Acute Kidney Injury in Non-Intensive Care Unit (ICU) Hospitalizations for Coronavirus Disease (COVID-19)

Abstract

Background: Acute kidney injury (AKI) is a common complication among SARS-CoV-2-positive patients who undergo hospitalization. Abundant evidence exists concerning the epidemiology of AKI in patients hospitalized in the ICU for COVID-19 but limited data are available about the occurrence of AKI in SARS-CoV-2-positive patients being hospitalized in a non-ICU setting. Aim and Methods: We have carried out a retrospective study to evaluate frequency and risk factors for AKI among patients consecutively admitted at a third-level university hospital starting from February 2020 (the beginning of the first wave of the SARS-CoV-2 pandemic); all patients were hospitalized outside the ICU. Results: A total of 387 SARS-CoV-2-positive patients were included in the current study; 372 (96.1%) had SARS-CoV-2-related pneumonia. In-hospital AKI onset was recorded in 119 (30.7%) patients, mainly with AKI stage 1 (n = 74, 62.2%); eighteen (4.6%) patients reported AKI stage 3 and six (1.5%) patients had HD-dependent AKI. There were 235 (60.7%) patients with severe COVID-19, and this was more common in patients developing AKI, 94.5% (86/119) vs. 86.1% (149/268), p = 0.02. Multivariate regression model (n = 144 patients) reported an independent and significant relationship between AKI occurrence and greater levels of ferritin (p = 0.036), IL-6 (p = 0.032), and azotemia at admission (p = 0.0001). A total of 69 (17.8%) SARS-CoV-2-positive patients died and strong predictors of in-hospital death resulted from age (p < 0.0001), serum ferritin (p < 0.0001) and white blood cells (p < 0.001). According to multivariable analysis (n = 163 patients), there was a consistent link between in-hospital death and AKI stage (1) (p = 0.021) and -stage (2) (p = 0.009). Our results support the notion that AKI occurs frequently among hospitalized COVID-19 patients even in a non-ICU setting and plays a pivotal role in the mortality of this population. Further studies are ongoing in order to clearly establish the frequency of AKI in patients with COVID-19; the mechanisms underlying kidney injury in this population are an area of active investigation. These data provide solid evidence to support close monitoring of COVID-19 patients for the development of AKI and measures taken to prevent this.

A study of hospitalized COVID-19 patients with AKI in a setting of multiracial developing country

“…In addition, ferritin, an acute phase reactant, tends to be elevated in inflammatory conditions, including infections. Reports have shown that a raised ferritin level can predict AKI among COVID-19 patients, and this is consistent with our cohort [45,46]. The ROCs of serum ferritin in predicting AKI are shown in Fig.…”

Urine Parameters in Patients with COVID-19 Infection

“…Especially in those patients requiring ICU support, AKI is associated with poor prognosis and increased risk of mortality. As a result of the studies mentioned above, we have observed that many laboratory parameters are useful as potential biomarkers to predict renal damage associated with COVID-19 [ 15 , 17 , 21 , 22 , 23 , 24 , 27 , 30 , 48 , 49 , 50 ].…”

Are Kidneys Affected by SARS-CoV-2 Infection? An Updated Review on COVID-19-Associated AKI

“…In the context of the current narrative review, we have carried out a pooled analysis of the medical literature regarding the incidence of AKI in hospitalized patients with COVID-19. We have included 24 reports ( n = 502, 593 unique patients) and found an incidence of AKI of 31.8% (range, 0.5% to 56.9%) ( Table 1 ) [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. Many surveys ( n = 9) were published very recently (2022–2023) ( Table 1 ).…”