Jyothika Venkataswamy Reddy

Background: Acute kidney injury (AKI) is a common complication of COVID-19-associated acute respiratory distress syndrome (ARDS), yet the impact of extracorporeal membrane oxygenation (ECMO) on outcomes in this high-risk population remains unclear. Methods: We performed a retrospective, survey-weighted study using the National Inpatient Sample (NIS) database from 2020–2022 to compare outcomes among adults hospitalized with COVID-19-associated ARDS and AKI managed with invasive mechanical ventilation (IMV) alone versus IMV and ECMO. The primary outcome was in-hospital mortality, while secondary outcomes included renal replacement therapy (RRT), complications, hospital length of stay (LOS), and healthcare utilization. Results: Among 198,395 hospitalizations with COVID-19 ARDS complicated by AKI, 4730 received IMV and ECMO. ECMO use was not associated with statistically significantly lower adjusted in-hospital mortality (adjusted odds ratio [aOR] 0.96, 95% CI 0.81–1.12). However, ECMO was associated with greater odds of RRT, intracranial hemorrhage, disseminated intravascular coagulation, cardiogenic shock, vasopressor use, tracheostomy, acute liver failure, deep vein thrombosis, ischemic stroke and ICU-acquired weakness. ECMO was also associated with longer LOS and higher hospitalization charges. Conclusions: Among hospitalizations with COVID-19-associated ARDS and AKI, ECMO was not associated with statistically significantly lower adjusted in-hospital mortality but was associated with markedly higher complication burden, longer hospitalization, and substantially greater healthcare resource utilization.

Background: Acute kidney injury (AKI) is a common complication of COVID-19-associated acute respiratory distress syndrome (ARDS), yet the impact of extracorporeal membrane oxygenation (ECMO) on outcomes in this high-risk population remains unclear. : Methods:We performed a retrospective study using the National Inpatient Sample (NIS) database from 2020–2022 to compare outcomes among adults hospitalized with COVID-19-associated ARDS and AKI managed with invasive mechanical ventilation (IMV) alone versus IMV and ECMO. The primary outcome was in-hospital mortality, while secondary outcomes included renal replacement therapy (RRT), complications, hospital length of stay (LOS), and healthcare utilization. Results: Among 198,395 patients with COVID-19 ARDS complicated by AKI, 4,730 received IMV and ECMO. ECMO was not associated with reduced mortality after multivariable adjustment (adjusted odds ratio [aOR] 0.96, 95% CI 0.81-1.12). However, ECMO was associated with greater odds of RRT, intracranial hemorrhage, disseminated intravascular coagulation, cardiogenic shock, vasopressor use, tracheostomy, acute liver failure, deep vein thrombosis, ischemic stroke and ICU-acquired weakness. ECMO was also associated with longer LOS and higher hospitalization costs. Conclusion: Among patients with COVID-19-associated ARDS and AKI, ECMO was not associated with a clear adjusted mortality benefit but was associated with markedly higher complication burden, longer hospitalization, and substantially greater healthcare resource utilization.

Coronavirus disease 2019 (COVID-19) causes a hyperinflammatory state, endothelial injury, microvascular thrombosis and myocardial dysfunction, which may lead to worsening circulatory failure in septic shock. Using a large National Inpatient Sample (NIS) database from 2020 to 2022, we aimed to compare in-hospital mortality, need for mechanical ventilation, acute kidney injury (AKI), need for renal replacement therapy (RRT), cardiac arrest, acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO), tracheostomy, acute liver failure, disseminated intravascular coagulation (DIC), hospital length of stay (LOS), and total hospital charges in septic shock hospitalizations with and without COVID-19. A total of 2,175,619 adult septic shock hospitalizations were identified, of which 378,635 (17.4%) had COVID-19 infection. Hospitalizations with COVID-19 had significantly higher mortality (60.3% vs. 32.2%; aOR 3.43, 95% CI 3.35–3.50), increased need for non-invasive ventilation, invasive ventilation, and higher incidence of AKI, RRT, cardiac arrest, ARDS, ECMO use, and tracheostomy. Additionally, hospital LOS and total hospital charges were also significantly higher in hospitalizations with COVID-19. There was no significant difference in acute liver failure or DIC. In conclusion, COVID-19 infection was independently associated with worse outcomes and increased hospital resource utilization in adult septic shock hospitalizations.

Circulating tumor DNA (ctDNA) is a revolutionary tool in the detection and monitoring of cancer: a minimally invasive, highly sensitive approach to analysing tumor-specific DNA in the bloodstream. Therefore, it is of interest to explore the current and evolving landscape of cancer genomics as precision tools in quantifying tumor dynamics. Thus, the role of ctDNA in tracking minimum residual disease, relapse, recurrence and the tailoring of therapeutic strategies for effective management of tumours is reviewed.