Risk factors, predictions, and progression of acute kidney injury in hospitalized COVID-19 patients: An observational retrospective cohort study

Abstract

Objectives Studies have shown that acute kidney injury (AKI) occurrence post SARS-CoV-2 infection is complex and has a poor prognosis. Therefore, more studies are needed to understand the rate and the predications of AKI involvement among hospitalized COVID-19 patients and AKI’s impact on prognosis while under different types of medications. Patients and methods This study is a retrospective observational cohort study conducted at Bahrain Defence Force (BDF) Royal Medical Services. Medical records of COVID-19 patients admitted to BDF hospital, treated, and followed up from April 2020 to October 2020 were retrieved. Data were analyzed using univariate and multivariate logistic regression with covariate adjustment, and the odds ratio (OR) and 95% confidence (95% CI) interval were reported. Results Among 353 patients admitted with COVID-19, 47.6% developed AKI. Overall, 51.8% of patients with AKI died compared to 2.2% of patients who did not develop AKI (p< 0.001 with OR 48.6 and 95% CI 17.2–136.9). Besides, deaths in patients classified with AKI staging were positively correlated and multivariate regression analysis revealed that moderate to severe hypoalbuminemia (<32 g/L) was independently correlated to death in AKI patients with an OR of 10.99 (CI 95% 4.1–29.3, p<0.001). In addition, 78.2% of the dead patients were on mechanical ventilation. Besides age as a predictor of AKI development, diabetes and hypertension were the major risk factors of AKI development (OR 2.04, p<0.01, and 0.05 for diabetes and hypertension, respectively). Also, two or more comorbidities substantially increased the risk of AKI development in COVID-19 patients. Furthermore, high levels upon hospital admission of D-Dimer, Troponin I, and ProBNP and low serum albumin were associated with AKI development. Lastly, patients taking ACEI/ARBs had less chance to develop AKI stage II/III with OR of 0.19–0.27 (p<0.05–0.01). Conclusions The incidence of AKI in hospitalized COVID-19 patients and the mortality rate among AKI patients were high and correlated with AKI staging. Furthermore, laboratory testing for serum albumin, hypercoagulability and cardiac injury markers maybe indicative for AKI development. Therefore, clinicians should be mandated to perform such tests on admission and follow-up in hospitalized patients.

The incidence of acute kidney injury and its association with mortality in patients diagnosed withCOVID‐19 followed up in intensive care unit

“…Similar to other infectious processes, systemic inflammation in the course of COVID-19 increases the disposition to AKI, while the severity of inflammation copresent with AKI development also increases. In our study, patients with AKI had higher neutrophil and monocyte counts but lower albumin and Hb levels, which had been reported in the literature before and were interpreted in favor of increased inflammation during the COVID-19 course [37,39]. While lower albumin level was an independent risk factor for AKI, no such relationship was not found for hematological indices in the present study.…”

“…Other risk factors for AKI development were older age and higher serum creatinine on admission in the recent study, which were emerged as a risk factor in terms of development of AKI in general and in the course of COVID‐19 [7, 18, 20, 37–39]. Since the baseline creatinine value of all patients was not known, creatinine values at admission were taken into account for the evaluation of AKI, as we explained in Section 2.…”

Acute kidney injury in critically ill COVID-19 infected patients requiring dialysis: experience from India and Pakistan

“…The incidence of AKI secondary to COVID-19 depends on the clinical setting and the parameters used to diagnose AKI. Most studies have reported an incidence of 30-50% in hospitalised patients [3,8,9]. The mortality in hospitalised patients with COVID -19 and AKI is relatively high and the development of AKI is a poor prognostic factor impacting outcome in patients with COVID -19 pneumonia [10,11].…”

Direct Application of 3-Maleimido-PROXYL for Proving Hypoalbuminemia in Cases of SARS-CoV-2 Infection: The Potential Diagnostic Method of Determining Albumin Instability and Oxidized Protein Level in Severe COVID-19

“…Many inflammatory and infectious diseases, traumatic injuries, and multiorgan failure are characterized by low levels of serum albumin [ 34 ], with more and more studies reporting hypoalbuminemia in patients with COVID-19 [ 21 , 35 , 36 , 37 , 38 ]. In SARS-CoV-2 infection, low protein levels are associated with increased disease severity and are a prerequisite for high mortality [ 35 ].…”