6):308-10.
18. Izzedine H, Jhaveri KD. Acute kidney injury in patients with COVID-19: an update on the pathophysiology. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2020.
19. Armocida B, Formenti B, Ussai S, Palestra F, Missoni E. The Italian health system and the COVID-19 challenge. The Lancet Public health. 2020;5(5):e253.
20. Arabi YM, Murthy S, Webb S. COVID-19: a novel coronavirus and a novel challenge for critical care. Intensive care medicine. 2020;46(5):833-6.
21. Hu B, Guo H, Zhou P, Shi Z-L. Characteristics of SARS-CoV-2 and COVID-19. Nature Reviews Microbiology. 2020.
22. Hashemian SM, Jamaati H, Farzanegan Bidgoli B, Farrokhi FR, Malekmohammad M, Roozdar S, et al. Outcome of Acute Kidney Injury in Critical Care Unit, Based on AKI Network. Tanaffos. 2016;15(2):89-95.
23. Hansrivijit P, Qian C, Boonpheng B, Thongprayoon C, Vallabhajosyula S, Cheungpasitporn W, et al. Incidence of acute kidney injury and its association with mortality in patients with COVID- 19: a meta-analysis. Journal of investigative medicine : the official publication of the American Federation for Clinical Research. 2020;68(7):1261-70.
24. Nadim MK, Forni LG, Mehta RL, Connor MJ, Jr., Liu KD, Ostermann M, et al. COVID-19- associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nature reviews Nephrology. 2020;16(12):747-64.
25. Lee PH, Kuo CT, Hsu CY, Lin SP, Fu PK. Prognostic Factors to Predict ICU Mortality in Patients with Severe ARDS Who Received Early and Prolonged Prone Positioning Therapy. J Clin Med. 2021;10(11).
26. Organization PAH. COVID-19 pandemic in the Americas. Response Strategy and Donor Appeal April 2022 – March 2023. Summary. 2022.
27. Organization WH. COVID-19 Strategic preparedness and response plan: Operational planning guideline. 202
28. Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nature reviews Microbiology. 2019;17(3):181-92.
29. Mokhtari T, Hassani F, Ghaffari N, Ebrahimi B, Yarahmadi A, Hassanzadeh G. COVID-19 and multiorgan failure: A narrative review on potential mechanisms. J Mol Histol. 2020;51(6):613-28.
30. Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARS- CoV-2. Nature medicine. 2020;26(4):450-2
31. Alvarez-Belon L, Sarnowski A, Forni LG. COVID-19 infection and the kidney. British journal of hospital medicine (London, England : 2005). 2020;81(10):1-8.
32. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney international. 2020;97(5):829-38.
33. Contini C, Di Nuzzo M, Barp N, Bonazza A, De Giorgio R, Tognon M, et al. The novel zoonotic COVID-19 pandemic: An expected global health concern. Journal of infection in developing countries. 2020;14(3):254-64.
34. Cotten M, Watson SJ, Kellam P, Al-Rabeeah AA, Makhdoom HQ, Assiri A, et al. Transmission and evolution of the Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive genomic study. Lancet (London, England). 2013;382(9909):1993-2002.
35. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of autoimmunity. 2020;109:102433.
37. Kunutsor SK, Laukkanen JA. Renal complications in COVID-19: a systematic review and meta-analysis. Annals of medicine. 2020;52(7):345-53.
36. Roser M, Ritchie H, Ortiz-Ospina E, Hasell J. Coronavirus disease (COVID-19)–Statistics and research. Our World in data. 2020
38. Kellum JA, van Till JWO, Mulligan G. Targeting acute kidney injury in COVID-19. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2020;35(10):1652-62
39. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England). 2020;395(10229):1054-62
40. Shao M, Li X, Liu F, Tian T, Luo J, Yang Y. Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: A systematic review and meta-analysis of 40 studies and 24,527 patients. Pharmacol Res. 2020;161:105107-.
41. Yang X, Jin Y, Li R, Zhang Z, Sun R, Chen D. Prevalence and impact of acute renal impairment on COVID-19: a systematic review and meta-analysis. Critical Care. 2020;24(1):356.
