Acute kidney injury in patients with severe COVID-19 in Mexico

  1. Gustavo A. Casas-Aparicio
  2. Isabel León-Rodríguez
  3. Claudia Alvarado-de la Barrera
  4. Mauricio González-Navarro
  5. Amy B. Peralta-Prado
  6. Yara Luna-Villalobos
  7. Alejandro Velasco-Morales
  8. Natalia Calderón-Dávila
  9. Christopher E. Ormsby
  10. Santiago Ávila-Ríos

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19.

Methods

We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of invasive mechanical ventilation (IMV) and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded.

Results

Of 99 patients studied, 58 developed AKI (58.6%). The risk factors for AKI were older age (OR = 1.07, 95% CI = 1.01–1.13, p = 0.024); obesity (OR = 6.58, 95% CI = 1.8–24.05, p = 0.040); and the need for IMV (OR = 6.18, CI = 1.29–29.58, p = 0.023). The risk factors for mortality were obesity (OR = 5.57, 95% CI = 1.48–20.93, p = 0.011); requirement of vasoactive drugs on admission (OR = 5.35, 95% CI = 1.16–24.61, p = 0.031); and AKI (OR = 8.61, 95% CI = 2.24–33.1, p = 0.002). In-hospital mortality was significantly higher in patients with AKI stage 3 (79.3%) and AKI stage 2 (68.7%) compared with those with AKI stage 1 (25%; p = 0.004). Fifty-three patients underwent the furosemide stress test (FST) to predict progression to AKI stage 3. Of those, 12 progressed to AKI stage 3 (22%). The ROC curve for the FST had an AUC of 0.681 (p = 0.009); a sensitivity of 81.6% and a specificity of 54.5%.

Conclusions

AKI was common in our cohort of patients with severe pneumonia caused by SARS-CoV-2 infection. The risk factors for AKI were older age, obesity and the need for of IMV on admission. The risk factors for mortality were obesity, requirement of vasoactive drugs on admission and AKI. Mortality was more frequent in patients with AKI stages 2–3. The FST had an acceptable predictive capacity to identify patients progressing to AKI stage 3.

Article activity feed

  1. Version published to 10.1371/journal.pone.0246595
  2. ScreenIT

    SciScore for 10.1101/2020.08.28.20167379: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The Institutional Review Board approved the study and waived the requirement for informed consent due to the retrospective design of the stud (Approval No. C39-20).
    Consent: The Institutional Review Board approved the study and waived the requirement for informed consent due to the retrospective design of the stud (Approval No. C39-20).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablePregnant women were not included in the study.

    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 main limitation of our study is its retrospective design. Also, the number of patients included in the study is limited. Another limitation is that we retrieved information during hospitalization, but a longer observation period would have provided additional information regarding the clinical outcome and the impact of AKI in the population studied. That is, we were not able to report the proportion of individuals developing chronic renal disease in the group with AKI. The lack of pre-hospital baseline sCr measurements was also a study limitation because baseline sCr values were an estimation. Since we could not assess the baseline renal status, we could not explore whether chronic kidney disease itself is a risk factor for AKI in the context of COVID-19. Finally, our study was conducted in a national referral center for respiratory diseases receiving disproportionately more patients with poor outcomes, and this represents a potential source of referral bias. Conclusion: AKI was common in our cohort of patients with severe COVID-19 and it was associated with mortality. The risk factors for AKI were obesity, elevated creatinine levels and higher D-dimer levels on admission.

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.08.28.20167379v1 on medRxiv