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

Abstract

Introduction 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.

Acute kidney injury prevalence, progression and long-term outcomes in critically ill patients with COVID-19: a cohort study

“…Similar to non-COVID-19 patients, positive fluid balance in the first 48 h after ICU admission was associated with AKI progression [30][31][32]. As in previous reports, invasive mechanical ventilation increased the risk of AKI by about fourfold [5,10,[33][34][35]. The use of KRT in our cohort was similar to reports from other institutions and national UK data [11,15], and our association between AKI stage and mortality was also in keeping with other studies [12,36].…”

Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study

“…Other smaller, or single centre studies, have typically focused either exclusively on patients who received critical care, or on one type of complication and lack systematic approaches to data collection. 4 , 34 , 35 , 36 , 37 , 38 Our study identifies high rates of complications and the risk factors for developing these, and describes severity, which previous studies have been unable to do at scale. In particular, we find that in the short term, respiratory and cardiovascular complications have the strongest association with mortality.…”

Mortality and evolution between community and hospital-acquired COVID-AKI

“…In our cohort, CA-AKI patients more frequently had hypertension, CKD and COPD than HA-AKI patients, antecedents that have been linked to a worse clinical evolution in patients with COVID [ 22 , 23 ], including the development of AKI [ 4 ].…”

“…Acute kidney injury (AKI) presents in 4.5% of cases [ 1 ] and up to 78% of patients in the intensive care unit [ 2 ]. AKI is associated with poor outcomes [ 3 ], and it has been reported that AKI has the highest risk of mortality in hospitalized patients [ 4 ]. Mexico has been one of the most adversely affected countries in the world by the pandemic [ 5 ].…”