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Observational Study
. 2021 Apr;34(2):305-314.
doi: 10.1007/s40620-021-00997-0. Epub 2021 Mar 3.

Role of blood pressure dysregulation on kidney and mortality outcomes in COVID-19. Kidney, blood pressure and mortality in SARS-CoV-2 infection

Chiara Lanzani #  1   2 , Marco Simonini #  1   2 , Teresa Arcidiacono  1   2 , Elisabetta Messaggio  1 , Romina Bucci  1   2 , Paolo Betti  1   2 , Monica Avino  1   2 , Giulia Magni  1   2 , Chiara Maggioni  1   2 , Caterina Conte  2   3 , Patrizia Rovere Querini  2   4 , Fabio Ciceri  2   5 , Antonella Castagna  2   6 , Giuseppe Vezzoli  7   8 , Paolo Manunta  1   2 ; Bio Angels for COVID-BioB Study Group
Collaborators, Affiliations
Observational Study

Role of blood pressure dysregulation on kidney and mortality outcomes in COVID-19. Kidney, blood pressure and mortality in SARS-CoV-2 infection

Chiara Lanzani et al. J Nephrol. 2021 Apr.

Abstract

Background: In February 2020 the corona virus disease 2019 (COVID-19) infection started spreading throughout Italy, hitting the Lombardy region very hard. Despite the high diffusion, only a subset of patients developed severe COVID-19: around 25% of them developed acute kidney injury (AKI) and one-third of them died. Elderly patients and patients with high comorbidities were identified as being at higher risk of severe COVID-19.

Methods: Our prospective observational cohort study includes 392 consecutive patients hospitalized for COVID-19 in Milan (median age 67 years, 75% male). We evaluated the relationship between blood pressure at presentation, presence of AKI at Emergency Department admission and during hospitalization, and total in-hospital mortality (24%).

Results: Although 58% of our study patients reported a history of hypertension (HYP) (86% on treatment), 30% presented with low blood pressure levels. Only 5.5% were diagnosed with AKI on admission; 75% of hypertensive patients discontinued therapy during hospitalization (only 20% were on treatment at discharge). Gender and hypertension were strongly associated with AKI at admission (odds ratio 11). Blood pressure was inversely correlated with increased risk of AKI upon admission, regardless of the severity of respiratory distress. Age over 65, history of hypertension, and severity of respiratory distress were the main predictors of AKI, which developed in 34.7% of cases during hospitalization. AKI was associated with increased in-hospital mortality. Hypertension and low blood pressure at presentation were the main predictors of in-hospital mortality, together with age over 65, baseline pulmonary involvement, and severity of illness.

Conclusions: In patients hospitalized for COVID-19, hypertension and low blood pressure at presentation are important risk factors for AKI and mortality. Early reduction of antihypertensive therapy may improve outcomes in patients with SARS-CoV-2 infection.

Keywords: AKI; Blood pressure; COVID-19; Hypertension; Mortality; SARS-CoV-2 infection.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Number of anti-hypertensive drugs being taken at the time of Emergency Department admission or at the time of hospital discharge (% of patients)
Fig. 2
Fig. 2
Total in-hospital mortality rate by ED-AKI (a) and H-AKI (b)
Fig. 3
Fig. 3
Effect of anamnestic data and Emergency Department parameters on AKI development and total in-hospital deaths in SARS-Cov2 infection
See this image and copyright information in PMC

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