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Observational Study
. 2022 Feb 12;22(1):119.
doi: 10.1186/s12877-022-02782-5.

Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19: a multicentre, European, observational cohort study

Ben Carter #  1 , Euan A Ramsay #  2 , Roxanna Short  3 , Sarah Goodison  4 , Jane Lumsden  5 , Amarah Khan  6 , Philip Braude  7 , Arturo Vilches-Moraga  6 , Terence J Quinn  8 , Kathryn McCarthy  7 , Jonathan Hewitt #  9 , Phyo K Myint #  2 ; COPE Study
Collaborators, Affiliations
Observational Study

Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19: a multicentre, European, observational cohort study

Ben Carter et al. BMC Geriatr. .

Abstract

Background: The reduced renal function has prognostic significance in COVID-19 and it has been linked to mortality in the general population. Reduced renal function is prevalent in older age and thus we set out to better understand its effect on mortality.

Methods: Patient clinical and demographic data was taken from the COVID-19 in Older People (COPE) study during two periods (February-June 2020 and October 2020-March 2021, respectively). Kidney function on admission was measured using estimated glomerular filtration rate (eGFR). The primary outcomes were time to mortality and 28-day mortality. Secondary outcome was length of hospital stay. Data were analysed with multilevel Cox proportional hazards regression, and multilevel logistic regression and adjusted for individual patient clinical and demographic characteristics.

Results: One thousand eight hundred two patients (55.0% male; median [IQR] 80 [73-86] years) were included in the study. 28-day mortality was 42.3% (n = 742). 48% (n = 801) had evidence of renal impairment on admission. Using a time-to-event analysis, reduced renal function was associated with increased in-hospital mortality (compared to eGFR ≥ 60 [Stage 1&2]): eGFR 45-59 [Stage 3a] aHR = 1.26 (95%CI 1.02-1.55); eGFR 30-44 [Stage 3b] aHR = 1.41 (95%CI 1.14-1.73); eGFR 1-29 [Stage 4&5] aHR = 1.42 (95%CI 1.13-1.80). In the co-primary outcome of 28-day mortality, mortality was associated with: Stage 3a adjusted odds ratio (aOR) = 1.18 (95%CI 0.88-1.58), Stage 3b aOR = 1.40 (95%CI 1.03-1.89); and Stage 4&5 aOR = 1.65 (95%CI 1.16-2.35).

Conclusion: eGFR on admission is a good independent predictor of mortality in hospitalised older patients with COVID-19 population. We found evidence of a dose-response between reduced renal function and increased mortality.

Keywords: COVID-19; Chronic kidney failure; Dose-response; Mortality; eGFR.

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Conflict of interest statement

EAR received the Gwyn Seymour Scholarship from the Department of Medicine for the Elderly, NHS Grampian, as part of the Aberdeen Summer Research Scholarship Scheme, Aberdeen Clinical Academic Training Programme, University of Aberdeen. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A Kaplan Meier survival function to assess categorised admission eGFR& on the time to mortality for patients hospitalised with COVID-19
See this image and copyright information in PMC

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