Acute Kidney Injury Is Associated With In-hospital Mortality in Older Patients With COVID-19

Abstract Background The epidemic of COVID-19 presents a special threat to older adults. However, information on kidney damage in older patients with COVID-19 is limited. Acute kidney injury (AKI) is common in hospitalized adults and associated with poor prognosis. We sought to explore the association between AKI and mortality in older patients with COVID-19. Methods We conducted a retrospective, observational cohort study in a large tertiary care university hospital in Wuhan, China. All consecutive inpatients older than 65 years with COVID-19 were enrolled in this cohort. Demographic data, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between patients with AKI and without AKI. The association between AKI and mortality was analyzed. Results Of 1764 in-hospital patients, 882 older adult cases were included in this cohort. The median age was 71 years (interquartile range: 68–77), 440 (49.9%) were men. The most presented comorbidity was cardiovascular diseases (58.2%), followed by diabetes (31.4%). Of 882 older patients, 115 (13%) developed AKI and 128 (14.5%) died. Patients with AKI had higher mortality than those without AKI (68 [59.1%] vs 60 [7.8%]; p < .001). Multivariable Cox regression analysis showed that increasing odds of in-hospital mortality are associated with higher interleukin-6 on admission, myocardial injury, and AKI. Conclusions Acute kidney injury is not an uncommon complication in older patients with COVID-19 but is associated with a high risk of death. Physicians should be aware of the risk of AKI in older patients with COVID-19.

Download Full-text

Duration of Acute Kidney Injury and in-hospital Mortality in Elder Patients With Severe COVID-19: a Retrospective Cohort Study

10.21203/rs.3.rs-580679/v1 ◽

2021 ◽

Author(s):

Yue Cai ◽

Qinglin Li ◽

Shanshan Guo ◽

Yanyan Chen ◽

Fang Wang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Cox Regression ◽

Kidney Injury ◽

Final Analysis ◽

Prognostic Impact ◽

Cox Regression Analysis ◽

Elder Patients ◽

Kaplan Meier ◽

Transient Aki

Abstract Background Patients with severe coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality. This study evaluated the prognostic impact of AKI duration on in-hospital mortality in elder patients.Methods We performed a retrospective study of 126 patients with confirmed COVID-19 with severe or critical disease who treated in the ICU from February 4, 2020, to April 16, 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes serum creatinine (Scr) criteria. AKI patients were divided into transient AKI and persistent AKI groups based on whether Scr level returned to baseline within 48 h post-AKI.Results In total, 107 patients were included in the final analysis. The mean age was 70 (64–78) years, and 69 (64.5%) patients were men. AKI occurred in 48 (44.9%) during their ICU stay. Of these, 11 (22.9%) had transient AKI, 37 (77.9%) had persistent AKI. In-hospital mortality was 18.6% (n =11) for patients without AKI, 72.7% (n=8) for patients with transient AKI, and 86.5% (n=32) for patients with persistent AKI (P<0.001). Kaplan–Meier curve analysis revealed that patients with both transient AKI and persistent AKI had significantly higher death rates than those without AKI (log-rank P<0.001). Multivariate Cox regression analysis revealed that transient and persistent AKI were an important risk factor for in-hospital mortality in older patients with severe COVID-19 even after adjustment for variables (hazard ratio [HR]=2.582; 95% CI: 1.025–6.505; P=0.044; and HR=6.974; 95% CI: 3.334–14.588; P<0.001).Conclusions AKI duration is a useful parameter to predict of worse clinical outcomes in elder patients with COVID-19 in the ICU. Among AKI patients, those persistent AKI have a lower in-hospital survival rate than those transient AKI, emphasizing the importance of identifying an appropriate treatment window for early intervention.

