Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality

Jin Hyuk Paek,Yaerim Kim,Woo Yeong Park,Miri Hyun,Hyun Ah Kim,Ji Yeon Lee,Kyubok Jin,Seungyeup Han,Jae Seok Park,Yong Shik Kwon,Jennifer A Hirst

doi:10.1371/journal.pone.0243528

Abstract

Although the lungs are major targets for COVID-19 invasion, other organs—such as the kidneys—are also affected. However, the renal complications of COVID-19 are not yet well explored. This study aimed to identify the incidence of acute kidney injury (AKI) in patients with COVID-19 and to evaluate its impact on patient outcomes. This retrospective study included 704 patients with COVID-19 who were hospitalized at two hospitals in Daegu, Korea from February 19 to March 31, 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The final date of follow-up was May 1, 2020. Of the 704 patients, 28 (4.0%) developed AKI. Of the 28 patients with AKI, 15 (53.6%) were found to have AKI stage 1, 3 (10.7%) had AKI stage 2, and 10 (35.7%) had AKI stage 3. Among these patients, 12 (42.9%) recovered from AKI. In the patients with AKI, the rates of admission to intensive care unit (ICU), administration of mechanical ventilator (MV), and in-hospital mortality were significantly higher than in patients without AKI. Multivariable analysis revealed that old age (Hazard ratio [HR] = 4.668, 95% confidence interval [CI] = 1.250–17.430, p = 0.022), high neutrophil-to-lymphocyte ratio (HR = 1.167, 95% CI = 1.078–1.264, p < 0.001), elevated creatinine kinase (HR = 1.002, 95% CI = 1.001–1.004, p = 0.007), and severe AKI (HR = 12.199, 95% CI = 4.235–35.141, p < 0.001) were independent risk factors for in-hospital mortality. The Kaplan-Meier curves showed that the cumulative survival rate was lowest in the AKI stage 3 group (p < 0.001). In conclusion, the incidence of AKI in patients with COVID-19 was 4.0%. Severe AKI was associated with in-hospital death.

Highlights

In late December 2019, a cluster of pneumonia of unknown cause was reported in Wuhan, Hubei province, China [1, 2]
We evaluated the incidence of acute kidney injury (AKI) in COVID-19 patients and its impact on outcomes
We analyzed 704 patients with COVID-19 who were admitted to a tertiary care hospital for treatment of severe to critically severe illness, and a community hospital for treatment of moderately severe illness in Daegu, Korea

Summary

Introduction

In late December 2019, a cluster of pneumonia of unknown cause was reported in Wuhan, Hubei province, China [1, 2]. High-throughput sequencing subsequently identified the pathogen causing this acute respiratory illness as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [3]. Severe acute kidney injury and in-hospital mortality discovered contagious disease as coronavirus disease 19 (COVID-19) [4]. By June 21, 2020, a total of 8,708,008 confirmed cases were reported worldwide, and the mortality rate was 5.3%. In South Korea, one of the earliest countries to experience an outbreak of COVID-19, 12,421 cases were identified with 280 deaths. In Daegu, an explosive increase of COVID-19 cases was reported after infection was initially identified, and 55.5% of COVID-19 patients in Korea were confirmed

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