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. 2021 Mar 15;10(6):1217.
doi: 10.3390/jcm10061217.

Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes

Muriel Ghosn  1 , Nizar Attallah  1   2 , Mohamed Badr  3 , Khaled Abdallah  3 , Bruno De Oliveira  3 , Ashraf Nadeem  3 , Yeldho Varghese  3 , Dnyaseshwar Munde  3 , Shameen Salam  3 , Baraa Abduljawad  3 , Khaled Saleh  3 , Hussam Elkambergy  3 , Ali Wahla  3 , Ahmed Taha  3 , Jamil Dibu  3 , Ahmed Bayrlee  3 , Fadi Hamed  3 , Nadeem Rahman  3 , Jihad Mallat  2   3   4
Affiliations

Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes

Muriel Ghosn et al. J Clin Med. .

Abstract

Background: Critically ill patients with COVID-19 are prone to develop severe acute kidney injury (AKI), defined as KDIGO (Kidney Disease Improving Global Outcomes) stages 2 or 3. However, data are limited in these patients. We aimed to report the incidence, risk factors, and prognostic impact of severe AKI in critically ill patients with COVID-19 admitted to the intensive care unit (ICU) for acute respiratory failure.

Methods: A retrospective monocenter study including adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection admitted to the ICU for acute respiratory failure. The primary outcome was to identify the incidence and risk factors associated with severe AKI (KDIGO stages 2 or 3).

Results: Overall, 110 COVID-19 patients were admitted. Among them, 77 (70%) required invasive mechanical ventilation (IMV), 66 (60%) received vasopressor support, and 9 (8.2%) needed extracorporeal membrane oxygenation (ECMO). Severe AKI occurred in 50 patients (45.4%). In multivariable logistic regression analysis, severe AKI was independently associated with age (odds ratio (OR) = 1.08 (95% CI (confidence interval): 1.03-1.14), p = 0.003), IMV (OR = 33.44 (95% CI: 2.20-507.77), p = 0.011), creatinine level on admission (OR = 1.04 (95% CI: 1.008-1.065), p = 0.012), and ECMO (OR = 11.42 (95% CI: 1.95-66.70), p = 0.007). Inflammatory (interleukin-6, C-reactive protein, and ferritin) or thrombotic (D-dimer and fibrinogen) markers were not associated with severe AKI after adjustment for potential confounders. Severe AKI was independently associated with hospital mortality (OR = 29.73 (95% CI: 4.10-215.77), p = 0.001) and longer hospital length of stay (subhazard ratio = 0.26 (95% CI: 0.14-0.51), p < 0.001). At the time of hospital discharge, 74.1% of patients with severe AKI who were discharged alive from the hospital recovered normal or baseline renal function.

Conclusion: Severe AKI was common in critically ill patients with COVID-19 and was not associated with inflammatory or thrombotic markers. Severe AKI was an independent risk factor of hospital mortality and hospital length of stay, and it should be rapidly recognized during SARS-CoV-2 infection.

Keywords: COVID-19; D-dimer; acute kidney injury; critically ill; intensive care unit; interleukin-6; mechanical ventilation; outcomes.

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Conflict of interest statement

The authors declare that they have no competing interests related to the subject of the study. The authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of COVID-19 patients admitted to the intensive care unit (ICU). AKI: acute kidney injury.
Figure 2
Figure 2
Comparisons of cumulative incidence function of hospital discharge between patients who had severe AKI (KDIGO stages 2 and 3) and those who did not. SHR: subhazard ratio.
See this image and copyright information in PMC

References

    1. Wu Z., McGoogan J.M. 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;323:1239–1242. doi: 10.1001/jama.2020.2648. - DOI - PubMed
    1. Yang X., Yu Y., Xu J., Shu H., Xia J., Liu H., Wu Y., Zhang L., Yu Z., Fung M., et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir. Med. 2020;8:475–481. doi: 10.1016/S2213-2600(20)30079-5. - DOI - PMC - PubMed
    1. Chan L., Chaudhary K., Saha A., Chauhan K., Vaid A., Zhao S., Paranjpe I., Richter F., Nadkarni G.N., Lala A., et al. Mount Sinai COVID Informatics Center (MSCIC). AKI in hospitalized patients with COVID-19. J. Am. Soc. Nephrol. 2021;32:151–160. doi: 10.1681/ASN.2020050615. - DOI - PMC - PubMed
    1. Hirsch J.S., Ng J.H., Ross D.W., Sharma P., Shah H.H., Barnett R.L., Hazzan A.D., Fishbane S., Jhaveri K.D., Abate M., et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98:209–218. doi: 10.1016/j.kint.2020.05.006. - DOI - PMC - PubMed
    1. Zheng X., Zhao Y., Yang L. Acute kidney injury in COVID-19: The Chinese experience. Semin. Nephrol. 2020;40:430–442. doi: 10.1016/j.semnephrol.2020.09.001. - DOI - PMC - PubMed