Acute Kidney Injury in Non-Intensive Care Unit (ICU) Hospitalizations for Coronavirus Disease (COVID-19)
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Ethics
2.2. Study Population and Inclusion Criteria
2.3. Exclusion Criteria
2.4. Data Collection and Measurements
2.5. Definitions
2.6. Outcomes
2.7. Statistical Analyses
3. Results
3.1. Baseline Characteristics
3.2. Acute Kidney Injury
3.3. Mortality
4. Discussion
5. Disclosures
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ACEIs | Angiotensin Converting Enzymes |
AE | Adverse Events |
AH | Arterial hypertension |
AKI | Acute kidney injury |
ARBs | Angiotensin receptor blockers |
CI | Confidence intervals |
CKD | Chronic kidney disease |
COVID-19 | Coronavirus disease 2019 |
COPD | Chronic obstructive pulmonary disease |
CPAP | Continuous positive airway pressure |
DM | Diabetes mellitus |
eGFR | Estimated glomerular filtration rate |
ESRD | End-stage renal disease |
FANS | Non-steroidal anti-inflammatory drugs |
HD | Haemodialysis |
HFNC | High flow nasal cannula |
ICU | Intensive care unit |
KDIGO | Kidney Disease: Improving Global Outcomes |
NA | Not available |
PRES | Posterior reversible encephalopathy syndrome |
RRT | Renal replacement therapy |
SARS-CoV-2 | Severe acute respiratory syndrome coronavirus 2 |
UTI | Urinary tract infection |
VM | Venturi mask |
WHO | World Health Organization |
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Patients, n | n = 387 |
---|---|
Age, years | 66.0 ± 15.81 |
Males, n | 247/387 (63.8%) |
Positive medical history: | |
Arterial hypertension, n | 174/387 (44.9%) |
Cardiomiopathy, n | 98/387 (25.3%) |
Chronic kidney insufficiency, n | 40/387 (10.3%) |
Chronic obstructive pulmonary disease (COPD), n | 38/387 (9.8%) |
Diabetes mellitus, n | 65/387 (16.8%) |
Malignancy, n | 53/387 (13.7%) |
Peripheral arterial disease, n | 50/387 (12.9%) |
Biochemistry at admission: | |
Serum creatinine, mg/dL | 1.59 ± 7.34 |
Azotemia, mg/dL | 51.9 ± 44 |
PCR, mg/L | 11.85 ± 21.9 |
IL-6, pg/mL | 91.9 ± 127.9 |
D-dimer, mcg/mL | 4420.1 ± 22,368 |
White blood cells, n | 8234.3 ± 4594.8 |
Lymphocytes, n | 1250.9 ± 2154.9 |
ALT, IU/L | 67.0 ± 216.7 |
LDH, IU/L | 342.3 ± 177.3 |
Ferritin, ng/mL | 876 (26,714; 69) |
Physical parameters at admission: | |
Blood pressure, mmHg | 131.1 ± 19.1/75.8 ± 12.0 |
Heart rate, bpm | 88.4 ± 17.3 |
Body temperature, degree | 37.9 ± 7.8 |
PaO2/FiO2 | 267.12 ± 102.5 |
(Stage 0) PaO2/FiO2 (>300) | 153 (46.7%)/328 |
(Stage 1) PaO2/FiO2 (300–201) | 89 (27.1%)/328 |
