Outcomes of Hospitalized Patients With COVID-19 With Acute Kidney Injury and Acute Cardiac Injury

Abstract

PurposeThis study investigated the incidence, disease course, risk factors, and mortality in COVID-19 patients who developed both acute kidney injury (AKI) and acute cardiac injury (ACI), and compared to those with AKI only, ACI only, and no injury (NI).MethodsThis retrospective study consisted of hospitalized COVID-19 patients at Montefiore Health System in Bronx, New York between March 11, 2020 and January 29, 2021. Demographics, comorbidities, vitals, and laboratory tests were collected during hospitalization. Predictive models were used to predict AKI, ACI, and AKI-ACI onset. Longitudinal laboratory tests were analyzed with time-lock to discharge alive or death.ResultsOf the 5,896 hospitalized COVID-19 patients, 44, 19, 9, and 28% had NI, AKI, ACI, and AKI-ACI, respectively. Most ACI presented very early (within a day or two) during hospitalization in contrast to AKI (p < 0.05). Patients with combined AKI-ACI were significantly older, more often men and had more comorbidities, and higher levels of cardiac, kidney, liver, inflammatory, and immunological markers compared to those of the AKI, ACI, and NI groups. The adjusted hospital-mortality odds ratios were 17.1 [95% CI = 13.6–21.7, p < 0.001], 7.2 [95% CI = 5.4–9.6, p < 0.001], and 4.7 [95% CI = 3.7–6.1, p < 0.001] for AKI-ACI, ACI, and AKI, respectively, relative to NI. A predictive model of AKI-ACI onset using top predictors yielded 97% accuracy. Longitudinal laboratory data predicted mortality of AKI-ACI patients up to 5 days prior to outcome, with an area-under-the-curve, ranging from 0.68 to 0.89.ConclusionsCOVID-19 patients with AKI-ACI had markedly worse outcomes compared to those only AKI, ACI and NI. Common laboratory variables accurately predicted AKI-ACI. The ability to identify patients at risk for AKI-ACI could lead to earlier intervention and improvement in clinical outcomes.

Longitudinal medical subspecialty follow-up of critically and non-critically ill hospitalized COVID-19 survivors up to 24 months after discharge

“…A novelty of our study is the longitudinal assessment of medical subspecialty care received by COVID-19 survivors at follow-up. The high rates of pulmonologist, cardiologist, and nephrologist, neurologist, and vascular medicine visits are consistent with commonly reported organ system involvement in acute COVID-19 [ 41 – 46 ]. Some of these medical usages could be associated with ongoing medical needs which might have been exacerbated by COVID-19, while others were associated with new subspecialist needs due to new problems caused by COVID-19.…”

New‐onset and persistent neurological and psychiatric sequelae of COVID‐19 compared to influenza: A retrospective cohort study in a large New York City healthcare network

“…All data originated from observational databases in the Montefiore Health System as described in previous reports (Hoogenboom, Fleysher, et al., 2021 ; Hoogenboom, Pham, et al., 2021 ; Lu, 2021 ; Lu et al., 2022 ). Briefly, patient data between January 1, 2020, and June 9, 2021, were standardized to the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) version 6, which uses standard vocabulary concepts, allowing for the systematic analysis of disparate observational databases such as electronic medical records and disease classification systems (e.g., ICD‐10, SNOWMED, LOINC) (Hripcsak et al., 2015 ).…”

Increasing cardiac troponin-I level as a cardiac injury index correlates with in-hospital mortality and biofactors in severe hospitalised COVID-19 patients

“…Previous studies reported the rate of cardiac injury and mortality in COVID-19 patients. Contextually, Lu and coworkers determined that 9.45% of the patients with COVID-19 experienced cardiac injury, and the mortality was 29.6% [ 14 ]. Moreover, Fan et al reported that the prevalence of cardiac injury was 16.44%, and the mortality rate of 64.4% among 73 patients with COVID-19 [ 15 ].…”