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Is it possible to predict persistent acute kidney injury in critically ill patients with COVID-19 infection?
Mahmut Yılmaz1, Sercan Yılmaz1, Hakan Sapmaz1
1Gulhane Training and Research Hospital, Department of Intensive Care, Ankara, Türkiye.
Insights
The Persistent Acute Kidney Injury Risk Index (PARI) can predict persistent acute kidney injury (pAKI) in critically ill COVID-19 patients. This index also helps identify patients at higher risk for short-term mortality.
Area of Science:
- Nephrology
- Critical Care Medicine
- Infectious Diseases
Background:
- Critically ill COVID-19 patients have a high risk of acute kidney injury (AKI) and mortality.
- The Persistent Acute Kidney Injury Risk Index (PARI) shows potential for predicting persistent AKI (pAKI) in non-COVID patients.
Purpose of the Study:
- To evaluate the predictive power of the PARI for identifying pAKI in COVID-19 patients.
- To assess the prognostic significance of PARI in relation to clinical outcomes.
Main Methods:
- Single-center retrospective study.
- Included 152 critically ill COVID-19 patients admitted to the ICU.
- Analyzed data on AKI, pAKI, and clinical outcomes.
Main Results:
- 37.5% developed AKI, 10.25% developed pAKI.
- Higher PARI, SOFA, and need for vasopressors, mechanical ventilation, and RRT in pAKI patients.
- PARI was significantly higher in patients with short-term mortality (AUC=0.733) and predicted pAKI (AUC=0.66).
Conclusions:
- The PARI score is a simple, reliable predictor of pAKI in severe COVID-19.
- Early identification of pAKI risk can guide protective interventions.
- Further research is needed to fully understand the PARI's role in COVID-19.
Introduction:
Critically ill patients with coronavirus disease 2019 (COVID-19) often face a heightened risk of morbidity and mortality, particularly due to complications such as acute kidney injury (AKI). While the persistent acute kidney injury risk index (PARI) has shown promise in predicting the risk of persistent AKI (pAKI) in non-COVID patients, its effectiveness in critically ill COVID-19 patients remains to be explored. We aimed to evaluate the predictive power of the PARI in identifying pAKI and its prognostic significance in terms of clinical outcomes.
Methodology:
This was a single-center retrospective study of patients with COVID-19 admitted at our 36-bed tertiary intensive care unit between April and December 2020.
Results:
There were 152 patients who fulfilled our inclusion criteria. Fifty seven (37.5%) had developed AKI and 16 (10.25%) had developed pAKI. Vasopressor, mechanical ventilation and renal replacement therapy (RRT) requirement, sequential organ failure assessment (SOFA), and PARI were significantly higher in patients who developed pAKI than those who did not. The PARI were significantly higher in patients with short-term mortality compared to survivors. The area under the receiver operating characteristic (ROC) curve (AUC) of the PARI score for predicting pAKI was 0.66 (95% CI: 0.53-0.79), whereas short-term mortality was 0.733 (95% CI, 0.65-0.81).
Conclusions:
The PARI score was evaluated as simple, useful, and reliable in predicting pAKI in severe cases with COVID-19; and therefore, pAKI and its related RRT complications can be prevented with protective interventions. Further comprehensive studies are warranted to deepen our understanding of this relationship.
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