(Stage 2) PaO2/FiO2 (200–101) | 60 (18.3%)/328 |
(Stage 3) PaO2/FiO2 (≤100) | 26 (7.9%)/328 |
Medical therapy at admission: | |
Angiotensin Converting Enzymes ACEIs, n | 47/386 (12.2%) |
Angiotensin Receptor Blockers ARBs, n | 39/386 (10.1%) |
Patients, n | n = 387 |
---|---|
AKI | 119/387 (30.7%) |
AKI stage 1 | 74/118 (62.7%) |
AKI stage 2 | 26/118 (22%) |
AKI stage 3 | 18/118 (15.2%) |
Respiratory support: | |
Low flow oxygen delivery, n | 202/387 (52.2%) |
High flow oxygen delivery, n | 192/387 (49.6%) |
Mechanical ventilation, n | 72/387 (18.6%) |
Clinical manifestations (and adverse events) during hospital stay: | |
SARS-CoV-2 -related pneumonia, n | 372/387 (96.1%) |
Anaemia, n | 11/387 (2.8%) |
Atrial fibrillation, n | 8/387 (2.0%) |
Haemodialysis, n | 6/387 (1.5%) |
Ischemic stroke, n | 2/387 (0.05%) |
Multi-organ failure, n | 10/387 (2.6%) |
Pleural effusion, n | 3/387 (0.07%) |
Posterior reversible encephalopathy syndrome (PRES), n | 2/387 (0.05%) |
Sepsis, n | 67/387 (17.3%) |
Thrombosis, n | 23/387 (5.9%) |
Urinary tract infection (UTI), n | 2/387 (0.05%) |
Concurrent medical therapy: | |
ACEIs and/or ARBs, n | 140/386 (36.3%) |
Antibiotics, n | 319/386 (82.6%) |
Antivirals, n | 147/386 (82.6%) |
Diuretics, n | 133/386 (34.4%) |
FANS, non-steroidal anti-inflammatory drugs, n | 87/387 (22.4%) |
Glucocorticoids, n | 159/385 (41.3%) |
Heparin, n | 326/386 (84.4%) |
Hydroxychloroquine, n | 342/385 (88.8%) |
Patients, n | AKI (n = 119) | No AKI (n = 268) | p |
---|---|---|---|
Age, years | 73.0 ± 14.9 | 62.2 ± 15.8 | 0.0001 |
Males, n | 79 (66.4%) | 168 (62.7%) | NS |
Systolic BP, mmHg | 125.3 ± 21 | 132.3 ± 18 | 0.04 |
Diastolic BP, mmHg | 69.7 ± 16.2 | 76.7 ± 11.3 | 0.001 |
Heart rate, bpm | 86.9 ± 20 | 88.5 ± 15.3 | NS |
Positive medical history: | |||
Arterial hypertension, n | 73 (61.3%) | 101 (41%) | 0.0001 |
Cardiomiopathy, n | 39 (32.7%) | 59 (22%) | 0.02 |
Chronic kidney insufficiency, n | 22 (18.5%) | 18 (6.7%) | 0.0001 |
COPD, n | 12 (10%) | 26 (9.7%) | NS |
Diabetes mellitus, n | 25 (21%) | 40 (14.9%) | NS |
Malignancy, n | 20 (16.8%) | 33 (12.3%) | NS |
Peripheral arterial disease, n | 27 (22.7%) | 23 (8.6%) | 0.0001 |
Biochemistries at admission: | |||
Creatinine, mg/dL | 1.82 ± 0.98 | 1.49 ± 8.8 | NS |
Azotemia, mg/dL | 80.1 ± 57.2 | 38.8 ± 28.1 | 0.001 |
Oxigen delivery at admission: | |||
Low flow (Nasal cannulas/masks) | 64 (53.8%) | 138 (51.5%) | NS |
High flow (C-PAP/HFNC) | 69 (57.9%) | 123 (45.9%) | 0.01 |
Mechanical ventilation | 22 (18.5%) | 50 (18.9%) | NS |
Medical therapy at admission: | |||
