Abstract
BackgroundWhile acute kidney injury (AKI) is frequent in severe SARS-CoV2-related pneumonia ICU patients, few data are still available about its risk factors.MethodsRetrospective observational study performed in four university affiliated hospitals in Paris. AKI was defined according to the KIDGO guidelines. Factors associated with AKI were picked up using multivariable mixed-effects logistic regression. Independent risk factors of day 28 mortality were assessed using Cox model.Results379 patients (median age 62 [53,69], 77% of male) were included. Half of the patients had AKI (n = 195, 52%) including 58 patients (15%) with AKI stage 1, 44 patients (12%) with AKI stage 2, and 93 patients (25% with AKI stage 3). Chronic kidney disease (OR 7.41; 95% CI 2.98–18.4), need for invasive mechanical ventilation at day 1 (OR 4.83; 95% CI 2.26–10.3), need for vasopressors at day 1 (OR 2.1; 95% CI 1.05–4.21) were associated with increased risk of AKI. Day 28 mortality in the cohort was 26.4% and was higher in patients with AKI (37.4 vs. 14.7%, P < 0.001). Neither AKI (HR 1.35; 95% CI 0.78–2.32) nor AKI stage were associated with mortality (HR [95% CI] for stage 1, 2 and 3 when compared to no AKI of, respectively, 1.02 [0.49–2.10], 1.73 [0.81–3.68] and 1.42 [0.78–2.58]).ConclusionIn this large cohort of SARS-CoV2-related pneumonia patients admitted to the ICU, AKI was frequent, mostly driven by preexisting chronic kidney disease and life sustaining therapies, with unclear adjusted relationship with day 28 outcome.
Highlights
While acute kidney injury (AKI) is frequent in severe SARS-CoV2-related pneumonia Intensive Care Unit (ICU) patients, few data are still available about its risk factors
We aimed to evaluate factors associated with AKI occurrence as well as its impact on day 28 mortality in SARS-CoV2 patients admitted to the ICU in four intensive care units from the Parisian area
Baseline characteristics Overall, 379 COVID-19 patients were admitted in the participating ICUs during the study periods (Additional file 1: Figure S1)
Summary
While acute kidney injury (AKI) is frequent in severe SARS-CoV2-related pneumonia ICU patients, few data are still available about its risk factors. The outbreak of severe acute respiratory syndrome (SARS-CoV2)-related disease has widely spread for almost a year [1]. The clinical presentation is mainly respiratory, potentially leading to severe respiratory failure [2]. Such a respiratory failure is complex and related to at least several factors including viral direct lung injury as well as multiple microthrombosis [3]. Kidney involvement is common in COVID-19 patients and may be observed in up to 40% of cases [4]. Kidney congestion related to right ventricular failure or interactions with mechanical ventilation, endothelitis may be the cornerstone of organ—and especially the kidney—involvement in SARSCoV2-related pneumonia
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