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Published on: February 2, 2021
Acute kidney injury in patients with severe COVID-19 in Mexico
Gustavo A Casas-Aparicio1, Isabel León-Rodríguez1, Claudia Alvarado-de la Barrera1
1Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
Introduction:
Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19.
Methods:
We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of invasive mechanical ventilation (IMV) and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded.
Results:
Of 99 patients studied, 58 developed AKI (58.6%). The risk factors for AKI were older age (OR = 1.07, 95% CI = 1.01-1.13, p = 0.024); obesity (OR = 6.58, 95% CI = 1.8-24.05, p = 0.040); and the need for IMV (OR = 6.18, CI = 1.29-29.58, p = 0.023). The risk factors for mortality were obesity (OR = 5.57, 95% CI = 1.48-20.93, p = 0.011); requirement of vasoactive drugs on admission (OR = 5.35, 95% CI = 1.16-24.61, p = 0.031); and AKI (OR = 8.61, 95% CI = 2.24-33.1, p = 0.002). In-hospital mortality was significantly higher in patients with AKI stage 3 (79.3%) and AKI stage 2 (68.7%) compared with those with AKI stage 1 (25%; p = 0.004). Fifty-three patients underwent the furosemide stress test (FST) to predict progression to AKI stage 3. Of those, 12 progressed to AKI stage 3 (22%). The ROC curve for the FST had an AUC of 0.681 (p = 0.009); a sensitivity of 81.6% and a specificity of 54.5%.
Conclusions:
AKI was common in our cohort of patients with severe pneumonia caused by SARS-CoV-2 infection. The risk factors for AKI were older age, obesity and the need for of IMV on admission. The risk factors for mortality were obesity, requirement of vasoactive drugs on admission and AKI. Mortality was more frequent in patients with AKI stages 2-3. The FST had an acceptable predictive capacity to identify patients progressing to AKI stage 3.
Insights
Acute kidney injury (AKI) is common in severe COVID-19 pneumonia, with older age, obesity, and invasive mechanical ventilation as key risk factors. AKI significantly increases mortality risk in these patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 pneumonia can lead to systemic disease affecting multiple organs.
- Limited data exists on acute kidney injury (AKI) development and outcomes in severe COVID-19, particularly in the Mexican population.
Purpose of the Study:
- To identify factors associated with AKI development in severe COVID-19 patients.
- To explore the relationship between AKI and mortality in this population.
- To evaluate the furosemide stress test (FST) for predicting AKI progression.
Main Methods:
- Retrospective review of medical records of severe COVID-19 pneumonia patients hospitalized in Mexico.
- Data collected included demographics, comorbidities, clinical and laboratory findings, and treatment details.
- Analysis of risk factors for AKI and mortality, and assessment of FST predictive capacity.
Main Results:
- 58.6% of 99 patients developed AKI.
- Risk factors for AKI included older age, obesity, and need for invasive mechanical ventilation (IMV).
- Obesity, vasoactive drug use, and AKI were risk factors for mortality; mortality was higher in AKI stages 2-3. FST showed acceptable predictive capacity for AKI stage 3 progression.
Conclusions:
- AKI is prevalent in severe COVID-19.
- Older age, obesity, and IMV are risk factors for AKI.
- Obesity, vasoactive drugs, and AKI increase mortality risk; FST can help predict AKI progression.
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