42. Mohamed MMB, Lukitsch I, Torres-Ortiz AE, Walker JB, Varghese V, Hernandez-Arroyo CF, et al. Acute Kidney Injury Associated with Coronavirus Disease 2019 in Urban New Orleans. Kidney360. 2020;1(7):614
43. Braun F, Lütgehetmann M, Pfefferle S, Wong MN, Carsten A, Lindenmeyer MT, et al. SARS- CoV-2 renal tropism associates with acute kidney injury. Lancet (London, England). 2020;396(10251):597-8.
44. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of thrombosis and haemostasis : JTH. 2020;18(4):844-7.
45. Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia. Journal of the American Society of Nephrology : JASN. 2020;31(6):1157-65.
46. Li Z, Wu M, Yao J, Guo J, Liao X, Song S, et al. Caution on Kidney Dysfunctions of COVID-19 Patients. medRxiv. 2020:2020.02.08.20021212.
47. Chan L, Chaudhary K, Saha A, Chauhan K, Vaid A, Baweja M, et al. Acute Kidney Injury in Hospitalized Patients with COVID-19. medRxiv. 2020:2020.05.04.20090944.
48. Chueh TI, Zheng CM, Hou YC, Lu KC. Novel Evidence of Acute Kidney Injury in COVID-19. Journal of clinical medicine. 2020;9(11).
49. Dill J, Bixby B, Ateeli H, Sarsah B, Goel K, Buckley R, et al. Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study. Int J Nephrol Renovasc Dis. 2018;11:249-57
50. Panitchote A, Mehkri O, Hastings A, Hanane T, Demirjian S, Torbic H, et al. Factors associated with acute kidney injury in acute respiratory distress syndrome. Annals of intensive care. 2019;9(1):1-10
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spelling Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)Manifiesto (Manifestamos) en este documento la voluntad de autorizar a la Biblioteca Jorge Roa Martínez de la Universidad Tecnológica de Pereira la publicación en el Repositorio institucional (http://biblioteca.utp.edu.co), la versión electrónica de la OBRA titulada: ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ La Universidad Tecnológica de Pereira, entidad académica sin ánimo de lucro, queda por lo tanto facultada para ejercer plenamente la autorización anteriormente descrita en su actividad ordinaria de investigación, docencia y publicación. La autorización otorgada se ajusta a lo que establece la Ley 23 de 1982. Con todo, en mi (nuestra) condición de autor (es) me (nos) reservo (reservamos) los derechos morales de la OBRA antes citada con arreglo al artículo 30 dehttps://creativecommons.org/licenses/by-nc-nd/4.0/http://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessEcheverry Piedrahita, David RicardoRestrepo Bastidas, Andrés Alirio2023-03-24T19:07:24Z2023-03-24T19:07:24Z2022https://hdl.handle.net/11059/14616Universidad Tecnológica de PereiraRepositorio Institucional Universidad Tecnológica de Pereirahttps://repositorio.utp.edu.co/homeINTRODUCCIÓN: La enfermedad crítica por SARS-CoV2 ha representado un determinante relevante de mortalidad dentro de las causas de ingreso a una unidad de cuidado crítico, se ha descrito que estos pacientes tienen mayor prevalencia de lesión renal comparado a otras causas de enfermedad crítica (38). Dada la similitud entre los mecanismos fisiopatológicos descritos para SARS-CoV2 y el Síndrome de Dificultad Respiratoria Aguda (SDRA), el objetivo del presente trabajo es determinar la relación entre la enfermedad crítica por SARS-CoV2 respecto a la prevalencia de lesión renal aguda, necesidad de terapia de reemplazo renal (TRR) y mortalidad en comparación con los pacientes críticos con SDRA severo. MÉTODOS: Hasta el 1 de junio de 2021, se realizó una revisión sistemática de la literatura en las bases de datos PubMed/Scopus/Cochrane/EMBASE/Google Scholar. Para identificar artículos de interés, se utilizó las siguientes palabras claves como estrategias de búsqueda “renal complications” o “acute kidney injury” o “kidney complications” o “renal replacement therapy” o “Y” seguido por “SARS-COV2” o “COVID-19” o “Y” “critically ill” para los estudios de SARS-COV2; mientras que para los escritos relacionados con SDRA se usó “renal complications” o “acute kidney injury” o “kidney complications” o “renal replacement therapy” o “Y” seguido por “Acute respiratory distress syndrome” o “Y” “Not COVID-19”. Se analizaron los estudios y se consolidó la información recolectada, luego se establecieron el Riesgo Relativo (RR), Diferencias de Riesgo (DR) y los Odds Ratio (OR) y medidas