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Multicenter Study
. 2022 Jul 25;26(1):225.
doi: 10.1186/s13054-022-04086-x.

Acute kidney injury in critical COVID-19: a multicenter cohort analysis in seven large hospitals in Belgium

Hannah Schaubroeck  1 , Wim Vandenberghe  2 , Willem Boer  3 , Eva Boonen  4 , Bram Dewulf  5 , Camille Bourgeois  5 , Jasperina Dubois  6 , Alexander Dumoulin  7 , Tom Fivez  3 , Jan Gunst  8   9 , Greet Hermans  9   10 , Piet Lormans  7 , Philippe Meersseman  10 , Dieter Mesotten  3   11 , Björn Stessel  6   11 , Marc Vanhoof  4 , Greet De Vlieger #  8   9 , Eric Hoste #  2   12
Affiliations
Multicenter Study

Acute kidney injury in critical COVID-19: a multicenter cohort analysis in seven large hospitals in Belgium

Hannah Schaubroeck et al. Crit Care. .

Abstract

Background: Acute kidney injury (AKI) has been reported as a frequent complication of critical COVID-19. We aimed to evaluate the occurrence of AKI and use of kidney replacement therapy (KRT) in critical COVID-19, to assess patient and kidney outcomes and risk factors for AKI and differences in outcome when the diagnosis of AKI is based on urine output (UO) or on serum creatinine (sCr).

Methods: Multicenter, retrospective cohort analysis of patients with critical COVID-19 in seven large hospitals in Belgium. AKI was defined according to KDIGO within 21 days after ICU admission. Multivariable logistic regression analysis was used to explore the risk factors for developing AKI and to assess the association between AKI and ICU mortality.

Results: Of 1286 patients, 85.1% had AKI, and KRT was used in 9.8%. Older age, obesity, a higher APACHE II score and use of mechanical ventilation at day 1 of ICU stay were associated with an increased risk for AKI. After multivariable adjustment, all AKI stages were associated with ICU mortality. AKI was based on sCr in 40.1% and UO in 81.5% of patients. All AKI stages based on sCr and AKI stage 3 based on UO were associated with ICU mortality. Persistent AKI was present in 88.6% and acute kidney disease (AKD) in 87.6%. Rapid reversal of AKI yielded a better prognosis compared to persistent AKI and AKD. Kidney recovery was observed in 47.4% of surviving AKI patients.

Conclusions: Over 80% of critically ill COVID-19 patients had AKI. This was driven by the high occurrence rate of AKI defined by UO criteria. All AKI stages were associated with mortality (NCT04997915).

Keywords: Acute kidney injury; COVID-19; Epidemiology; Intensive care unit; KDIGO; Kidney replacement therapy; Mortality; Renal replacement therapy; Serum creatinine; Urine output.

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Conflict of interest statement

EH received Speakers fees from Alexion, Sopachem and Astute Medical paid to the institution and a travel grant from AM Pharma. All other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study flowchart. Flowchart summarizing patient selection and inclusion process as well as number of patients with AKI according to the full KDIGO definition, to sCr or to UO criteria
Fig. 2
Fig. 2
Occurrence rate and ICU mortality of AKI stages. a Occurrence rate and b ICU mortality of AKI stages defined according to the full KDIGO definition and its components AKI-sCr and AKI-UO. AKI = acute kidney injury, AKI-sCr = AKI based on creatinine criteria only, AKI-UO = AKI based on urine output criteria only. Statistical significance of comparison of ICU mortality in AKI-sCr versus AKI-UO stages: AKI stage 0: p = 0.002; AKI stage 1: p < 0.001; AKI stage 2: p = 0.001; AKI stage 3: p = 0.070
Fig. 3
Fig. 3
Association between ICU mortality and AKI stages. Association between ICU mortality and AKI stage according to serum creatinine and/or urine output: a unadjusted, b adjusted
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