Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep 3;10(1):117.
doi: 10.1186/s13613-020-00734-z.

Acute kidney injury in patients with SARS-CoV-2 infection

Adrien Joseph  1 , Lara Zafrani  2   3 , Asma Mabrouki  1 , Elie Azoulay  1   4 , Michael Darmon  1   4
Affiliations

Acute kidney injury in patients with SARS-CoV-2 infection

Adrien Joseph et al. Ann Intensive Care. .

Abstract

Background: Acute Kidney Injury (AKI) is a frequent complication of severe SARS-CoV-2 infection. Multiple mechanisms are involved in COVID-19-associated AKI, from direct viral infection and secondary inflammation to complement activation and microthrombosis. However, data are limited in critically-ill patients. In this study, we sought to describe the prevalence, risk factors and prognostic impact of AKI in this setting.

Methods: Retrospective monocenter study including adult patients with laboratory confirmed SARS-CoV-2 infection admitted to the ICU of our university Hospital. AKI was defined according to both urinary output and creatinine KDIGO criteria.

Results: Overall, 100 COVID-19 patients were admitted. AKI occurred in 81 patients (81%), including 44, 10 and 27 patients with AKI stage 1, 2 and 3 respectively. The severity of AKI was associated with mortality at day 28 (p = 0.013). Before adjustment, the third fraction of complement (C3), interleukin-6 (IL-6) and ferritin levels were higher in AKI patients. After adjustment for confounders, both severity (modified SOFA score per point) and AKI were associated with outcome. When forced in the final model, C3 (OR per log 0.25; 95% CI 0.01-4.66), IL-6 (OR per log 0.83; 95% CI 0.51-1.34), or ferritin (OR per log 1.63; 95% CI 0.84-3.32) were not associated with AKI and did not change the model.

Conclusion: In conclusion, we did not find any association between complement activation or inflammatory markers and AKI. Proportion of patients with AKI during severe SARS-CoV-2 infection is higher than previously reported and associated with outcome.

Keywords: Acute kidney injury; COVID-19; Complement system proteins; Intensive care units; Interleukin-6; Outcome.

PubMed Disclaimer

Conflict of interest statement

MD declares having received grant from MSD, speaker fees from MSD, Astelas and Gilead-Kite and having attended an advisory board for Gilead-Kite. LZ declares having received research grant from Jazz Pharmaceuticals. The other authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Boxplots depicting relationship between AKI severity and C3 [ng/mL] (p = 0.01) (a), IL-6 [ng/mL] (p = 0.02) (b), sC5b9 [ng/mL] (p = 0.42) (c) and ferritin levels [mg/L] (p = 0.03) (d) levels
Fig. 2
Fig. 2
Kaplan–Meier curves for day-28 survival in patients with (n = 81) and without AKI (n = 19) (a) and with AKI stage 1 (n = 44), 2 (n = 10) and 3 (n = 27) (b)
See this image and copyright information in PMC

References

    1. COVID-19 Map. Johns Hopkins Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html.
    1. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020. https://www-nejm-org.proxy.insermbiblio.inist.fr/doi/10.1056/NEJMoa2002032. - DOI - PMC - PubMed
    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. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed
    1. Gabarre P, Dumas G, Dupont T, Darmon M, Azoulay E, Zafrani L. Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med. 2020;46:1339. doi: 10.1007/s00134-020-06153-9. - DOI - PMC - PubMed
    1. Koeze J, Keus F, Dieperink W, van der Horst ICC, Zijlstra JG, van Meurs M. Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria. BMC Nephrol. 2017;18(1):70. doi: 10.1186/s12882-017-0487-8. - DOI - PMC - PubMed

LinkOut - more resources