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Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients
Antonio Mirijello1, Pamela Piscitelli1, Angela de Matthaeis1
1Unit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
Insights
Reduced kidney function (eGFR) in hospitalized COVID-19 patients significantly increases their risk of ICU admission or death. Early identification and supportive care are crucial for managing these high-risk individuals.
Area of Science:
- Nephrology
- Infectious Diseases
- Cardiology
Background:
- COVID-19 severity is heightened in elderly patients with cardio-metabolic conditions.
- Chronic kidney disease (CKD) is an independent cardiovascular risk factor.
- Reduced estimated glomerular filtration rate (eGFR) may impact COVID-19 outcomes.
Purpose of the Study:
- To assess the impact of decreased eGFR on ICU admission and mortality in hospitalized COVID-19 patients.
- To identify risk factors associated with severe COVID-19 outcomes.
- To evaluate the role of kidney function in COVID-19 prognosis.
Main Methods:
- Retrospective analysis of 231 hospitalized COVID-19 patients.
- Patients grouped by eGFR: ≥60 mL/min/1.73 m² vs. <60 mL/min/1.73 m².
- Primary outcome: composite of ICU admission or death; secondary outcomes: individual components.
Main Results:
- 34.2% of patients experienced the composite outcome (ICU admission or death).
- Low eGFR (<60 mL/min/1.73 m²) was significantly associated with the composite outcome (p < 0.0001).
- Low eGFR (HR 1.64) and older age were independent predictors of the composite outcome in multivariate analysis.
Conclusions:
- Reduced eGFR at admission identifies COVID-19 patients at high risk for adverse outcomes.
- These patients require intensified supportive treatment to mitigate risks.
- Kidney function is a critical factor in COVID-19 patient management and prognosis.
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.
