Characteristics and Outcomes of Patients With Covid-19 With Acute Kidney Injury in Icu

Abstract

The disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and later called Covid-19 has resulted in considerable morbidity worldwide. The virus mainly affects the respiratory tract, but it can cause various complications and affect many other organ systems. Preliminary reports have shown that Acute Kidney Injury (AKI) is common in patients with Covid-19, however, the incidence and severity of kidney injury in hospitalized patients especially in the ICU settings is not well described. The objective of this study was to describe the incidence, severity, and outcomes of Covid-19 patients with AKI in ICU setting. METHODS:This was a single-center, retrospective observational cohort study. All patients (age $18) with positive by polymerase chain reaction testing (PCR) of a nasopharyngeal sample for Covid-19 who required hospitalization were included in the study. Patients with End-stage kidney disease (ESKD), kidney transplants were excluded. We compared outcomes of patients with and without AKI. We used univariable and multivariable Cox regression model to evaluate the relationship between AKI and in-hospital and ICU mortality. RESULTS:Overall, 220 patients were included in the study. Within the cohort 62 (15%) patients died and 158 (72%) were discharged from the hospital. Total of 71 (32%) patients required ICU admission, 47 (21%) required mechanical ventilation, and 35 (15%) required vasopressor support. Overall, 89 (40%) patients developed AKI. In-hospital mortality of patients with AKI was markedly higher than in patients without AKI (39 (43.8%) vs 23 (17.5%) p<0.001). Univariable and multivariable Cox regression analysis showed that AKI in Covid-19 patients was associated with increased in-hospital death with unadjusted HR 2.01 (CI 1.23-3.14; p<0.001). The risk remained significantly high following adjustment for baseline demographics and comorbidities, adjusted HR 1.8 (CI 1.10-2.74, P¼0.015). In ICU setting 28 (39%) patients developed AKI and the mortality was also markedly higher compared to patients without AKI (12/28 (42%) vs 7/44 (15%) P¼0.011). There was also a significant difference with mechanical ventilation and vasopressor requirement in AKI vs Non-AKI patient, (25 (28%) vs 22 (16%) P¼0.048) and (23 (25%) vs 14 (10%) P¼0.013) respectively. CONCLUSIONS: AKI is a common condition among patients hospitalized with COVID-19, and it is associated with an increased risk of in-hospital and ICU mortality. CLINICAL IMPLICATIONS:The findings in the study highlight the need to consider this complication and outcomes in COVID-19 management.