Critically ill Covid-19 patients with acute kidney injury: A single-center cohort study

Abstract

Background/Aim: Acute kidney injury (AKI) is a common serious complication associated with morbidity and mortality in critically ill COVID-19 patients. Although there is very limited data on the incidence of AKI in this cohort, conflicting results were recently reported. The incidence of AKI in critically ill COVID-19 patients ranged between 0.5-50% in the early studies. This study aimed to evaluate the incidence and determine the demographic parameters, clinical courses, and outcomes of AKI in critically ill COVID-19 patients admitted to the intensive care unit (ICU). Methods: After ethics committee approval was obtained, critically ill COVID-19 patients admitted to our ICU between June 1- December 30, 2020, were analyzed in this retrospective cohort study. Patients over the age of 18 years who were admitted to the intensive care unit with the diagnosis of COVID-19 or whose real-time polymerase chain reactions (RT-PCR) test were positive were included in the study. Incidence and stages of AKI among the included critically ill COVID-19 patients were evaluated. The patients were divided into two groups according to the presence of AKI to define the risk factors and clinical outcomes. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines based on serum creatinine and urine output. Results: We analyzed seventy-four critically ill confirmed COVID-19 patients. The mean age was 70.7 (14.8) years and 63.5% were male. Thirty-four patients (45.9%) had AKI, 12 patients in stage I (16.2%), 13 patients in stage II (17.6%), and 9 patients in stage III (12.1%). Renal replacement therapy (RRT) was initiated in 28.4% of patients with AKI; 16.2% received intermittent hemodialysis and 12.2%, continuous renal replacement therapy. APACHE II score and GCS at ICU admission were similar in patients with or without AKI (P>0.05), but the SOFA score was significantly higher in patients with AKI (P=0.03). ARDS and shock were significantly higher in patients with AKI than without (P=0.01 and P=0.039, respectively). Compared to the patients without AKI, those with AKI required higher amounts of oxygen therapy (high-flow oxygen therapy, non-invasive mechanical ventilation) and invasive mechanical ventilation (P=0.01 and P/g,""); st = st.replace(//g,""); st = st.replace(/<\/strong>/g,""); st = st.replace(/ /g,""); let title = "Background/Aim:"; if(st.includes(title)){ st = st.replace(title, ""+title+" "); } else{ title = "Aim:"; st = st.replace(title, ""+title+""); } let titles = ["Methods:", "Conclusion:", "Results:"]; titles.forEach((title, ndx) => { //console.log(title); st = st.replace(title, " "+title+""); }); //console.log(st); innerHTML = ''+st+''; }); Downloads Download data is not yet available. References WHO. Novel coronavirus – China. Jan 12, 2020. http://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/ (accessed Jan 19, 2020). COVID-19 (SARS-CoV-2 INFECTION) guide. Republic of Turkey, Ministry of Health November 7th 2020, Ankara. https://covid19.saglik.gov.tr/TR-66301/covid-19-rehberi.html Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020 Mar;579(7798):270-3. doi: 10.1038/s41586-020-2012-7. Epub 2020 Feb 3. PMID: 32015507; PMCID: PMC7095418. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020 Apr;14(2):185-92. doi: 10.1007/s11684-020-0754-0. Epub 2020 Mar 12. PMID: 32170560; PMCID: PMC7088738. Kabbani N, Olds JL. Does COVID19 Infect the Brain? If So, Smokers Might Be at a Higher Risk. Mol Pharmacol. 2020 May;97(5):351-3. doi: 10.1124/molpharm.120.000014. Epub 2020 Apr 1. PMID: 32238438; PMCID: PMC7237865. Jiang L, Zhu Y, Luo X, Wen Y, Du B, Wang M, Zhao Z, Yin Y, Zhu B, Xi X. Beijing Acute Kidney Injury Trial (BAKIT) workgroup. Epidemiology of acute kidney injury in intensive care units in Beijing: the multi-center BAKIT study. BMC Nephrol. 2019 Dec 16;20(1):468. doi: 10.1186/s12882-019-1660-z. PMID: 31842787; PMCID: PMC6915890. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015 Aug;41(8):1411-23. doi: 10.1007/s00134-015-3934-7. Epub...