The Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury in Critically Ill Patients with COVID-19: A Multicenter Study (original) (raw)
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20 Pages Posted: 23 Apr 2020
Xin Zhang
Government of the People's Republic of China - Department of Pulmonary and Critical Care Medicine
Wei Guo
Peking University - Trauma Center
Jing Hua
Tongji University - Department of Pulmonary and Critical Care Medicine
Zhibing Luo
Tongji University - Department of Pulmonary and Critical Care Medicine
Shaoyong Gao
Tongji University - Department of Pulmonary and Critical Care Medicine
Linyu Ran
Tongji University - Department of Pulmonary and Critical Care Medicine
Shengyun Wang
Government of the People's Republic of China - Department of Emergency and Critical Care Medicine
Chenchen Qian
UPMC Pinnacle Hospital - Department of Internal Medicine
Zhe Ge
Government of the People's Republic of China - Department of Infectious Disease and Tuberculosis
Rongzhang Chen
Tongji University - Department of Pulmonary and Critical Care Medicine
Liming Zhao
Tongji University - Department of Pulmonary and Critical Care Medicine
Xiaodong Wu
Tongji University - Department of Respiratory and Critical Care Medicine
Qian Guo
Tongji University - Department of Pulmonary and Critical Care Medicine
Chunfeng He
Tongji University - Department of Pulmonary and Critical Care Medicine
Tian Li
Tongji University - Department of Pulmonary and Critical Care Medicine
Xiaoyu Ren
Tongji University - Department of Pulmonary and Critical Care Medicine
Weibo Gao
Peking University - Department of Emergency
Zhongmin Liu
Tongji University - Department of Pulmonary and Critical Care Medicine
Qiang Li
Tongji University - Department of Respiratory and Critical Care Medicine
Feilong Wang
Tongji University - Department of Pulmonary and Critical Care Medicine
Abstract
Background Acute kidney injury (AKI) is associated with worse outcome in patients with infection. However, the epidemiological feature of AKI among patients with COVID-19 is poorly understood.
Methods: In this multicenter retrospective study, we recruited consecutive adult patients who had died or been discharged in 11 designated ICUs for caring for COVID-19 in Wuhan, China. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria and the primary outcome was in-hospital mortality. Potential risk factors of AKI as well as the association between AKI and in-hospital mortality were analyzed.
Results: A total of 282ICU patients with COVID-19 were included in the study and 43.6% (123/282) of them had AKI. In comparison with patients without AKI, patients who developed AKI tended to be older, had higher proportion of chronic kidney disease (CKD), more likely to develop acute organ dysfunction and had higher SOFA score. Multivariate analysis showed that medical history of CKD and SOFA score were independently associated with occurrence of AKI. Increasing AKI severity was associated with hospital mortality when adjusted for other potential variables: odds ratio of stage 1 = 3.766 (95% CI1.599–8.870; p = 0.002), stage 2 = 4.858 (95% CI1.269–18.597; p = 0.021), and stage 3 = 25.635 (95% CI8.240–79749; p<0.001).
Conclusion: In this large-scale, multicenter study, we found that more than 2 in 5 critically ill patients with COVID-19 experienced AKI during their hospital stay. Increasing AKI severity was strongly associated with increased in-hospital mortality.
Funding Statement: This work was supported by the National Key Research and Development Project of the Ministry of Science and Technology, China (2018YFC1313700), “Gaoyuan” project of Pudong Health and Family Planning Commission (PWYgy2018-6) and the research Foundation of shanghai science and technology commission (No.18140904100).
Declaration of Interests: The authors declare no competing interests.
Ethics Approval Statement: This study was approved by the Shanghai East Hospital Ethics Committee and carried out in accordance with the Declaration of Helsinki.
Keywords: COVID-19, SARS-CoV-2, Acute kidney injury, mortality, Risk factors:
Suggested Citation: Suggested Citation
Zhang, Xin and Guo, Wei and Hua, Jing and Luo, Zhibing and Gao, Shaoyong and Ran, Linyu and Wang, Shengyun and Qian, Chenchen and Ge, Zhe and Chen, Rongzhang and Zhao, Liming and Wu, Xiaodong and Guo, Qian and He, Chunfeng and Li, Tian and Ren, Xiaoyu and Gao, Weibo and Liu, Zhongmin and Li, Qiang and Wang, Feilong, The Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury in Critically Ill Patients with COVID-19: A Multicenter Study (4/7/2020). Available at SSRN: https://ssrn.com/abstract=3572908 or http://dx.doi.org/10.2139/ssrn.3572908