The impact of transient and persistent acute kidney injury in hospital mortality in COVID-19 patients

Abstract

Introduction: Acute kidney injury (AKI) has been described in Coronavirus Disease 2019 (COVID-19) patients and is considered a marker of disease severity and a negative prognostic factor for survival. In this study, the authors aimed to study the impact of transient and persistent acute kidney injury (pAKI) on in-hospital mortality in COVID-19 patients. Methods: This was a retrospective observational study of patients hospitalized with COVID-19 in the Department of Medicine of the Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal, between March 2020 and August 2020. A multivariate analysis was performed to predict AKI development and in-hospital mortality. Results: Of 544 patients with COVID-19, 330 developed AKI: 166 persistent AKI (pAKI), 164 with transient AKI. AKI patients were older, had more previous comorbidities, had higher need to be medicated with RAAS inhibitors, had higher baseline serum creatine (SCr) (1.60 mg/dL vs 0.87 mg/dL), higher NL ratio, and more severe acidemia on hospital admission, and more frequently required admission in intensive care unit, mechanical ventilation, and vasopressor use. Patients with persistent AKI had higher SCr level (1.71 mg/dL vs 1.25 mg/dL) on hospital admission. In-hospital mortality was 14.0% and it was higher in AKI patients (18.5% vs 7.0%). CKD and serum ferritin were independent predictors of AKI. AKI did not predict mortality, but pAKI was an independent predictor of mortality, as was age and lactate level. Conclusion: pAKI was independently associated with in-hospital mortality in COVID-19 patients but its impact on long-term follow-up remains to be determined.

Association of vasopressors with mortality in critically ill patients with COVID-19: A systematic review and meta-analysis

“…The studies originated from multiple countries, with 13 of coming from institutions located in the USA [20,21,23,[32][33][34][35]38,42,43,45,48,51]. Nineteen studies included only patients admitted in the ICU [20,22,24,25,27,[30][31][32][35][36][37][38][39][43][44][45][46][47]52], five studies included patients admitted in a COVID-19-dedicated HDU [28,29,33,34,42], eight studies included patients who were admitted in both HDU and ICU [21,23,26,40,41,48,49,51], and one study included Emergency Department patients who were later admitted either in the HDU of ICU [50]. Thirty studies included data about patients who received vs. patients who did not receive vasopressors…”

“…Ten studies provided data on AKI in patients who received vs. patients who did not receive vasopressors, resulting in a total population of 3519 individuals [21][22][23][25][26][27][28][29][30]44]. Due to high heterogeneity (I 2 : 92%, PQ<0.001), the random-effects model was implemented.…”

Covid-19 e os rins acometidos com lesão aguda ou crônica: um aprendizado crescente

“…Dois estudos de grupos portugueses são apresentados nesse fascículo do JBN 7,8 . Um deles 7 investigou retrospectivamente os impactos transitórios e permanentes da LRA na mortalidade intra-hospitalar de 544 pacientes com Covid-19, dos quais 330 desenvolveram LRA, segundo critérios do KDIGO, sendo 166 de forma persistente e 164 transitoriamente.…”

COVID-19 and acute or chronic kidney disease: a crescent learning

“…Two Portuguese studies are presented in this JBN issue 7 , 8 . One study 7 retrospectively investigated transitory and permanent impacts of AKI in intra-hospital mortality among 544 patients with COVID-19, 330 of which developed AKI based on KDIGO criteria, 166 having the persistent form and 164, the transitory form.…”

“…Two Portuguese studies are presented in this JBN issue 7 , 8 . One study 7 retrospectively investigated transitory and permanent impacts of AKI in intra-hospital mortality among 544 patients with COVID-19, 330 of which developed AKI based on KDIGO criteria, 166 having the persistent form and 164, the transitory form. The most important risk factors for temporary change of kidney function were age, comorbidities, use of renin angiotensin aldosterone system inhibitors (63.4% were hypertensive), higher creatinine levels, higher acidemia on admission, need of mechanical ventilation, and use of vasopressor drugs.…”