de frecuencia de eventos para lesión renal aguda, necesidad de Terapia de Reemplazo Renal (TRR) y para mortalidad asociada a la presencia de daño renal.INTRODUCTION: Critical disease by COVID-19 has been an important cause of mortality compared to other etiologies for admission in critical care, it has been described that these patients have a greater prevalence of kidney injury compared to the others causes of critical disease. Due the similarity in the pathophysiology described for COVID-19 and ARDS, the objective of the present work is to determine the relationship between critical illness due to COVID-19 with respect to the proportion of acute kidney injury and mortality compared to critical patients with ARDS. METHODS: Until June 1 of 2021, it was realized a systematic review of the literature in the databases of PubMed/Scopus/Cochrane/EMBASE/Google Scholar. To identify the relevant articles, using the following keywords as search strategies “renal complications” or “acute kidney injury” or “renal replacement therapy” or “AND” followed by “SARS-COV2” or “COVID-19” or “AND” “critically ill” for SARS-COV2 studies; while it used “renal complications” or “acute kidney injury” or “renal replacement therapy” or “AND” followed by “Acute respiratory distress syndrome” or “AND” “Not COVID-19” for ARDS studies. The studies were assessed, and the collected data was organized, then RRs, DRs and ORs; and frequency measurements were calculated for acute kidney injury, need of RRT and mortality associated.TABLA DE CONTENIDO Prevalencia de lesión renal aguda y mortalidad asociada de los pacientes críticamente enfermos que cursan con una infección por SARS-CoV2 versus un SDRA severo: una revisión sistemática de la literatura y meta análisis …………………………………………………………………………………………………… Error! Bookmark not defined. Prevalence of acute kidney injury and associated mortality in critically ill patients SARS-COV2 vs. severe ARDS: A systematic review of the literature and meta-analysis ……………………………………… 1 RESUMEN..........................................................................................Error! Bookmark not defined. ABSTRACT......................................................................................... Error! Bookmark not defined. LISTADO DE ILUSTRACIONES ...........................................................................................................7 LISTADO DE TABLAS........................................................................................................................ 8 TABLA DE CONTENIDO.................................................................................................................... 9 INTRODUCCIÓN................................................................................ Error! Bookmark not defined. 1. PLANTEAMIENTO DEL PROBLEMA...........................................Error! Bookmark not defined. 1.1 Planteamiento de la pregunta problema.............................................................................14 2. JUSTIFICACIÓN..........................................................................Error! Bookmark not defined. 3. OBJETIVOS................................................................................ Error! Bookmark not defined. 3.1 Objetivo General............................................................... Error! Bookmark not defined. 3.2 Objetivos Específicos.........................................................Error! Bookmark not defined. 4 MARCO TEÓRICO......................................................................Error! Bookmark not defined. 4.1 Epidemiología....................................................................Error! Bookmark not defined. 4.2 Lesión renal aguda en SARS-COV2....................................Error! Bookmark not defined. 4.3 Factores de riesgo y condiciones asociadas......................Error! Bookmark not defined. 4.4 Fisiopatología de la lesión renal aguda asociada a SARS-COV2Error! Bookmark not defined. 4.5 Manifestaciones clínicas de la lesión renal aguda asociada a SARS-CoV2 Error! Bookmark not defined. 4.6 Complicaciones, curso clínico y pronóstico de la lesión renal aguda asociada a SARS- COV2 Error! Bookmark not defined. 4.7 Diagnóstico de SDRA.........................................................Error! Bookmark not defined. 