Acute kidney injury in hospitalized patients due to COVID-19

  1. Pehuén Fernández
  2. Emanuel José Saad
  3. Augusto Douthat
  4. Federico Ariel Marucco
  5. María Celeste Heredia
  6. Ayelén Tarditi Barra
  7. Silvina Trinidad Rodriguez Bonazzi
  8. Melani Zlotogora
  9. María Antonella Correa Barovero
  10. Sofía Villada
  11. Juan Pablo Maldonado
  12. Juan Pablo Caeiro
  13. Ricardo Arturo Albertini
  14. Jorge De La Fuente
  15. Walter Guillermo Douthat

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Abstract

The incidence of acute kidney injury (AKI) in hospitalized patients with coronavirus disease 2019 (COVID-19) is variable, being associated with worse outcomes. The objectives of the study were to evaluate the incidence, risk factors and impact of AKI in subjects hospitalized for COVID-19 in two third- level hospitals in Córdoba, Argentina.

A retrospective cohort study was conducted. 448 adults who were consecutively hospitalized for COVID-19 between March and the end of October 2020 at Hospital Privado Universitario de Córdoba and Hospital Raúl Angel Ferreyra were included. The incidence of AKI was 19% (n = 85). 50.6% presented AKI stage 1 (n=43), 20% stage 2 (n=17) and 29.4% stage 3 (n=25, of which 18 required renal replacement therapy). In the multivariate analysis, the variables that were independently associated with AKI were: age (adjusted Odd ratio -aOR- =1.30, 95%CI=1.04-1.63, p=0.022), history of chronic kidney disease (aOR=9.92, 95%CI=4.52-21.77, p<0.001), blood neutrophil count at admission (aOR=1.09, 95%CI=1.01-1.18, p=0.037) and requirement for mechanical ventilation (MV) (aOR=6.69, 95%CI=2.24-19.9, p=0.001). AKI was associated with longer hospitalization, greater admission and length of stay in the intensive care unit, a positive association with bacterial superinfection, sepsis, respiratory distress syndrome, MV requirement and mortality (mortality with AKI=47.1% vs without AKI=12.4%, p<0.001). AKI was independently associated with higher mortality (aOR=3.32, 95%CI=1.6-6.9, p=0.001).

In conclusion, the incidence of AKI in adults hospitalized for COVID-19 was 19% and had a clear impact on morbidity and mortality. Local predisposing factors for AKI were identified.

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    SciScore for 10.1101/2021.05.31.21257656: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The limitations of our study are mainly based on its retrospective nature, although in both institutions there was a protocol for action against COVID-19 which would tend to unify management. This study is the first in our country to evaluate the incidence, risk factors, and prognosis associated with AKI in adults hospitalized for COVID-19. The epidemiological analysis of AKI incidence, degrees of affectation, requirement of ICU, MV and RRT can be useful for planning and allocating resources in the event of a possible new outbreak. The determination of AKI risk factors allows the early identification of the susceptible subjects. The analysis of complications and the impact associated with AKI, such as mortality and prolongation of hospital stay, reflect the importance of early diagnosis and adequate treatment. In conclusion, the incidence of AKI in hospitalized subjects due to active COVID-19 infection was 19%. The independent predictors of AKI were age, CKD history, neutrophil count, and MV. AKI was associated with bacterial superinfection, sepsis, respiratory distress syndrome, prolonged hospitalization days, higher ICU and MV requirement, and was also independently associated with higher in-hospital mortality.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2021.05.31.21257656v1 on medRxiv