ACEIs, n | 22 (18.5%) | 25 (9.4%) | 0.01 |
ARBs, n | 16 (13.4%) | 23 (8.6%) | NS |
At admission: | |||
PaO2/FiO2 | 237.0 ± 107.1 | 286.2 ± 100 | 0.001 |
Body temperature, degree | 37.3 ± 4.7 | 37.9 ± 7.5 | NS |
Patients, n | AKI (n = 119) | No AKI (n = 268) | p |
---|---|---|---|
Medical therapy during hospital stay: | |||
Antibiotics, n | 108 (91.5%) | 211 (78.7%) | 0.001 |
Antivirals, n | 42 (35.3%) | 105 (39.3%) | NS |
Diuretics, n | 49 (41.5%) | 84 (31.3%) | 0.035 |
FANS, n | 28 (23.5%) | 59 (22%) | NS |
Glucocorticoids, n | 59 (50%) | 100 (37.4%) | 0.01 |
Heparin, n | 101 (85.5%) | 225 (83.9%) | NS |
Hydroxychloroquine, n | 103 (87.3%) | 239 (89.5%) | NS |
ACEIs/ARBs, n | 48 (40.3%) | 92 (34.3%) | NS |
Clinical parameters during in-hospital stay: | |||
Multi Organ Failure (MOF), n | 7 (5.9%) | 3 (1.1%) | 0.01 |
Haemodialysis (HD), n | 6 (5%) | 0 | 0.001 |
Severe COVID-19, n | 86 (94.5%) | 149 (86.1%) | 0.02 |
COVID-19 related pneumonia, n | 117 (98%) | 255 (95.1%) | NS |
Sepsis, n | 31 (26%) | 36 (13.4%) | 0.002 |
Biochemistries at admission: | |||
IL-6, pg/mL | 159.6 ± 195 | 65.3 ± 74 | 0.0001 |
LDH, IU/L | 399.8 ± 197.8 | 316.78 ± 161.4 | 0.001 |
PCR, mg/dL | 12.2 ± 10 | 11.6 ± 25.5 | NS |
D-dimer, mcg/mL | 5663.64 ± 26791.1 | 3873.6 ± 20173.3 | NS |
Ferritin, ng/mL | 2264.3 ± 3518,4 | 1103.1 ± 1145.7 | 0.001 |
ALT, IU/L | 99.3 ± 375.5 | 53.1 ± 78.9 | NS |
B | SE | Wald Test | p | Exp (B) | |
---|---|---|---|---|---|
LDH | 0.001 | 0.001 | 0.872 | 0.350 | 1.001 |
IL-6 | 0.006 | 0.003 | 4.578 | 0.032 | 1.006 |
Ferritin | 0.000 | 0.000 | 4.384 | 0.036 | 1.000 |
Azotemia | 0.039 | 0.010 | 15.651 | 0.000 | 1.040 |
Arterial hypertension | 0.087 | 0.532 | 0.027 | 0.871 | 1.090 |
Peripheral arterial disease | 0.534 | 0.734 | 0.529 | 0.467 | 1.706 |
Cardiomiopathy | 0.110 | 0.610 | 0.032 | 0.857 | 1.116 |
COPD | −3.77 | 1.949 | 3.754 | 0.053 | 0.023 |
ACEIs/ARBs | −0.366 | 0.509 | 0.516 | 0.472 | 0.694 |
Constant | −4.528 | 0.854 | 28.107 | 0.0001 | 0.011 |
Patients, n | Exitus (n = 69) | No Exitus (n = 318) | p |
---|---|---|---|
Age, years | 78 ± 12 | 63 ± 15 | 0.001 |
Males, n | 44/69 (63.8%) | 203/318 (63.8%) | NS |
Body temperature, degree | 37.3 ± 1.08 | 37.9 ± 7.9 | NS |
Positive medical history: | |||
Arterial hypertension, n | 47/69 (68%) | 127/318 (39.9%) | 0.001 |
Cardiomiopathy, n | 36/69 (52.1%) | 62/318 (19.5%) | 0.001 |
Chronic kidney insufficiency, n | 15/69 (21.7%) | 25/318 (7.9%) | 0.02 |
COPD, n | 14/69 (20.2%) | 24/318 (7.5%) | 0.001 |
Diabetes mellitus, n | 16/69 (23.1%) | 49/318 (15.4%) | NS |