4.8 Tratamiento del SDRA.......................................................Error! Bookmark not defined. 5 CONSIDERACIONES BIOÉTICAS ................................................ Error! Bookmark not defined. 6 MATERIALES Y MÉTODOS........................................................ Error! Bookmark not defined. 10 6.1 Revisión de la literatura.................................................... Error! Bookmark not defined. 6.2 Elegibilidad y selección de estudios..................................Error! Bookmark not defined. 6.3 Búsqueda y evaluación de los estudios............................ Error! Bookmark not defined. 6.4 Análisis estadístico............................................................ Error! Bookmark not defined. 7 RESULTADOS......................................................................................Error! Bookmark not defined. 6.5 Características de los estudios de SARS-COV2..................Error! Bookmark not defined. 6.6 Características generales de los estudios de SDRA severoError! Bookmark not defined. 6.7 Prevalencia de lesión renal aguda .................................... Error! Bookmark not defined. 6.8 Prevalencia de Terapia reemplazo renal...........................Error! Bookmark not defined. 6.9 Mortalidad por LRA...........................................................Error! Bookmark not defined. 6.10 Comparación entre SARS-COV2 y SDRA severo................Error! Bookmark not defined. 8 DISCUSIÓN................................................................................... Error! Bookmark not defined. 8.1 LIMITACIONES................................................................... Error! Bookmark not defined. 8 RECOMENDACIONES................................................................ Error! Bookmark not defined. 9 CONCLUSIONES.........................................................................Error! Bookmark not defined. 10 REFERENTES BIBLIOGRÁFICOS............................................. Error! Bookmark not defined. 11 ANEXOS..............................................................................................................................75 11.1 Cuadro de operacionalización de variables...................................................................75 11.2 Rutas de búsqueda por metabuscador..........................................................................76 11.3 Formato de recolección de datos.................................................................................. 78 11.4 Aprobación del trabajo de grado...................................... Error! Bookmark not defined. 11.5 Formato del artículo científico..........................................Error! Bookmark not defineEspecializaciónEspecialista en Medicina Crítica y Cuidado Intensivo87 Páginasapplication/pdfspaUniversidad Tecnológica de PereiraEspecialización en Medicina Crítica y Cuidado IntensivoFacultad de Ciencias de la SaludPereira610 - Medicina y salud::616 - EnfermedadesMeta-AnalysisEpidemiology of Infectious DiseasesSARS-CoV-2 InfectionCovid 19ARDSAcute Kidney FailureMortalityPrevalencia de lesión renal aguda y mortalidad asociada de los pacientes críticamente enfermos que cursan con una infección por SARS-CoV2 versus un SDRA severo: una revisión sistemática de la literatura y meta análisTrabajo de grado - Especializacióninfo:eu-repo/semantics/acceptedVersionhttp://purl.org/coar/resource_type/c_46echttp://purl.org/coar/resource_type/c_93fcTextinfo:eu-repo/semantics/report1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England). 2020;395(10223):497-506.2. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet (London, England). 2020;395(10224):565-74.3. Bedford J, Enria D, Giesecke J, Heymann DL, Ihekweazu C, Kobinger G, et al. COVID-19: towards controlling of a pandemic. Lancet (London, England). 2020;395(10229):1015-8.4. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. The New England journal of medicine. 2020;382(8):727-33.5. Anthony SJ, Johnson CK, Greig DJ, Kramer S, Che X, Wells H, et al. Global patterns in coronavirus diversity. Virus Evolution. 2017;3(1).6. Chan JFW, Lau SKP, To KKW, Cheng VCC, Woo PCY, Yuen K-Y. Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease. Clin Microbiol Rev. 2015;28(2):465-522.7. Stringhini S, Wisniak A, Piumatti G, Azman AS, Lauer SA, Baysson H, et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study. Lancet (London, England). 