Spectrum, Outcomes, and Mortality Predictors of Acute Kidney Injury among Non-COVID-19 Patients during COVID-19 Pandemic: Data from Four Intensive Care Units

Abstract

A bstract Introduction The data of acute kidney injury (AKI), that is, community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI) among non-COVID patients from intensive care units (ICU) during the coronavirus disease-2019 (COVID-19) pandemic are scarce. We planned to study the change in the profile of such patients compared to the pre-pandemic era. Materials and methods This prospective observational study was conducted at four ICUs dealing with non-COVID patients at a government hospital in North India, and was aimed at assessing outcomes, and mortality predictors of AKI among non-COVID patients during the COVID-19 pandemic. Renal and patient survival at ICU transfer-out and hospital discharge, ICU and hospital stay duration, mortality predictors, and dialysis requirement at discharge were evaluated. The current or previous COVID-19 infection, previous AKI or chronic kidney disease (CKD), organ donors, and organ transplant patients were excluded. Results Among the 200 non-COVID-19 AKI patients, diabetes mellitus (DM), primary hypertension, and cardiovascular diseases were the predominant comorbidities in descending order. The commonest cause of AKI was severe sepsis, followed by systemic infections and post-surgery patients. Dialysis requirements at ICU admission during ICU stay and above 30 days were seen in 20.5, 47.5, and 6.5% of patients, respectively. Incidence of CA-AKI and HA-AKI was 1.24:1, whereas dialysis requirement above 30 days was 0.85:1, respectively. The 30-day mortality was 42%. Hepatic dysfunction [hazard ratio (HR): 3.471], septicemia (HR: 3.342), age above 60 years (HR: 4.000), higher sequential organ failure assessment (SOFA) score (HR: 1.107; p = 0.001), anemia ( p = 0.003), and low serum iron ( p = 0.001) were important mortality predictors in AKI. Conclusion Compared to the pre-COVID era, CA-AKI was more common than HA-AKI due to restricted elective surgeries during the COVID-19 pandemic. Acute kidney injury with multiorgan involvement and hepatic dysfunction, elderly age with higher SOFA score and sepsis were predictors of adverse renal and patient outcomes. How to cite this article Singh B, Dogra PM, Sood V, Singh V, Katyal A, Dhawan M, et al . Spectrum, Outcomes, and Mortality Predictors of Acute Kidney Injury among Non-COVID-19 Patients during COVID-19 Pandemic: Data from Four Intensive Care Units. Indian J Crit Care Med 2023;27(2):119–126.

Deliberating a Re(n)al-world Research Setting

“…Singh et al are sincerely congratulated for their exemplary research endeavor assessing the spectrum of acute kidney injury (AKI) amongst non-COVID-19 patients across 200 adult patients admitted to four intensive care units (ICUs) in their tertiary care center. 1 Ahead of the interesting observations on the AKI pattern emanating from the index study, there remain additional points necessitating deliberation for improved comprehension of the subject.…”

“…Quite understandably, they attribute the same to restricted surgeries during times of pandemic. 1 Appropriate to the context, Boyer et al elaborate an even more important role of the nature of surgical interventions in determining the overall predisposition to postoperative AKI. 2 Withstanding, one misses the account of the type of surgeries performed in the Singh et al prospective study.…”

“…Notably, so the study involved two surgical ICUs with post-surgery being the third leading etiology with a 22.5% contribution to the AKI burden. 1 Moreover, with one of the ICUs being dedicated to cardiothoracic surgical care, the operative use of cardiopulmonary bypass would have also been far from benign with regards to AKI as an outcome. 1 , 2 …”

“… 1 Moreover, with one of the ICUs being dedicated to cardiothoracic surgical care, the operative use of cardiopulmonary bypass would have also been far from benign with regards to AKI as an outcome. 1 , 2 …”

“…Secondly, the lack of data on the diagnostic-therapeutic procedural use of contrast agents in the critically ill culminating into AKI, limits the understanding of the disease spectrum in the present study. 1 Contrast administration, alongside accentuating the propensity to AKI has relevant prognostic implications highlighted by Cheng et al in a large cohort of 2,77,898 hospitalized patients. 3 Furthermore, the former group discovered elevated all-cause mortality in the post-contrast AKI subset with persistent renal dysfunction (RR; 95% CI: 3.77; 1.61–8.81, p -value = 0.002).…”