Malignancy, n | 21/69 (30.4%) | 32/317 (10%) | 0.001 |
Peripheral arterial disease, n | 24/69 (34.8%) | 26/318 (8.2%) | 0.001 |
Biochemistries at admission: | |||
Creatinine, mg/dL | 1.44 ± 0.6 | 1.62 ± 8.1 | 0.001 |
Azotemia, mg/dL | 75.0 ± 50.7 | 47.6 ± 51.0 | 0.001 |
Oxigen delivery at admission: | |||
Low flow (Nasal cannulas/masks) | 30/69 (43.5%) | 172/318 (54%) | NS |
High flow (C-PAP/HFNC) | 40/69 (57.9%) | 152/318 (47.8%) | NS |
Mechanical ventilation | 2/69 (2.9%) | 70/318 (22%) | 0.001 |
Medical therapy at admission: | |||
ACEIs, n | 7/67 (10.5%) | 40/318 (12.6%) | NS |
ARBs, n | 6/68 (8.9%) | 34/318 (10.7%) | NS |
Patients, n | Exitus (n = 69) | No Exitus (n = 317) | p |
---|---|---|---|
Biochemistries at admission: | |||
IL-6, pg/mL | 116.2 ± 95 | 89.7 ± 130.5 | NS |
LDH, IU/L | 372.8 ± 151 | 337.8 ± 180.5 | NS |
PCR, mg/dL | 12.4 ± 9.1 | 11.7 ± 23.6 | NS |
D-dimer, mcg/mL | 2912.3 ± 4434 | 4624.3 ± 23778.6 | NS |
Ferritin, ng/mL | 1831.5 ± 4337 | 1412.7 ± 1732.3 | 0.02 |
ALT, IU/L | 152.5 ± 521.06 | 50.8 ± 60.2 | 0.001 |
White blood cells | 9432.1 ± 4802 | 7985.5 ± 4518 | 0.04 |
AKI, n | 39 (56.5%) | 80 (25.1%) | 0.0001 |
AKI stage 1, n | 24 (34.7%) | 50 (15.7%) | |
AKI stage 2, n | 10 (14.4%) | 16 (5%) | |
AKI stage 3, n | 5 (7%) | 13 (16.2%) |
Patients, n | Exitus (n = 69) | No Exitus (n = 317) | p |
---|---|---|---|
Medical therapy during hospital stay: | |||
Antibiotics, n | 64/69 (92.7%) | 255/317 (80.4%) | 0.01 |
Diuretics, n | 37/69 (53.6%) | 96/317 (30.3%) | 0.001 |
FANS, n | 17/69 (24.6%) | 70/318 (22%) | NS |
Glucocorticoids, n | 26/69 (37.7%) | 133/316 (42%) | NS |
Heparin, n | 54/69 (78.3%) | 272/317 (85.8%) | NS |
Hydroxychloroquine, n | 57/69 (82.6%) | 285/316 (90.2%) | NS |
ACEIs/ARBs, n | 23/69 (33.3%) | 117/317 (36.9%) | NS |
Antivirals, n | 22/69 (31.9%) | 125/317 (39.4%) | NS |
Contrast medium, n | 7/69 (10.1%) | 65/318 (20.4%) | NS |
Clinical parameters during hospital stay: | |||
MOF, n | 3/69 (4.3%) | 7/318 (2.2%) | NS |
Sepsis, n | 14/69 (20.3%) | 53/318 (16.7%) | NS |
COVID-19 related pneumonia, n | 68/69 (98.5%) | 304/318 (95.6%) | NS |
HD, n | 0 | 6/318 (1.9%) | NS |
Severe COVID-19, n | 49/51 (96%) | 186/213 (87.3%) | 0.04 |
Biochemistries during hospital stay: | |||
Serum creatinine, mg/dL | 1.36 ± 0.88 | 0.9 ± 0.34 | 0.0001 |
Azotemia, mg/dL | 84.09 ± 45.7 | 37.7 ± 30.4 | 0.0001 |
D-dimer, mcg/mL | 6086.5 ± 10,709.0 | 1180.8 ± 1254.8 | 0.0001 |
IL-6, pg/mL | 51.4 ± 65.1 | 38.2 ± 168.8 | NS |
ALT, IU/L | 45.9 ± 51.3 | 52.2 ± 42.4 | NS |
