Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 10;11(3):845.
doi: 10.3390/biomedicines11030845.

Acute Kidney Injury Associated with Severe SARS-CoV-2 Infection: Risk Factors for Morbidity and Mortality and a Potential Benefit of Combined Therapy with Tocilizumab and Corticosteroids

Jose Iglesias  1   2   3 , Andrew Vassallo  4 , Justin Ilagan  1 , Song Peng Ang  5 , Ndausung Udongwo  1 , Anton Mararenko  1 , Abbas Alshami  1 , Dylon Patel  6 , Yasmine Elbaga  7 , Jerrold S Levine  8   9
Affiliations

Acute Kidney Injury Associated with Severe SARS-CoV-2 Infection: Risk Factors for Morbidity and Mortality and a Potential Benefit of Combined Therapy with Tocilizumab and Corticosteroids

Jose Iglesias et al. Biomedicines. .

Abstract

Background: Acute kidney injury (AKI) is a common complication in patients with severe COVID-19.

Methods: We retrospectively reviewed 249 patients admitted to an intensive care unit (ICU) during the first wave of the pandemic to determine risk factors for AKI. Demographics, comorbidities, and clinical and outcome variables were obtained from electronic medical records.

Results: Univariate analysis revealed older age, higher admission serum creatinine, elevated Sequential Organ Failure Assessment (SOFA) score, elevated admission D-Dimer, elevated CRP on day 2, mechanical ventilation, vasopressor requirement, and azithromycin usage as significant risk factors for AKI. Multivariate analysis demonstrated that higher admission creatinine (p = 0.0001, OR = 2.41, 95% CI = 1.56-3.70), vasopressor requirement (p = 0.0001, OR = 3.20, 95% CI = 1.69-5.98), elevated admission D-Dimer (p = 0.008, OR = 1.0001, 95% CI = 1.000-1.001), and elevated C-reactive protein (CRP) on day 2 (p = 0.033, OR = 1.0001, 95% CI = 1.004-1.009) were independent risk factors. Conversely, the combined use of Tocilizumab and corticosteroids was independently associated with reduced AKI risk (p = 0.0009, OR = 0.437, 95% CI = 0.23-0.81).

Conclusion: This study confirms the high rate of AKI and associated mortality among COVID-19 patients admitted to ICUs and suggests a role for inflammation and/or coagulopathy in AKI development. One should consider the possibility that early administration of anti-inflammatory agents, as is now routinely conducted in the management of COVID-19-associated acute respiratory distress syndrome, may improve clinical outcomes in patients with AKI.

Keywords: COVID-19; Tocilizumab; acute kidney injury; anti-inflammatory.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Forest plot depicting the effect of the indicated pharmacologic interventions on the odds ratio (OR) for developing AKI as determined by univariate analysis.
Figure 2
Figure 2
Forest plot depicting the impact of the indicated risk factors on the odds ratio (OR) for developing AKI as determined by logistic regression with stepwise forward variable selection. For continuous variables, the odds ratio (OR) represents the relative amount by which the odds ratio for the outcome variable increases or decreases when the independent variable is increased by exactly one unit.
Figure 3
Figure 3
Forest plot depicting the impact of the indicated risk factors on the hazard ratio (HR) for mortality as determined by Cox proportional hazards with stepwise forward variable selection. For continuous variables, the hazard ratio (HR) represents the relative amount by which the probability of obtaining the outcome increases or decreases when the independent variable is changed by exactly one unit.
See this image and copyright information in PMC

References

    1. Chávez-Valencia V., Orizaga-de-la-Cruz C., Lagunas-Rangel F.A. Acute Kidney Injury in COVID-19 Patients: Pathogenesis, Clinical Characteristics, Therapy, and Mortality. Diseases. 2022;10:53. doi: 10.3390/diseases10030053. - DOI - PMC - PubMed
    1. Ahmadian E., Hosseiniyan Khatibi S.M., Razi Soofiyani S., Abediazar S., Shoja M.M., Ardalan M., Zununi Vahed S. COVID-19 and Kidney Injury: Pathophysiology and Molecular Mechanisms. Rev. Med. Virol. 2021;31:e2176. doi: 10.1002/rmv.2176. - DOI - PMC - PubMed
    1. Ahmed A.R., Ebad C.A., Stoneman S., Satti M.M., Conlon P.J. Kidney Injury in COVID-19. World J. Nephrol. 2020;9:18–32. doi: 10.5527/wjn.v9.i2.18. - DOI - PMC - PubMed
    1. El-Sayed E.E., Allayeh A.K., Salem A.A., Omar S.M., Zaghlol S.M., Abd-Elmaguid H.M., Abdul-Ghaffar M.M., ElSharkawy M.M. Incidence of Acute Kidney Injury among COVID-19 Patients in Egypt. Ren. Replace Ther. 2021;7:32. doi: 10.1186/s41100-021-00356-6. - 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. 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