2020;396(10247):313-98. Havers FP, Reed C, Lim T, Montgomery JM, Klena JD, Hall AJ, et al. Seroprevalence of Antibodies to SARS-CoV-2 in 10 Sites in the United States, March 23-May 12, 2020. JAMA Internal Medicine. 20209. Oran DP, Topol EJ. Prevalence of Asymptomatic SARS-CoV-2 Infection : A Narrative Review. Annals of internal medicine. 2020;173(5):362-10. Lavezzo E, Franchin E, Ciavarella C, Cuomo-Dannenburg G, Barzon L, Del Vecchio C, et al. Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo'. Nature. 2020;584(7821):425-9.11. Bajema KL, Oster AM, McGovern OL, Lindstrom S, Stenger MR, Anderson TC, et al. Persons Evaluated for 2019 Novel Coronavirus - United States, January 2020. MMWR Morbidity and mortality weekly report. 2020;69(6):166-7012. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet (London, England). 2020;395(10223):514-23.13. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. Jama. 2020;323(13):1239-4214. Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. Jama. 2020;323(15):1499-500.15. Kant S, Menez SP, Hanouneh M, Fine DM, Crews DC, Brennan DC, et al. The COVID-19 nephrology compendium: AKI, CKD, ESKD and transplantation. BMC nephrology. 2020;21(1):449.16. Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney international. 2020;98(1):209-18.17. Ronco C, Reis T. Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nature reviews Nephrology. 2020;16(6):308-10.18. Izzedine H, Jhaveri KD. Acute kidney injury in patients with COVID-19: an update on the pathophysiology. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2020.19. Armocida B, Formenti B, Ussai S, Palestra F, Missoni E. The Italian health system and the COVID-19 challenge. The Lancet Public health. 2020;5(5):e253.20. Arabi YM, Murthy S, Webb S. COVID-19: a novel coronavirus and a novel challenge for critical care. Intensive care medicine. 2020;46(5):833-6.21. Hu B, Guo H, Zhou P, Shi Z-L. Characteristics of SARS-CoV-2 and COVID-19. Nature Reviews Microbiology. 2020.22. Hashemian SM, Jamaati H, Farzanegan Bidgoli B, Farrokhi FR, Malekmohammad M, Roozdar S, et al. Outcome of Acute Kidney Injury in Critical Care Unit, Based on AKI Network. Tanaffos. 2016;15(2):89-95.23. Hansrivijit P, Qian C, Boonpheng B, Thongprayoon C, Vallabhajosyula S, Cheungpasitporn W, et al. Incidence of acute kidney injury and its association with mortality in patients with COVID- 19: a meta-analysis. Journal of investigative medicine : the official publication of the American Federation for Clinical Research. 2020;68(7):1261-70.24. Nadim MK, Forni LG, Mehta RL, Connor MJ, Jr., Liu KD, Ostermann M, et al. COVID-19- associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nature reviews Nephrology. 2020;16(12):747-64.25. Lee PH, Kuo CT, Hsu CY, Lin SP, Fu PK. Prognostic Factors to Predict ICU Mortality in Patients with Severe ARDS Who Received Early and Prolonged Prone Positioning Therapy. J Clin Med. 2021;10(11).26. Organization PAH. COVID-19 pandemic in the Americas. Response Strategy and Donor Appeal April 2022 – March 2023. Summary. 2022.27. Organization WH. COVID-19 Strategic preparedness and response plan: Operational planning guideline. 20228. Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nature reviews Microbiology. 2019;17(3):181-92.29. Mokhtari T, Hassani F, Ghaffari N, Ebrahimi B, Yarahmadi A, Hassanzadeh G. COVID-19 and multiorgan failure: A narrative review on potential mechanisms. J Mol Histol. 2020;51(6):613-28.30. Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARS- CoV-2. Nature medicine. 2020;26(4):450-231. Alvarez-Belon L, Sarnowski A, Forni LG. COVID-19 infection and the kidney. British journal of hospital medicine (London, England : 2005). 2020;81(10):1-8.32. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney international. 2020;97(5):829-38.33. Contini C, Di Nuzzo M, Barp N, Bonazza A, De Giorgio R, Tognon M, et al. The novel zoonotic COVID-19 pandemic: An expected global health concern. Journal of infection in developing countries. 2020;14(3):254-64.34. Cotten M, Watson SJ, Kellam P, Al-Rabeeah AA, Makhdoom HQ, Assiri A, et al. Transmission and evolution of the Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive genomic study. Lancet (London, England). 