Longitudinal Clinical Profiles of Hospital vs. Community-Acquired Acute Kidney Injury in COVID-19.

Justin Y Lu,Ioannis Babatsikos,Molly C Fisher,Tim Q Duong,Wei Hou

doi:10.3389/fmed.2021.647023

Abstract

Acute kidney injury (AKI) is associated with high mortality in coronavirus disease 2019 (COVID-19). However, it is unclear whether patients with COVID-19 with hospital-acquired AKI (HA-AKI) and community-acquired AKI (CA-AKI) differ in disease course and outcomes. This study investigated the clinical profiles of HA-AKI, CA-AKI, and no AKI in patients with COVID-19 at a large tertiary care hospital in the New York City area. The incidence of HA-AKI was 23.26%, and CA-AKI was 22.28%. Patients who developed HA-AKI were older and had more comorbidities compared to those with CA-AKI and those with no AKI (p < 0.05). A higher prevalence of coronary artery disease, heart failure, and chronic kidney disease was observed in those with HA-AKI compared to those with CA-AKI (p < 0.05). Patients with CA-AKI received more invasive and non-invasive mechanical ventilation, anticoagulants, and steroids compared to those with HA-AKI (p < 0.05), but patients with HA-AKI had significantly higher mortality compared to those with CA-AKI after adjusting for demographics and clinical comorbidities (adjusted odds ratio = 1.61, 95% confidence interval = 1.1–2.35, p < 0.014). In addition, those with HA-AKI had higher markers of inflammation and more liver injury (p < 0.05) compared to those with CA-AKI. These results suggest that HA-AKI is likely part of systemic multiorgan damage and that kidney injury contributes to worse outcomes. These findings provide insights that could lead to better management of COVID-19 patients in time-sensitive and potentially resource-constrained environments.

Highlights

Coronavirus disease 2019 (COVID-19) [1, 2] caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) is the worst public health disaster of the century, accounting for millions of infections and deaths globally
There were 148 CA-Acute kidney injury (AKI), 197 hospital-acquired AKI (HA-AKI), and 681 noAKI patients admitted to the general floor
We found that patients who developed HA-AKI were older and had more comorbidities and a higher prevalence of coronary artery disease, heart failure, and chronic kidney disease compared to patients with community-acquired AKI (CA-AKI)

Summary

Introduction

Coronavirus disease 2019 (COVID-19) [1, 2] caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) is the worst public health disaster of the century, accounting for millions of infections and deaths globally. Most studies on AKI associated with COVID-19 have investigated clinical variables upon hospital admission as predictors of AKI. Hospital and Community Acquired AKI in COVID-19 of disease severity, and some patients present with AKI upon admission, known as community-acquired AKI (CA-AKI). It is unclear whether HA-AKI and CA-AKI COVID-19 patients differ in disease severity, course, and outcomes. There are currently limited data on differences in the clinical characteristics and outcomes among patients with HA-AKI and CA-AKI who are hospitalized with COVID-19. A better understanding of the clinical presentation and outcomes of HA-AKI and CA-AKI in the context of COVID-19 may allow for earlier recognition, intervention, and improvement in clinical outcomes

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