Background: Coronavirus disease 2019 (COVID-19) is often compared to seasonal influenza and the two diseases share similarities including the risk of systemic manifestations such as acute kidney injury (AKI). The aim of this study was to perform a comparative analysis of the prevalence, risk factors, and outcomes of AKI in hospitalized patients with COVID-19 and influenza. Methods: Retrospective cohort study of hospitalized patients with COVID-19 (n=325) or seasonal influenza (n=433). AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Baseline characteristics and hospitalization data were collected, and multivariable analysis was performed to determine the independent predictors for AKI. Results: AKI occurred in 32.6% of COVID-19 hospitalizations (COV-AKI) and 33.0% of influenza hospitalizations (FLU-AKI). After adjusting for age, gender, and comorbidity count, the risk of stage 3 AKI was significantly higher in COV-AKI (OR: 3.46; 95% CI 1.63, 7.37). Preexisting CKD was associated with a 6- to 7-fold increased likelihood for FLU-AKI and COV-AKI. Mechanical ventilation was associated with a higher likelihood of developing AKI in the COVID-19 cohort (OR: 5.85; 95% CI 2.30, 15.63). African American race, after adjustment for comorbidities, was an independent risk for COV-AKI. Conclusion: Pre-existing CKD was a major risk factor for AKI in both cohorts. African American race (independent of comorbidities) and mechanical ventilation were associated with a higher risk of developing COV-AKI which is characterized by a higher burden of stage 3 AKI and overall poorer prognosis.
MACHINE-LEARNING CHARACTERIZATION OF SUBTLE HEMODYNAMIC INSTABILITY DIFFERENTIATES COVID-19 VERSUS SEASONAL INFLUENZA IN HOSPITALIZED PATIENTS
