Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients

Abstract

Background: The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. Methods: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or <60 mL/min/1.73 m2. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. Results: Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (p < 0.0001). Age (p < 0.001), SpO2 (p < 0.001), previous anti-platelet treatment (p = 0.006), Charlson’s Comorbidities Index (p < 0.001), serum creatinine (p < 0.001), eGFR (p = 0.003), low eGFR (p < 0.001), blood glucose levels (p < 0.001), and LDH (p = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02–2.63, p = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10–1.36, p < 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (p = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (p < 0.001). Conclusions: Patients with reduced eGFR at admission should be considered at high risk for clinical deterioration and death, requiring the best supportive treatment in order to prevent the worst outcome.

Is Previous eGFR a Reliable Risk Factor for COVID-19 Death? Single Centre Analysis in Chronic Kidney Disease Patients in Northern Italy

“…Our results corroborated the previous results on the death rate estimated between 15 and 45% [13][14][15][16] and the prevalence of admission in intensive care units [17,18] for CKD patients.…”

Remdesivir significantly reduces SARS‐CoV‐2 viral load on nasopharyngeal swabs in hospitalized patients with COVID‐19: A retrospective case–control study

“…First, the optimal timing for remdesivir administration to prevent disease progression and complication is still under evaluation. 1 Moreover, the identification of early predictors for severe disease (i.e., low admission eGFR) 22 could help in the risk stratification to choose the best treatment strategies (i.e., high‐dose glucocorticoids treatment or other immunomodulating drugs). 21 , 23 …”

Differential Bias for Creatinine- and Cystatin C- Derived Estimated Glomerular Filtration Rate in Critical COVID-19

“…In this context, it should be noted that visceral adipose tissue predicts disease risk and mortality better than BMI [ 61 ], and that the assessment of compartmental adipose tissue in patients hospitalized with COVID-19 turned out to be independent prognostic factors [ 62 ]. Low relative eGFR predicts worse outcomes in COVID-19 [ 63 ] cases, but it is a drawback of relative eGFR that these equations usually are body surface area (BSA) indexed, causing a risk of underestimation of GFR in the obese and the contrary in those with underweight [ 64 ]. Thus, it seems reasonable to assume that absolute eGFR should be preferred, not only when dosing and evaluating toxicity of renally excreted drugs, but also in reducing biases due to divergencies in BSA [ 32 ].…”