Epidemiology and outcomes of early-onset AKI in COVID-19-related ARDS in comparison with non-COVID-19-related ARDS: insights from two prospective global cohort studies

Abstract

Background Acute kidney injury (AKI) is a frequent and severe complication of both COVID-19-related acute respiratory distress syndrome (ARDS) and non-COVID-19-related ARDS. The COVID-19 Critical Care Consortium (CCCC) has generated a global data set on the demographics, management and outcomes of critically ill COVID-19 patients. The LUNG-SAFE study was an international prospective cohort study of patients with severe respiratory failure, including ARDS, which pre-dated the pandemic. Methods The incidence, demographic profile, management and outcomes of early AKI in patients undergoing invasive mechanical ventilation for COVID-19-related ARDS were described and compared with AKI in a non-COVID-19-related ARDS cohort. Results Of 18,964 patients in the CCCC data set, 1699 patients with COVID-19-related ARDS required invasive ventilation and had relevant outcome data. Of these, 110 (6.5%) had stage 1, 94 (5.5%) had stage 2, 151 (8.9%) had stage 3 AKI, while 1214 (79.1%) had no AKI within 48 h of initiating invasive mechanical ventilation. Patients developing AKI were older and more likely to have hypertension or chronic cardiac disease. There were geo-economic differences in the incidence of AKI, with lower incidence of stage 3 AKI in European high-income countries and a higher incidence in patients from middle-income countries. Both 28-day and 90-day mortality risk was increased for patients with stage 2 (HR 2.00, p < 0.001) and stage 3 AKI (HR 1.95, p < 0.001). Compared to non-COVID-19 ARDS, the incidence of shock was reduced with lower cardiovascular SOFA score across all patient groups, while hospital mortality was worse in all groups [no AKI (30 vs 50%), Stage 1 (38 vs 58%), Stage 2 (56 vs 74%), and Stage 3 (52 vs 72%), p < 0.001]. The time profile of onset of AKI also differed, with 56% of all AKI occurring in the first 48 h in patients with COVID-19 ARDS compared to 89% in the non-COVID-19 ARDS population. Conclusion AKI is a common and serious complication of COVID-19, with a high mortality rate, which differs by geo-economic location. Important differences exist in the profile of AKI in COVID-19 versus non-COVID-19 ARDS in terms of their haemodynamic profile, time of onset and clinical outcomes.

Accuracy of the persistent AKI risk index in predicting acute kidney injury in patients admitted to the intensive care unit for acute respiratory failure

“…In our analysis, the PARI cutoff point of ≥ 4 was the one that best discriminated persistent AKI in patients admitted to the ICU for acute respiratory failure, lower than the ≥ 8 identified by Matsuura et al ( 7 ) The lower PARI score found in our study could mean that the population with acute respiratory failure is more likely to develop renal dysfunction in the first 7 days after ICU admission, reinforcing the lung-kidney crosstalk, ( 23 - 25 ) and/or it could mean our population was not as severe at ICU admission, given their SOFA and APACHE II values.…”

Acute Kidney Injury Associated with Severe SARS-CoV-2 Infection: Risk Factors for Morbidity and Mortality and a Potential Benefit of Combined Therapy with Tocilizumab and Corticosteroids

“…Moreover, AKI in the setting of COVID-19 tends to be more severe. As compared to historical controls, COVID-19 patients had a 2.6-fold higher mortality and an increased requirement for RRT [ 37 , 38 ]. A recent meta-analysis involving over 25,000 COVID-19 patients found a pooled incidence of AKI of 53% in those with severe disease [ 39 ].…”

Are Kidneys Affected by SARS-CoV-2 Infection? An Updated Review on COVID-19-Associated AKI

“…In the context of the current narrative review, we have carried out a pooled analysis of the medical literature regarding the incidence of AKI in hospitalized patients with COVID-19. We have included 24 reports ( n = 502, 593 unique patients) and found an incidence of AKI of 31.8% (range, 0.5% to 56.9%) ( Table 1 ) [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. Many surveys ( n = 9) were published very recently (2022–2023) ( Table 1 ).…”

“…As listed in Supplementary Table S1 , most reports had a retrospective design, and a few ( n = 2) had a prospective nature [ 35 , 49 ]. Some ( n = 7) had a multicenter approach [ 31 , 38 , 40 , 42 , 45 , 46 , 50 ]. The weighted average of male frequency was 52% (range, 37.1% to 74.6%).…”