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Published on: November 3, 2023
Incidence, Clinical Characteristics and Outcomes Associated with Acute Kidney Injury in Patients Hospitalized with
Sanjay Shrestha1, Kijan Maharjan1, Milan Bajracharya1
1Department of Internal Medicine, Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Nepal.
Insights
Acute kidney injury (AKI) affects over 20% of COVID-19 patients, increasing mortality risk. Factors like older age, comorbidities, and mechanical ventilation are linked to AKI development and worse outcomes.
Area of Science:
- Infectious Diseases
- Nephrology
- Critical Care Medicine
Background:
- Coronavirus disease (COVID-19) is associated with adverse clinical outcomes, including a significant risk of death.
- Acute kidney injury (AKI) is a recognized complication of COVID-19, impacting patient prognosis.
- Understanding AKI incidence and risk factors in COVID-19 is crucial for improving patient care.
Purpose of the Study:
- To determine the incidence of AKI among COVID-19 patients in a tertiary infectious disease hospital in Nepal.
- To identify clinical characteristics associated with AKI development in COVID-19 patients.
- To analyze the association of AKI with clinical outcomes, including mortality and hospital stay duration.
Main Methods:
- A retrospective cross-sectional study reviewed medical and laboratory records of COVID-19 inpatients.
- Data from 393 patients admitted between April and July 2021 (during the Delta strain wave) were analyzed.
- Exclusion criteria included patients under 18, pregnant females, and those with pre-existing chronic kidney disease.
Main Results:
- The incidence of AKI among COVID-19 patients was 21.1% (83 out of 393 admissions).
- Significant associations with AKI development included older age, multiple comorbidities, mechanical ventilation, lymphopenia, elevated Neutrophil to Lymphocyte Ratio, and d-dimer levels.
- COVID-19 patients with AKI had significantly higher mortality (36.14% vs. 15.8%) and longer hospital stays (10 days vs. 6 days) compared to those without AKI.
Conclusions:
- AKI is a common complication in COVID-19 patients, affecting a substantial percentage.
- Development of AKI is significantly associated with increasing age, multiple comorbidities, specific biomarkers, and the need for mechanical ventilation.
- AKI in COVID-19 patients is linked to poorer outcomes, including increased mortality and morbidity.
Background:
Acute kidney Injury associated with Coronavirus disease COVID-19 appeared to negatively influence clinical outcomes and is found to be associated with significant risk of death. This retrospective study aimed to describe the incidence of Acute Kidney Injury, its associations with clinical characteristics and outcomes among COVID-19 patients in Sukraraj Tropical and Infectious Disease Hospital, a tertiary infectious disease hospital in Nepal.
Methods:
A cross-sectional study was done where. Medical and lab records of reverse transcriptase Polymerase chain reaction positive COVID-19 inpatients, admitted between April 2021 to July 2021 were reviewed. It represented the second wave of wave of coronavirus pandemic caused by the delta strain. Patients aged less than 18 years, pregnant females and patients with known chronic kidney disease were excluded Results: Of 393 admissions, 83 (21.1%) patients developed Acute Kidney Injury. Characteristics found to have significant association with development of AKI was age (p <0.001), multiple co morbidities (2 or more) (p <0.001), use of mechanical ventilation (p <0.001), lymphopenia (p<0.001), Neutrophil to Lymphocyte Ratio (p =0.001) and d-dimer levels (p <0.001). Mortality was found to be significantly higher in COVID-19 patients with AKI compared to COVID-19 patients without AKI ((36.14% vs 15.8%, p value <0.01)). The median duration of hospital stay for patients with AKI was higher than for patients without AKI (10 days vs 6 days,p <0.01).
Conclusions:
AKI develops in a sizeable percentage of patients with COVID-19 and is significantly associated with increasing age, multiple comorbidities, increased biomarkers, use of mechanical ventilation and is associated with poor outcome in terms of mortality and morbidity.
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