Characteristics, Outcomes and 60-Day Hospital Mortality of ICU Patients with COVID-19 and Acute Kidney Injury

Abstract

BackgroundAKI has been reported in patients with COVID-19 pneumonia and it is associated with higher mortality. The aim of our study is to describe characteristics, outcomes, and 60-day hospital mortality of patients with COVID-19 pneumonia and AKI in the intensive care unit (ICU).MethodsWe conducted a retrospective study in which all adult patients with confirmed COVID-19 who were admitted to ICUs of Montefiore Medical Center and developing AKI were included. The study period ranged from March 10 to April 11, 2020. The 60-day follow-up data through June 11, 2020 were obtained.ResultsOf 300 adults admitted to the ICUs with COVID-19 pneumonia, 224 patients (75%) presented with AKI or developed AKI subsequent to admission. A total of 218 (97%) patients required invasive mechanical ventilation for moderate to severe acute respiratory distress syndrome (ARDS). A total of 113 (50%) patients had AKI on day 1 of ICU admission. The peak AKI stages observed were stage 1 in 49 (22%), stage 2 in 35 (16%), and stage 3 in 140 (63%) patients, respectively. Among patients with AKI, 114 patients (51%) required RRT. The mortality rate of patients requiring RRT was 70%. Of the 34 patients who were survivors, 25 (74%) were able to be weaned off RRT completely before hospital discharge. Nonsurvivors were older and had significantly higher admission and peak creatinine levels, admission hemoglobin, and peak phosphate levels compared with survivors. The 60-day hospital mortality was 67%.ConclusionsCOVID-19 requiring ICU admission is associated with high incidence of severe AKI, necessitating RRT in approximately half of such patients. The majority of patients with COVID-19 and AKI in ICU developed moderate to severe ARDS, requiring invasive mechanical ventilation. Timing or severity of AKI did not affect outcomes. The 60-day hospital mortality is high (67%). Patients with AKI requiring RRT have high mortality, but survivors have good rates of RRT recovery.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_12_31_KID0004282020.mp3

Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single centre cohort study

“…Among our all AKI cases, the mortality for the AKI groups, Stage I, Stage II and the RRT group are 25, 25 and 27% respectively. This is lower than the 56% national mortality in patients receiving RRT reported in the UK ICNARC outcome dataset and from other international studies [ 3 , 4 , 18 ]. Patients in our RRT cohort had similar age and acute severity indices (APACHE II of 21, PaO 2 /FiO 2 15.1 kPa or 113 mmHg) with higher mechanical ventilation rate (100%) and 92% had vasoactive agents as advanced cardiovascular support suggesting this group is comparable to the ICNARC dataset [ 4 ].…”

“…Our renal replacement rate is also comparable to the reports from larger cohorts with a rate of 20–31% [ 3 , 4 ]. However, in studies of mostly invasively ventilated critically ill COVID 19 patients, the incidence of AKI was reported to be as high as 75% with an RRT rate of 17.7–51% [ 10 , 18 , 19 ]. In contrast, our cohort was inclusive of patients with noninvasive ventilation, which may account for the difference in AKI prevalence, RRT rate and mortality.…”

COVID-19 und akute Nierenschädigung im Intensivbereich

“…Bei 60–90 % dieser Patient*innen kommt es zum AKI, bei 20–37 % sogar zu einem nierenersatztherapiepflichtigen AKI (Tab. 1 ; [ 13 , 17 , 34 ]).…”

“…33–50 % der COVID-19-Patient*innen mit AKI gegenüber 7–8 % der Patient*innen ohne AKI sterben während des Krankenhausaufenthalts [ 10 , 13 ]. Die Mortalität steigt stadienabhängig und ist erwartungsgemäß mit 57–73 % am höchsten bei Patient*innen, die Nierenersatztherapie erhalten [ 17 , 18 , 20 , 34 ]. Zum Vergleich: Die Krankenhausmortalität unter den AOK-Patient*innen, welche invasiv beatmet wurden, jedoch kein Nierenersatzverfahren benötigten, betrug 44,8 % [ 20 ].…”

“…Ein ähnliches Bild zeigte sich bei den Überlebenden mit dialysepflichtigem AKI. In 2 Studien konnten mehr als zwei Drittel der Patient*innen das Akutkrankenhaus ohne Dialyse verlassen [ 17 , 34 ].…”