Renal Manifestations and their Association with Mortality and Length of Stay in COVID-19 Patients at a Safety-net Hospital

Abstract

Background Renal involvement in COVID-19 leads to severe disease and higher mortality. We study renal parameters in COVID-19 patients and their association with mortality and length of stay in hospital. Methods A retrospective study (n=340) of confirmed COVID-19 patients with renal involvement determined by the presence of acute kidney injury. Multivariate analyses of logistic regression for mortality and linear regression for length of stay (LOS) adjusted for relevant demographic, comorbidity, disease severity, and treatment covariates. Results Mortality was 54.4% and mean LOS was 12.9 days. For mortality, creatinine peak (OR:35.27, 95% CI:2.81, 442.06, p<0.01) and persistent renal involvement at discharge (OR:4.47, 95% CI:1.99,10.06, p<0.001) were each significantly associated with increased odds for mortality. Increased blood urea nitrogen peak (OR:0.98, 95%CI:0.97,0.996, p<0.05) was significantly associated with decreased odds for mortality. For LOS, increased blood urea nitrogen peak (B:0.001, SE:<0.001, p<0.01), renal replacement therapy (B:0.19, SE:0.06, p<0.01), and increased days to acute kidney injury (B:0.19, SE:0.05, p<0.001) were each significantly associated with increased length of stay. Conclusion Our study emphasizes the importance in identifying renal involvement parameters in COVID-19 patients. These parameters are associated with LOS and mortality, and may assist clinicians to prognosticate COVID-19 patients with renal involvement.

Acute Kidney Injury as a Predictor of in-Hospital Mortality in Patients With a Diagnosis of Severe Covid-19

“…On the other hand, it was identified that the cohort exposed to ARI had a higher level of serum creatinine at admission compared to the non-exposed cohort (0.68% vs 0.84%), which is similar to the results obtained by Cheng et al 21 , showing that elevated creatinine levels predicted a higher probability of developing ARF during hospitalization. Furthermore, in the study by Gómez-Paz et al 22 found that higher creatinine values were related to a higher death rate in Covid-19 patients who developed ARF, which could be due to the loss of renal excretory function, giving way to the storage of nitrogenous products such as urea and creatinine. Furthermore, when there is a decrease in GFR (<50%), creatinine becomes a functional marker, its excretion depending not only on glomerular filtration but also on the renal tubules, reaching 50% as a compensation mechanism by reducing the glomerular filtration rate.…”

“…Furthermore, in the study by Gómez-Paz et al 22 found that higher creatinine values were related to a higher death rate in Covid-19 patients who developed ARF, which could be due to the loss of renal excretory function, giving way to the storage of nitrogenous products such as urea and creatinine. Furthermore, when there is a decrease in GFR (<50%), creatinine becomes a functional marker, its excretion depending not only on glomerular filtration but also on the renal tubules, reaching 50% as a compensation mechanism by reducing the glomerular filtration rate.…”

Unveiling the Unexpected: Why Doctors Should Look beyond the Lungs when Predicting COVID-19 Mortality

“…Many studies have traditionally focused on laboratory parameters and respiratory factors, such as images, respiratory rate, and oxygen saturation as these have been traditionally linked with COVID-19's pulmonary nature [6,22,23]. However, recent research has identified renal parameters, including AKI and CKD, as factors that contribute to increased mortality from COVID-19 [9,[24][25][26][27]. Additionally, recent research indicates that eGFR may predict the mortality form COVID-19 [9].…”