Background Although COVID-19 patients who developed in-hospital AKI have worse short-term outcomes, their long-term outcomes have not been fully characterized. We investigated 90-day and one-year outcomes after hospital AKI grouped by time to recovery from AKI. Methods This study consisted of 3,296 COVID-19 patients with hospital AKI stratified by early recovery (<48 hours), delayed recovery (2-7 days), and prolonged recovery (>7-90 days). Demographics, comorbidities, laboratory values were obtained at admission and up to one-year follow-up. Incidence of major adverse cardiovascular event (MACE) and major adverse kidney event (MAKE), rehospitalization, recurrent AKI, and new-onset chronic kidney disease (CKD) were obtained 90-days post COVID-19 discharge. Results The incidence of hospital AKI was 28.6%. Of COVID-19 patients with AKI, 58.0% experienced early recovery, 14.8% delayed recovery and 27.1% prolonged recovery. Patients with longer AKI recovery time had higher prevalence of CKD (p<0.05) and were more likely to need invasive mechanical ventilation (p<0.001) and to die (p<0.001). Many COVID-19 patients developed MAKE, recurrent AKI, and new-onset CKD within 90 days, and these incidences were higher in the prolonged recovery group (p<0.05). Incidence of MACE peaked 20-40 days post-discharge, whereas MAKE peaked 80-90 days post-discharge. Logistic regression models predicted 90-day MACE and MAKE with 82.4±1.6% and 79.6.9±2.3% accuracy, respectively. Conclusion COVID-19 survivors who developed hospital AKI are at high risk for adverse cardiovascular and kidney outcomes, especially those with longer AKI recovery time and those with history of CKD. These patients may require long-term follow-up for cardiac and kidney complications.
Background: Many COVID-19 survivors experience persistent COVID-19 related cardiac abnormalities weeks to months after recovery from acute SARS-CoV-2 infection. Non-invasive cardiac magnetic resonance (CMR) imaging is an important tool of choice for clinical diagnosis of cardiac dysfunctions. In this systematic review, we analyzed the CMR findings and biomarkers of COVID-19 related cardiac sequela after SARS-CoV-2 infection. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), we conducted a systematic review of studies that assessed COVID-19 related cardiac abnormalities using cardiovascular magnetic resonance imaging. A total of 21 cross-sectional, case-control, and cohort studies were included in the analyses. Results: Ten studies reported CMR results <3 months after SARS-CoV-2 infection and 11 studies >3 months after SARS-CoV-2 infection. Abnormal T1, abnormal T2, elevated extracellular volume, late gadolinium enhancement and myocarditis was reported less frequently in the >3-month studies. Eight studies reported an association between biomarkers and CMR findings. Elevated troponin was associated with CMR pathology in 5/6 studies, C-reactive protein in 3/5 studies, N-terminal pro-brain natriuretic peptide in 1/2 studies, and lactate dehydrogenase and D-dimer in a single study. The rate of myocarditis via CMR was 18% (154/868) across all studies. Most SARS-CoV-2 associated CMR abnormalities resolved over time. Conclusions: There were CMR abnormalities associated with SARS-CoV-2 infection and most abnormalities resolved over time. A panel of cardiac injury and inflammatory biomarkers could be useful in identifying patients who are likely to present with abnormal CMR pathology after COVID-19. Multiple mechanisms are likely responsible for COVID-19 induced cardiac abnormalities.
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