2013;382(9909):1993-2002.35. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of autoimmunity. 2020;109:102433.37. Kunutsor SK, Laukkanen JA. Renal complications in COVID-19: a systematic review and meta-analysis. Annals of medicine. 2020;52(7):345-53.36. Roser M, Ritchie H, Ortiz-Ospina E, Hasell J. Coronavirus disease (COVID-19)–Statistics and research. Our World in data. 202038. Kellum JA, van Till JWO, Mulligan G. Targeting acute kidney injury in COVID-19. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2020;35(10):1652-6239. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England). 2020;395(10229):1054-6240. Shao M, Li X, Liu F, Tian T, Luo J, Yang Y. Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: A systematic review and meta-analysis of 40 studies and 24,527 patients. Pharmacol Res. 2020;161:105107-.41. Yang X, Jin Y, Li R, Zhang Z, Sun R, Chen D. Prevalence and impact of acute renal impairment on COVID-19: a systematic review and meta-analysis. Critical Care. 2020;24(1):356.42. Mohamed MMB, Lukitsch I, Torres-Ortiz AE, Walker JB, Varghese V, Hernandez-Arroyo CF, et al. Acute Kidney Injury Associated with Coronavirus Disease 2019 in Urban New Orleans. Kidney360. 2020;1(7):61443. Braun F, Lütgehetmann M, Pfefferle S, Wong MN, Carsten A, Lindenmeyer MT, et al. SARS- CoV-2 renal tropism associates with acute kidney injury. Lancet (London, England). 2020;396(10251):597-8.44. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of thrombosis and haemostasis : JTH. 2020;18(4):844-7.45. Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia. Journal of the American Society of Nephrology : JASN. 2020;31(6):1157-65.46. Li Z, Wu M, Yao J, Guo J, Liao X, Song S, et al. Caution on Kidney Dysfunctions of COVID-19 Patients. medRxiv. 2020:2020.02.08.20021212.47. Chan L, Chaudhary K, Saha A, Chauhan K, Vaid A, Baweja M, et al. Acute Kidney Injury in Hospitalized Patients with COVID-19. medRxiv. 2020:2020.05.04.20090944.48. Chueh TI, Zheng CM, Hou YC, Lu KC. Novel Evidence of Acute Kidney Injury in COVID-19. Journal of clinical medicine. 2020;9(11).49. Dill J, Bixby B, Ateeli H, Sarsah B, Goel K, Buckley R, et al. Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study. Int J Nephrol Renovasc Dis. 2018;11:249-5750. Panitchote A, Mehkri O, Hastings A, Hanane T, Demirjian S, Torbic H, et al. Factors associated with acute kidney injury in acute respiratory distress syndrome. Annals of intensive care. 2019;9(1):1-10PublicationORIGINALTRABAJO DE GRADO.pdfTRABAJO DE GRADO.pdfapplication/pdf2260538https://dspace7-utp.metabuscador.org/bitstreams/4081714f-4851-4b07-b30e-92bccf937b7b/downloadff3192ce0abb78be85130077a803c7d1MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-814828https://dspace7-utp.metabuscador.org/bitstreams/b69e1351-b86e-47ca-a080-f44bddcbf89d/download2f9959eaf5b71fae44bbf9ec84150c7aMD52TEXTTRABAJO DE GRADO.pdf.txtTRABAJO DE GRADO.pdf.txtExtracted texttext/plain122916https://dspace7-utp.metabuscador.org/bitstreams/1f6eaee5-5080-4aea-8e30-fe4c2786d5bc/download9a39cb762e96ff56666bfb499f963316MD53THUMBNAILTRABAJO DE GRADO.pdf.jpgTRABAJO DE GRADO.pdf.jpgGenerated Thumbnailimage/jpeg6239https://dspace7-utp.metabuscador.org/bitstreams/839c7782-2359-43c6-9313-939a67d7931f/download3f387510f0bed2ed0c7a3d0131871e2cMD5411059/14616oai:dspace7-utp.metabuscador.org:11059/146162024-09-05 17:25:19.169https://creativecommons.org/licenses/by-nc-nd/4.0/Manifiesto (Manifestamos) en este documento la voluntad de autorizar a la Biblioteca Jorge Roa Martínez de la Universidad Tecnológica de Pereira la publicación en el Repositorio institucional (http://biblioteca.utp.edu.co), la versión electrónica de la OBRA titulada: ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ La Universidad Tecnológica de Pereira, entidad académica sin ánimo de lucro, queda por lo tanto facultada para ejercer plenamente la autorización anteriormente descrita en su actividad ordinaria de investigación, docencia y publicación. 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Con todo, en mi (nuestra) condición de autor (es) me (nos) reservo (reservamos) los derechos morales de la OBRA antes citada con arreglo al artículo 30 deopen.accesshttps://dspace7-utp.metabuscador.orgRepositorio de la Universidad Tecnológica de 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