The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study

Sang, Ling; Chen, Sibei; Zheng, Xia; Guan, Weijun; Zhang, Zhihui; Liang, Wenhua; Zhong, Ming; Jiang, Li; Pan, Chun; Zhang, Wei; Xia, Jiaan; Chen, Nanshan; Wu, Wenjuan; Wu, Haishan; Xu, Yonghao; Liu, Xuesong; Liu, Xiaoqing; He, Jianxing; Li, Shiyue; Zhang, Dingyu; Zhong, Nanshan; Li, Yimin

doi:10.1186/s12890-020-01305-5

Cited by 42 publications

(57 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The rate of AKI among our group was higher than the reported rate by Wang et al, who found that only twelve (10.8%) experienced a slight increase in serum creatinine or urea nitrogen within the first 48 h of hospital stay; however, this report was in non-critically ill COVID-19 patients (Wang et al, 2020a,b). Previous studies have identified older age and comorbidities, and severe ARDS as risk factors for AKI in hospitalized and critically ill viral infection patients (Sang et al, 2020). After adjusting our population baseline disease severity, we found that AKI is a significant risk factor for ICU mortality in critically ill COVID-19 patients.…”

Section: Discussionmentioning

confidence: 52%

Clinical features and outcomes of critically ill patients with coronavirus disease 2019 (COVID-19): A multicenter cohort study

Sulaiman¹,

Aljuhani²,

Eljaaly³

et al. 2021

International Journal of Infectious Diseases

View full text Add to dashboard Cite

Background Coronavirus disease-19 (COVID-19) manifested by a broad spectrum of symptoms, ranging from asymptomatic manifestations to severe illness and death. The purpose of the study was to extensively describe the clinical features and outcomes in critically ill patients with COVID19 in Saudi Arabia. Method A multi-center, non-interventional, cohort study for all critically ill patients aged 18 years or older who are admitted to intensive care units (ICUs) between March 1 st to August 31 st , 2020 with an objectively confirmed diagnosis of COVID19. The diagnosis of COVID19 was confirmed by Reverse Transcriptase–Polymerase Chain Reaction (RT-PCR) on nasopharyngeal and/or throat swabs. Multivariate logistic regression and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. Results A total of 560 patients met the inclusion criteria. An extensive list of clinical features were associated with higher 30-days ICU mortality rate such as requiring mechanical ventilation (MV) or developing acute kidney injury within 24 hours of ICU admission, higher body temperature, white blood cells, blood glucose level, serum creatinine, fibrinogen, procalcitonin, creatine phosphokinase, aspartate aminotransferase and Total iron-binding capacity. The most common complication during ICU stay was respiratory failure that required MV (71.4%), followed by acute kidney injury (AKI) and thrombosis with a proportion of 46.8% and 11.4% respectively. Conclusion Among patients with COVID19 who were admitted to the ICU, several variables were associated with increasing the risk of ICU mortality at 30 days. Respiratory failure that required MV, AKI and thrombosis were the most common complications during ICU stay.

show abstract

Section: Discussionmentioning

confidence: 52%

Clinical features and outcomes of critically ill patients with coronavirus disease 2019 (COVID-19): A multicenter cohort study

Sulaiman¹,

Aljuhani²,

Eljaaly³

et al. 2021

International Journal of Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Several mechanisms are possibly involved in kidney injury during SARS-CoV-2 infection, including direct invasion of SARS-CoV-2 into the renal parenchyma, an imbalanced RAAS and microthrombosis but also kidney injury secondary to hemodynamic instability, inflammatory cytokines, and the consequences of therapeutics that are used in ICU (nephrotoxic drugs, mechanical ventilation). [55][56][57] The images are presented in Figure 3. We also compared changes in laboratory indicators in patients with and without kidney damage.…”

Section: Discussionmentioning

confidence: 99%

Abnormal Indexes of Liver and Kidney Injury Markers Predict Severity in COVID-19 Patients

Qu¹,

Zhu²,

Huang³

et al. 2021

IDR

View full text Add to dashboard Cite

Background SARS-CoV-2 can damage not only the lungs but also the liver and kidney. Most critically ill patients with coronavirus disease 2019 (COVID-19) have liver and kidney dysfunction. We aim to investigate the levels of liver and kidney function indexes in mild and severe COVID-19 patients and their capability to predict the severity of the disease. Methods The characteristics and laboratory indexes were compared between patients with different conditions. We applied binary logistic regression to find the independent risk factors of severe patients. Receiver operating characteristic (ROC) analysis was used to predict the severity of COVID-19 using the liver and kidney function indexes. Results This study enrolled 266 COVID-19 patients, including 235 mild patients and 31 severe patients. Compared with mild patients, severe patients had lower albumin (ALB) and higher alanine aminotransferase (ALT), aspartate aminotransferase (AST), and urea nitrogen (BUN) (all p<0.001). Binary logistic regression analysis also identified ALB [OR=0.273 (0.079–0.947), p=0.041] and ALT [OR=2.680 (1.036–6.934), p=0.042] as independent factors of severe COVID-19 patients. Combining ALB, ALT, BUN, and LDH exhibited the area under ROC at 0.914, with a sensitivity of 86.7% and specificity of 83.0%. Conclusion COVID-19 patients, especially severe patients, have damage to liver and kidney function. ALT, AST, LDH, and BUN could be independent factors for predicting the severity of COVID-19. Combining the ALB, ALT, BUN, and LDH could predict the transition from mild to severe in COVID-19 patients.

show abstract

“…Administration of nephrotoxins (for example, vancomycin, colistin and aminoglycosides) has also been associated with an increased risk of AKI in patients with COVID-19 (ref. 151 ).…”

Section: Pathophysiology Of Covid-19 Akimentioning

confidence: 99%

Pathophysiology of COVID-19-associated acute kidney injury

et al. 2021

View full text Add to dashboard Cite

Although respiratory failure and hypoxaemia are the main manifestations of COVID-19, kidney involvement is also common. Available evidence supports a number of potential pathophysiological pathways through which acute kidney injury (AKI) can develop in the context of SARS-CoV-2 infection. Histopathological findings have highlighted both similarities and differences between AKI in patients with COVID-19 and in those with AKI in non-COVID-related sepsis. Acute tubular injury is common, although it is often mild, despite markedly reduced kidney function. Systemic haemodynamic instability very likely contributes to tubular injury. Despite descriptions of COVID-19 as a cytokine storm syndrome, levels of circulating cytokines are often lower in patients with COVID-19 than in patients with acute respiratory distress syndrome with causes other than COVID-19. Tissue inflammation and local immune cell infiltration have been repeatedly observed and might have a critical role in kidney injury, as might endothelial injury and microvascular thrombi. Findings of high viral load in patients who have died with AKI suggest a contribution of viral invasion in the kidneys, although the issue of renal tropism remains controversial. An impaired type I interferon response has also been reported in patients with severe COVID-19. In light of these observations, the potential pathophysiological mechanisms of COVID-19-associated AKI may provide insights into therapeutic strategies.

show abstract

The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study

Cited by 42 publications

References 30 publications

Clinical features and outcomes of critically ill patients with coronavirus disease 2019 (COVID-19): A multicenter cohort study

Clinical features and outcomes of critically ill patients with coronavirus disease 2019 (COVID-19): A multicenter cohort study

Abnormal Indexes of Liver and Kidney Injury Markers Predict Severity in COVID-19 Patients

Pathophysiology of COVID-19-associated acute kidney injury

Contact Info

Product

Resources

About