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Observational Study
. 2020 Oct 7;15(10):1394-1402.
doi: 10.2215/CJN.04650420. Epub 2020 Sep 22.

The Incidence, Risk Factors, and Prognosis of Acute Kidney Injury in Adult Patients with Coronavirus Disease 2019

Yichun Cheng  1 , Ran Luo  1 , Xu Wang  2 , Kun Wang  1 , Nanhui Zhang  1 , Meng Zhang  1 , Zhixiang Wang  1 , Lei Dong  1 , Junhua Li  1 , Rui Zeng  1 , Ying Yao  1 , Shuwang Ge  1 , Gang Xu  1
Affiliations
Observational Study

The Incidence, Risk Factors, and Prognosis of Acute Kidney Injury in Adult Patients with Coronavirus Disease 2019

Yichun Cheng et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Since December 2019, coronavirus disease 2019 (COVID-19) outbreak occurred and has rapidly spread worldwide. However, little information is available about the AKI in COVID-19. We aimed to evaluate the incidence, risk factors, and prognosis of AKI in adult patients with COVID-19.

Design, setting, participants, & measurements: This was a retrospective cohort study of 1392 patients with COVID-19 admitted to a tertiary teaching hospital. Clinical characteristics and laboratory data were extracted from electronic hospitalization and laboratory databases. AKI was defined and staged according to the 2012 Kidney Disease: Improving Global Outcomes criteria. Risk factors for AKI and the association of AKI with in-hospital mortality were assessed.

Results: A total of 7% (99 of 1392) of patients developed AKI during hospitalization, 40% (40 of 99) of which occurred within 1 week of admission. Factors associated with a higher risk of AKI include severe disease (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.37 to 3.67), higher baseline serum creatinine (OR, 2.19; 95% CI, 1.17 to 4.11), lymphopenia (OR, 1.99; 95% CI, 1.12 to 3.53), and elevated D-dimer level (OR, 2.68; 95% CI, 1.07 to 6.70). The in-hospital mortality in patients with AKI stage 1, stage 2, and stage 3 was 62%, 77%, and 80%, respectively. AKI was associated with in-hospital mortality even after adjustment for confounders (OR, 5.12; 95% CI, 2.70 to 9.72).

Conclusions: AKI is uncommon but carries high in-hospital mortality in patients with COVID-19.

Keywords: COVID-19; acute kidney injury; mortality; prognosis; risk factors.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Flow chart of the study population selection. COVID-19, coronavirus disease 2019.
Figure 2.
Figure 2.
Most AKI occured early in patients with coronavirus disease 19.
Figure 3.
Figure 3.
AKI is associated with higher in-hospital mortality in patients with coronavirus disease 19.
Figure 4.
Figure 4.
Association of AKI with in-hospital death in patients with coronavirus disease 2019, by participant characteristics. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained in multivariable logistic regression models after adjustment for age, sex, disease severity, intensive care unit admission, lymphopenia, and D-dimer level. In subgroup analysis, the grouping variables were not included in the model.
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