LDH, IU/L | 418.4 ± 179.8 | 206.2 ± 69.6 | 0.001 |
PCR, mg/dL | 52.7 ± 317.2 | 1.26 ± 2.32 | 0.004 |
White blood cells | 10,021.7 ± 5082.5 | 6736.7 ± 2364.6 | 0.0001 |
B | SE | Wald Test | p | Exp (B) | |
---|---|---|---|---|---|
Age | 0.109 | 0.027 | 15.969 | 0.000 | 1.115 |
Arterial hypertension | 0.119 | 0.574 | 0.043 | 0.836 | 1.112 |
Cardiomiopathy | 1.605 | 0.530 | 9.19 | 0.002 | 4.98 |
COPD | 0.269 | 0.770 | 0.122 | 0.726 | 1.3 |
ACEIs/ARBs | −0.865 | 0.604 | 2.051 | 0.152 | 0.421 |
Creatinine | −0.11 | 0.419 | 0.069 | 0.792 | 0.85 |
Azotemia | −0.001 | 0.006 | 0.042 | 0.838 | 0.994 |
Ferritin | 0.002 | 0.000 | 22.898 | 0.000 | 1.002 |
Chronic kidney insufficiency | 0.386 | 0.894 | 0.186 | 0.666 | 1.471 |
Constant | −12.279 | 2.356 | 27.156 | 0.000 | 0.000 |
B | SE | Wald Test | p | Exp (B) | |
---|---|---|---|---|---|
AKI stage (1) | 1.446 | 0.625 | 5.363 | 0.021 | 4.248 |
AKI stage (2) | 2.052 | 0.787 | 6.792 | 0.009 | 7.781 |
AKI stage (3) | −0.117 | 1.261 | 0.009 | 0.926 | 0.889 |
Ferritin | 0.000 | 0.000 | 1.236 | 0.266 | 1.000 |
D-dimer | 0.000 | 0.000 | 0.096 | 0.754 | 1.000 |
GB | 0.000 | 0.000 | 11.610 | 0.001 | 1.000 |
Constant | −4.134 | 0.740 | 31.219 | 0.000 | 0.016 |
HR (95% CI) or Wald Test (SE) | p | |
---|---|---|
Unadjusted | 3.85 (2.24; 6.60) | p < 0.001 |
Adjusted (model 1) | 10.089 (±0.576) | p = 0.001 |
Adjusted (model 2) | 5.363 (±0.625) | p = 0.021 |
Adjusted (model 3) | 3.959 (±0.569) | p = 0.041 |
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Fabrizi, F.; Alfieri, C.M.; Molinari, P.; Tamborini, F.; Tangredi, M.; Sikharulidze, A.; Blasi, F.; Fracanzani, A.; Monzani, W.; Peyvandi, F.; et al. Acute Kidney Injury in Non-Intensive Care Unit (ICU) Hospitalizations for Coronavirus Disease (COVID-19). Pathogens 2022, 11, 1272. https://doi.org/10.3390/pathogens11111272
Fabrizi F, Alfieri CM, Molinari P, Tamborini F, Tangredi M, Sikharulidze A, Blasi F, Fracanzani A, Monzani W, Peyvandi F, et al. Acute Kidney Injury in Non-Intensive Care Unit (ICU) Hospitalizations for Coronavirus Disease (COVID-19). Pathogens. 2022; 11(11):1272. https://doi.org/10.3390/pathogens11111272
Chicago/Turabian StyleFabrizi, Fabrizio, Carlo M. Alfieri, Paolo Molinari, Francesco Tamborini, Marianna Tangredi, Anna Sikharulidze, Francesco Blasi, Anna Fracanzani, Walter Monzani, Flora Peyvandi, and et al. 2022. "Acute Kidney Injury in Non-Intensive Care Unit (ICU) Hospitalizations for Coronavirus Disease (COVID-19)" Pathogens 11, no. 11: 1272. https://doi.org/10.3390/pathogens11111272