Acute Kidney Injury Associated with Coronavirus Disease 2019 in Urban New Orleans

Mohamed, Muner M.B.; Lukitsch, Ivo; Torres‐Ortiz, Aldo; Walker, Jacqueline L.; Varghese, Vipin; Hernandez-Arroyo, C. F.; Alqudsi, Muhannad; LeDoux, Jason R.; Velez, Juan Carlos Q.

doi:10.34067/kid.0002652020

Cited by 220 publications

(281 citation statements)

References 25 publications

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“…In comparison, the mortality rates in COVID-19 hospitalized patients without AKI are in most cases much lower, around 6%. Finally, consistent with observations of increased COVID-19 morbidity and mortality in minorities, the studies of Zahid et al [5] and Mohamed et al [8] also demonstrate that AKI in minorities with COVID-19 is more severe and associated with an increased mortality compared to non-minority populations.…”

Section: Tablesupporting

confidence: 84%

“…In COVID-19 patients admitted to the ICU, the incidence of AKI is even greater, ranging from 61 to 76%. Second, AKI in COVID-19 patients is frequently severe – 31–66% of AKI patients have Stage 3 AKI, and 14–55% of cases require RRT, although the 55% observation is an outlier for unclear reasons [8]. In addition, 19–34% of ventilated patients required RRT.…”

Section: Tablementioning

confidence: 99%

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Acute Kidney Injury in COVID-19: Another Challenge for Nephrology

Rudnick

Hilburg

2020

Am J Nephrol

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Section: Tablesupporting

confidence: 84%

Section: Tablementioning

confidence: 99%

Acute Kidney Injury in COVID-19: Another Challenge for Nephrology

Rudnick

Hilburg

2020

Am J Nephrol

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“…We found the incidence of AKI in COVID-19 patients was more than double the incidence of AKI in non-COVID-19 patients. The incidence of AKI in COVID-19 in our study is similar to that reported from the United States of America (22.2% to 36%) but much higher than that reported from China (5.1% to 10.5%) [ 1 , 2 , 6 , 7 , 15 , 16 ]. The variation in the incidence of AKI in COVID-19 in different countries or regions may be explained in part by variable inclusion criteria (intensive care and all hospital admissions) and also the varying demographic characteristics and comorbidities of study populations.…”

Section: Discussionsupporting

confidence: 91%

“…Large variation has been reported in the prevalence of comorbidities in patients with COVID-19 and AKI. For example, we observed that diabetes was present in 25% of patients with COVID-19 and AKI, whereas the proportion with diabetes in studies from the US has been reported as 41% to 47% and from China as 14% [ 5 , 6 , 15 ]. We did not identify diabetes as risk factor for AKI or mortality in contrast to a study from the US [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Acute kidney injury associated with COVID-19: A retrospective cohort study

et al. 2020

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Background Initial reports indicate a high incidence of acute kidney injury (AKI) in Coronavirus Disease 2019 (COVID-19), but more data are required to clarify if COVID-19 is an independent risk factor for AKI and how COVID-19–associated AKI may differ from AKI due to other causes. We therefore sought to study the relationship between COVID-19, AKI, and outcomes in a retrospective cohort of patients admitted to 2 acute hospitals in Derby, United Kingdom. Methods and findings We extracted electronic data from 4,759 hospitalised patients who were tested for COVID-19 between 5 March 2020 and 12 May 2020. The data were linked to electronic patient records and laboratory information management systems. The primary outcome was AKI, and secondary outcomes included in-hospital mortality, need for ventilatory support, intensive care unit (ICU) admission, and length of stay. As compared to the COVID-19–negative group ( n = 3,374), COVID-19 patients ( n = 1,161) were older (72.1 ± 16.1 versus 65.3 ± 20.4 years, p < 0.001), had a greater proportion of men (56.6% versus 44.9%, p < 0.001), greater proportion of Asian ethnicity (8.3% versus 4.0%, p < 0.001), and lower proportion of white ethnicity (75.5% versus 82.5%, p < 0.001). AKI developed in 304 (26.2%) COVID-19–positive patients (COVID-19 AKI) and 420 (12.4%) COVID-19–negative patients (AKI controls). COVID-19 patients aged 65 to 84 years (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.11 to 2.50), needing mechanical ventilation (OR 8.74, 95% CI 5.27 to 14.77), having congestive cardiac failure (OR 1.72, 95% CI 1.18 to 2.50), chronic liver disease (OR 3.43, 95% CI 1.17 to 10.00), and chronic kidney disease (CKD) (OR 2.81, 95% CI 1.97 to 4.01) had higher odds for developing AKI. Mortality was higher in COVID-19 AKI versus COVID-19 patients without AKI (60.5% versus 27.4%, p < 0.001), and AKI was an independent predictor of mortality (OR 3.27, 95% CI 2.39 to 4.48). Compared with AKI controls, COVID-19 AKI was observed in a higher proportion of men (58.9% versus 51%, p = 0.04) and lower proportion with white ethnicity (74.7% versus 86.9%, p = 0.003); was more frequently associated with cerebrovascular disease (11.8% versus 6.0%, p = 0.006), chronic lung disease (28.0% versus 19.3%, p = 0.007), diabetes (24.7% versus 17.9%, p = 0.03), and CKD (34.2% versus 20.0%, p < 0.001); and was more likely to be hospital acquired (61.2% versus 46.4%, p < 0.001). Mortality was higher in the COVID-19 AKI as compared to the control AKI group (60.5% versus 27.6%, p < 0.001). In multivariable analysis, AKI patients aged 65 to 84 years, (OR 3...

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Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US

et al. 2020

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IMPORTANCE The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19. OBJECTIVES To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020. EXPOSURES Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds. MAIN OUTCOMES AND MEASURES The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes. RESULTS A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (Ն80 vs <40 years of age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 95% CI, 1.19-1.90), higher body mass index (Ն40 vs <25: OR, 1.51; 95% CI, 1.01-2.25), coronary artery disease (OR, 1.47; 95% CI, 1.07-2.02), active cancer (OR, 2.15; 95% CI, 1.35-3.43), and the presence of hypoxemia (PaO 2 :FIO 2 <100 vs Ն300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2 vs 0: OR, 2.61; 95% CI, 1.30-5.25), and kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0: OR, 2.43; 95% CI, 1.46-4.05) at ICU admission. Patients admitted to hospitals with fewer ICU beds had a higher risk of death (<50 vs Ն100 ICU beds: OR, 3.28; 95% CI, 2.16-4.99). Hospitals varied considerably in the risk-adjusted proportion of patients who died (range, 6.6%-80.8%) and in the percentage of patients who received hydroxychloroquine, tocilizumab, and other treatments and supportive therapies. CONCLUSIONS AND RELEVANCE This study identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically ill patients with COVID-19 and can facilitate the identification of medications and supportive therapies to improve outcomes.

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Acute Kidney Injury Associated with Coronavirus Disease 2019 in Urban New Orleans

Cited by 220 publications

References 25 publications

Acute Kidney Injury in COVID-19: Another Challenge for Nephrology

Acute Kidney Injury in COVID-19: Another Challenge for Nephrology

Acute kidney injury associated with COVID-19: A retrospective cohort study

Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US

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