A Prospective Study on Risk Factors for Acute Kidney Injury and All-Cause Mortality in Hospitalized COVID-19 Patients From Tehran (Iran)

Abstract

BackgroundSeveral reports suggested that acute kidney injury (AKI) is a relatively common occurrence in hospitalized COVID-19 patients, but its prevalence is inconsistently reported across different populations. Moreover, it is unknown whether AKI results from a direct infection of the kidney by SARS-CoV-2 or it is a consequence of the physiologic disturbances and therapies used to treat COVID-19. We aimed to estimate the prevalence of AKI since it varies by geographical settings, time periods, and populations studied and to investigate whether clinical information and laboratory findings collected at hospital admission might influence AKI incidence (and mortality) in a particular point in time during hospitalization for COVID-19.MethodsHerein we conducted a prospective longitudinal study investigating the prevalence of AKI and associated factors in 997 COVID-19 patients admitted to the Baqiyatallah general hospital of Tehran (Iran), collecting both clinical information and several dates (of: birth; hospital admission; AKI onset; ICU admission; hospital discharge; death). In order to examine how the clinical factors influenced AKI incidence and all-cause mortality during hospitalization, survival analysis using the Cox proportional-hazard models was adopted. Two separate multiple Cox regression models were fitted for each outcome (AKI and death).ResultsIn this group of hospitalized COVID-19 patients, the prevalence of AKI was 28.5% and the mortality rate was 19.3%. AKI incidence was significantly enhanced by diabetes, hyperkalemia, higher levels of WBC count, and blood urea nitrogen (BUN). COVID-19 patients more likely to die over the course of their hospitalization were those presenting a joint association between ICU admission with either severe COVID-19 or even mild/moderate COVID-19, hypokalemia, and higher levels of BUN, WBC, and LDH measured at hospital admission. Diabetes and comorbidities did not increase the mortality risk among these hospitalized COVID-19 patients.ConclusionsSince the majority of patients developed AKI after ICU referral and 40% of them were admitted to ICU within 2 days since hospital admission, these patients may have been already in critical clinical conditions at admission, despite being affected by a mild/moderate form of COVID-19, suggesting the need of early monitoring of these patients for the onset of eventual systemic complications.

Persistence of Symptoms 15 Months since COVID-19 Diagnosis: Prevalence, Risk Factors and Residual Work Ability

“…COVID-19 is a systemic disease which can present with a wide clinical spectrum ranging from general respiratory symptoms to multi-organ failure [ 1 , 2 , 3 , 4 ], yet in 40% cases patients it may remain asymptomatic [ 5 ].…”

Development and validation of a prognostic model based on clinical laboratory biomarkers to predict admission to ICU in Omicron variant-infected hospitalized patients complicated with myocardial injury

“…In the study of 182 COVID-19 patients by Li et al., WBC, hs-C-reactive protein, and PCT were independently associated with MI in a multivariable adjusted analysis ( 39 ). Furthermore, elevated BUN levels were observed, suggesting potential renal function impairment or dehydration, which can be associated with a poorer prognosis ( 40 – 42 ). The pathogenic mechanisms leading to MI, such as reduced cardiac output and subsequent renal hypoperfusion, could elucidate the observed increase in BUN levels ( 43 , 44 ).…”

Enhancing the expression of a key mitochondrial enzyme at the inception of ischemia-reperfusion injury can boost recovery and halt the progression of acute kidney injury

“…Yet, beyond certain thresholds, these disorders induce persistent cell death and progressing degrees of atrophy that drive the progression of AKI ( Holderied et al, 2020 ). At this stage, current treatment regimens, which comprise fluid, electrolyte, and acid-base balance management, are still mainly supportive and unable to halt the progression of the illness ( Kinsey and Okusa, 2011b ; Rostami et al, 2022 ). As a result, gene therapy has been proposed as an alternative to treat and prevent the underlying causes and progression of AKI ( Humes et al, 1997 ; Torras et al, 2008 ; Molitoris et al, 2009 ).…”