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Severe acute kidney injury in critically ill COVID-19 patients
Gaston J Piñeiro1, Alicia Molina-Andújar2, Evelyn Hermida2
1Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona and REDinREN, Villarroel 170, 08036, Barcelona, Spain. gjpineir@clinic.cat.
Insights
Acute kidney injury (AKI) is common in critically ill COVID-19 patients, often leading to severe outcomes. This study identifies key factors and outcomes associated with AKI in these patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a frequent complication in patients with Coronavirus Infection Disease 2019 (COVID-19).
- Limited data exists on factors associated with AKI and its outcomes in intensive care unit (ICU) patients with COVID-19.
Purpose of the Study:
- To describe the characteristics of moderate-to-severe AKI in COVID-19 ICU patients.
- To identify predictors of AKI progression, need for Renal Replacement Therapy (RRT), and mortality.
Main Methods:
- Prospective observational study of COVID-19 patients in the ICU (March-April 2020).
- Included patients with AKI stage 2 or higher (AKIN classification).
- Analyzed AKI progression, RRT requirement, and mortality predictors.
Main Results:
- 52/237 ICU patients developed moderate-to-severe AKI.
- High Sequential Organ Failure Assessment (SOFA) score (≥8) predicted RRT need (OR 5.2).
- AKI patients showed worse liver profiles and higher inflammation markers; 50% progressed AKI, 28.85% required RRT.
- Corticosteroid use (69.2%) was linked to reduced RRT need (OR 0.13).
- AKI correlated with high mortality (50%) and longer hospital stay (35 vs 18 days).
Conclusions:
- Moderate-to-severe AKI is prevalent in critically ill COVID-19 patients.
- AKI significantly increases mortality risk and hospital length of stay.
Background:
Acute kidney injury (AKI) is frequent in Coronavirus Infection Disease 2019 (COVID-19) patients. Factors associated with AKI in COVID-19 intensive care unit (ICU) patients and their outcomes have not been previously explored.
Methods:
Prospective observational study of COVID-19 patients admitted to the ICUs of the Hospital Clínic of Barcelona (Spain), from March 25th to April 21st, 2020, who developed AKI stage 2 or higher (AKIN classification). The primary goal was to describe the characteristics of moderate-severe AKI of COVID-19 patients in an ICU context. As a secondary goal, we aimed to find independent predictors of AKI progression, Renal Replacement Therapy (RRT) requirement and mortality among these patients.
Results:
During the study period, 52 out of 237 ICU patients, developed AKIN stage 2 or higher and were included in the study. A Sequential Organ Failure Assessment (SOFA) score at AKI diagnosis of 8 or higher was associated with RRT, OR 5.2, p 0.032. At the time of AKI diagnosis, patients had a worse liver profile and higher inflammation markers than at admission. Fifty per cent of the patients presented AKI progression from AKIN 2 to 3 and 28.85% required RRT. The use of corticosteroids in 69.2% of patients was associated with a reduced requirement of RRT, OR 0.13 (CI 95% 0.02-0.89), p 0.037. AKI was associated with high mortality (50%) and a longer hospital stay, median 35 vs 18 days (p 0.024).
Conclusions:
The prevalence of moderate/severe AKI in COVID-19 patients admitted to the ICU is high and has a strong correlation with mortality and length of hospital stay.
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