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Acute Kidney Injury and Early Predictive Factors in COVID-19 Patients
Jiaye Liu1, Tingyan Wang2, Qingxian Cai1
1National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China.
Insights
Coronavirus disease 2019 (COVID-19) patients face risks of acute kidney injury (AKI) and declining kidney function during hospitalization. Early prediction of AKI is possible using baseline patient factors.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) has been associated with various organ complications.
- Acute kidney injury (AKI) is a recognized complication in severe COVID-19 cases.
- Understanding early predictive factors for AKI in COVID-19 is crucial for timely intervention.
Purpose of the Study:
- To determine the incidence of AKI in hospitalized COVID-19 patients.
- To identify early predictive factors for the development of AKI in this population.
- To assess the trajectory of renal function throughout hospitalization and at discharge.
Main Methods:
- Retrospective cohort study of 408 patients admitted with COVID-19.
- Monitoring of clinical outcomes and renal function (eGFR, creatinine) during hospitalization.
- Analysis of baseline factors to identify independent predictors of AKI using hazard ratios.
Main Results:
- 19.36% of patients had renal dysfunction at baseline (eGFR <90 ml/min/1.73 m²).
- 3.9% of patients developed AKI during follow-up.
- Independent predictors of AKI included age ≥60 years, PaO2/FiO2 ratio <300, and higher baseline creatinine.
Conclusions:
- COVID-19 patients are susceptible to AKI and continuous eGFR decline.
- Baseline clinical factors can predict the risk of AKI early in the disease course.
- A significant proportion of patients exhibit renal dysfunction even upon hospital discharge.
Abstract:
Objectives: Our objective was to explore the incidence and early predictive factors of acute kidney injury in coronavirus disease 2019 (COVID-19) patients. Method: We established a retrospective cohort of 408 patients who were admitted to Shenzhen Third People's Hospital in Shenzhen, China, between January 1 and March 31, 2020. Clinical outcomes and renal function were monitored until April 12, 2020, with a median follow-up duration of 21 days [interquartile range (IQR) = 14-33]. Results: When first admitted to hospital (baseline), 19.36% (79/408) presented renal dysfunction [estimated glomerular filtration rate (eGFR) <90 ml/min/1.73 m2]. During follow-up, 3.9% (16/408) developed acute kidney injury (AKI). Age ≥60 years [hazard ratio (HR) = 4.78, 95% CI = 1.10-20.69], PaO2/FiO2 ratio <300 (HR = 3.48, 95% CI = 1.04-11.62), and higher creatinine (HR = 1.04, 95% CI = 1.01-1.07) at baseline independently predicted the risk of AKI. Respectively, 25.0% (102/408), 3.9% (16/408), 0.5% (2/408), 1.0% (4/408), and 0.2% (1/408) experienced G2, G3a, G3b, G4, and G5 as their most severe category during hospitalization, while 69.4% (283/408) had normal eGFRs throughout the follow-up period. When finally discharged from hospital, there were 12.5% (51/408) of patients with abnormal eGFRs. Conclusions: COVID-19 patients can be at risk of AKI and continuous eGFR decline during hospitalization, which can be early predicted by baseline factors. Some individuals still had renal dysfunction when finally discharged from hospital.
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