POS-860 Correlation of AKI with risk factors, ventilatory support, renal replacement therapy in a cohort of COVID-19 patients

Abstract

India, the second-most populous country with the second-largest burden of COVID-19 and the case fatality rate of 1.3 %, has put immense pressure on the healthcare system with partial collapse of the infrastructure. There was gross under-reporting of COVID-19 related morbidity and mortality as in any other developing country due to inadequate documentation and healthcare facilities. The confluence of different disciplines of medicine such as allopathy, Ayurveda, homoeopathy, naturopathy, and Siddha were all utilised to prevent and treat COVID-19 in India. Since there is a scarcity of information on the Incidence and Outcomes of Acute Kidney Injury in COVID-19 patients in India. We analysed the correlation of AKI risk factors, ventilatory support, and renal replacement therapy in this tertiary care centre in COVID-19 patients. In this single centre retrospective study, we analysed patients medical records with positive RT-PCR for Sars-CoV2 between July 2020 and May 2021. Inclusion criteria: 1) Patients who tested positive for COVID-19 with available admission serum creatinine values (n= 1260). 2) Age ≥ 18 years. Exclusion criteria: 1) patients with end-stage kidney disease. 2) those with missing admission serum creatinine. 3) hospitalization lasted < 24 hours. AKI was defined using the kidney disease: Improving Global Outcomes. Statistical analysis was performed using SPSS software version 26 (SPSS, Inc., New York). A total of 1260 patients with COVID-19 were included in our cohort. The median duration of illness onset to admission was 6 days. Median Age = 56 (IQR 47 -66). Diabetes was the most frequent comorbidity (55.2%), followed by hypertension (42.1%) and hypothyroidism (11.3%). A total of 229 (18.17%) patients were admitted in ICU; 574 (45.5%) received ventilation; 26 (2.0%) required invasive mechanical ventilation; 36 (2.9%) patients died, patients requiring renal replacement therapy were 0.6% (n=8).Among 1260 patients, 6.8% (n=86) patients developed AKI; Stage 1 AKI - 57 (66%); Stage 2 AKI - 20 (23%); Stage 3 AKI - 9 (11%). Because the median period from sickness to admission was 6 days, 98% of the patients presented with AKI on the day of admission. Disposition of patients with AKI: ICU admission (54.6%) Required ventilation (72.09%) Mortality (24.41%) Requiring mechanical ventilation: (72.09%) The incidence of in-hospital death in the patients with AKI as per the stage from 1 to 3 was 9 (15.8%), 7 (35%), 5 (55.6%), respectively. Risk factors for AKI: Diabetes OR 1.95 (1.219 – 3.148) Hypertension OR 3.25 (2.031 – 5.201) Coronary artery disease OR 4.035 (2.33 – 6.9) Dyslipidemia OR 3.002 (1.413 – 6.376) C reactive protein ≥ 10 mg/dl, OR 3.66 (1.67 – 8.037) D-dimer ≥ 250 pg/ml, OR 4.206 (2.57 – 6.87) Blood urea ≥ 20 mg/dl, OR 12.244 (2.29 – 50.1) Need for ventilation OR 3.063 (1.88 – 4.9) Conclusión: In our retrospective study the AKI prevalence was 6.8%, with a mortality rate of 24.4%, patients requiring dialysis were 0.63%.