Abstract
Risk factors associated with severity and mortality attributable to COVID-19 have been reported in different cohorts, highlighting the occurrence of acute kidney injury (AKI) in 25% of them. Among other, SARS-CoV-2 targets renal tubular cells and can cause acute renal damage. The aim of the present study was to evaluate the usefulness of urinary parameters in predicting intensive care unit (ICU) admission, mortality and development of AKI in hospitalized patients with COVID-19. Retrospective observational study, in a tertiary care hospital, between March 1st and April 19th, 2020. We recruited adult patients admitted consecutively and positive for SARS-CoV-2. Urinary and serum biomarkers were correlated with clinical outcomes (AKI, ICU admission, hospital discharge and in-hospital mortality) and evaluated using a logistic regression model and ROC curves. A total of 199 COVID-19 hospitalized patients were included. In AKI, the logistic regression model with a highest area under the curve (AUC) was reached by the combination of urine blood and previous chronic kidney disease, with an AUC of 0.676 (95%CI 0.512–0.840; p = 0.023); urine specific weight, sodium and albumin in serum, with an AUC of 0.837 (95% CI 0.766–0.909; p < 0.001) for ICU admission; and age, urine blood and lactate dehydrogenase levels in serum, with an AUC of 0.923 (95%CI 0.866–0.979; p < 0.001) for mortality prediction. For hospitalized patients with COVID-19, renal involvement and early alterations of urinary and serum parameters are useful as prognostic factors of AKI, the need for ICU admission and death.
Highlights
Risk factors associated with severity and mortality attributable to COVID-19 have been reported in different cohorts, highlighting the occurrence of acute kidney injury (AKI) in 25% of them
The receiver-operating characteristics (ROC) curve analyses performed on the different significant clinical variables and biomarkers revealed that the highest area under the curve (AUC) was reached by a combination of urine specific weight, sodium and albumin in serum, with an AUC of 0.837
We found that patients with adverse clinical outcomes were predominantly older men with an age above 65 years, chronic kidney disease, lower levels of sodium and albumin in serum and an lactate dehydrogenase (LDH) activity > 400 Urate (mg/dL) Albumin (g/L) AST (U/L) upon hospital admission, which correlated with the severity of the in-hospital episode compared to those hospitalized patients without these initial findings
Summary
Risk factors associated with severity and mortality attributable to COVID-19 have been reported in different cohorts, highlighting the occurrence of acute kidney injury (AKI) in 25% of them. The aim of the present study was to evaluate the usefulness of urinary parameters in predicting intensive care unit (ICU) admission, mortality and development of AKI in hospitalized patients with COVID-19. Abbreviations AKI Acute kidney injury ACE2 Angiotensin-converting enzyme receptor 2 AUC Area under the curve CKD Chronic kidney disease COVID-19 Coronavirus disease CRP C-reactive protein CK Creatinine phosphokinase eGFR Estimated glomerular filtration rate HF Heart failure ICU Intensive care unit IQR Interquartile ranges amplitude KDIGO Kidney Disease: Improving Global Outcomes LDH Lactate dehydrogenase ROC Receiver-operating characteristics ARDS Respiratory distress syndrome in the adult. Several severity and mortality-associated risk factors have been r eported[6,7,8], with acute kidney injury (AKI) being described in up to 25% of p atients[6,9]. AKI onset has been described on the 9 days after hospital admission due to COVID-19, and associated to factors such as age, infection severity, cardiorenal syndrome and diabetes[6,9]
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