Download Full-text

Incidence, Risk Factors and Mortality Outcome in Patients with Acute Kidney Injury in COVID-19: A Single-Center Observational Study

10.1101/2020.06.24.20138230 ◽

2020 ◽

Cited By ~ 1

Author(s):

Alfano Gaetano ◽

Ferrari Annachiara ◽

Fontana Francesco ◽

Mori Giacomo ◽

Magistroni Riccardo ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cox Regression ◽

Case Fatality ◽

Kidney Injury ◽

Serum Levels ◽

University Hospital ◽

Hospital Death ◽

Cox Regression Analysis ◽

Incidence Risk

AbstractBackgroundAcute kidney injury (AKI) is a recently recognized complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate the incidence, risk factors and case-fatality rate of AKI in patients with documented COVID-19.MethodsWe reviewed the health medical records of 307 consecutive patients hospitalized for symptoms of COVID-19 at the University Hospital of Modena, Italy.ResultsAKI was diagnosed in 69 out of 307 (22.4%) patients. The stages of AKI were stage 1 in 57.9%, stage 2 in 24.6% and stage 3 in 17.3%. Hemodialysis was performed in 7.2% of the subjects. AKI patients had a mean age of 74.7±9.9 years and higher serum levels of the main marker of inflammation and organ involvement (lung, liver, hearth and liver) than non-AKI patients. AKI events were more frequent in subjects with severe lung comprise. Two peaks of AKI events coincided with in-hospital admission and death of the patients. Kidney injury was associate with a higher rate of urinary abnormalities including proteinuria (0.448±0.85 vs 0.18±0.29; P=<0.0001) and hematuria (P=0.032) compared to non-AKI patients. At the end of follow-up, 65.2% of the patients did not recover their renal function after AKI. Risk factors for kidney injury were age, male sex, CKD and non-renal SOFA. Adjusted Cox regression analysis revealed that AKI was independently associated with in-hospital death (hazard ratio [HR]=3.74; CI 95%, 1.34-10.46) compared to non-AKI patients. Groups of patients with AKI stage 2-3 and failure to recover kidney function were associated with the highest risk of in-hospital mortality. Lastly, long-hospitalization was positively associated with a decrease of serum creatinine, likely due to muscle depletion occurred with prolonged bed rest.ConclusionsAKI was a dire consequence of patients with COVID-19. Identification of patients at high-risk for AKI and prevention of kidney injury by avoiding dehydration and nephrotoxic agents is imperative in this vulnerable cohort of patients.

Download Full-text

Acute Kidney Injury in Sub-Sahara Africa: A Single-Center Experience from Khartoum, Sudan

Blood Purification ◽

10.1159/000485214 ◽

2018 ◽

Vol 45 (1-3) ◽

pp. 201-207 ◽

Cited By ~ 2

Author(s):

Dalia E. Yousif ◽

Alice R. Topping ◽

Maha F. Osman ◽

Jochen G. Raimann ◽

Elfadil M. Osman ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cox Regression ◽

Kidney Injury ◽

University Hospital ◽

Hair Dye ◽

Cox Regression Analysis ◽

Tertiary Referral Center ◽

Single Center Experience ◽

Kaplan Meier ◽

Poor Outcomes

Background: The burden of acute kidney injury (AKI) is high in Africa. While there are no reliable statistics about AKI in Africa, the Global Snapshot Study of the 0by25 initiative of the International Society of Nephrology has determined dehydration, infections, animal envenomation, and complications during pregnancy as the main causes. Methods: This study was conducted at the Soba University Hospital (SUH), Khartoum, Sudan, a tertiary referral center. We included all hemodialysis patients treated for AKI at SUH between January 1, 2013 and December 31, 2014 in the study. We reviewed patients’ hospital records and characterized pathogenesis, treatment, and patient outcomes. In addition, we investigated survival by Kaplan-Meier and Cox regression analysis. Results: Out of 520 patients who received emergency HD, 71 patients (14%) had AKI (age 40.6 ± 17.3 years, 56.5% were males). Glomerular and tubular-interstitial diseases were the leading cause of AKI, followed by envenomation and intoxication by hair dye. Patients received a median of 5 dialysis sessions for a median of 8 days. In 32 patients (45%) renal function recovered, 10 patients (14%) died, and 29 patients (41%) remained dialysis-dependent. Mortality was significantly higher in females compared to men (hazard ratio 4.1 [95% CI 1.02–16.67]). Outcomes were worse in patients with pre-renal AKI and intoxications. Conclusion: Our results indicate a higher mortality in females and in patients with pre-renal AKI and intoxications. Awareness of factors associating with poor outcomes is central to diagnostic and therapeutic efforts, and must be considered in the design of initiatives to reduce risk factors and improve outcomes of AKI in developing countries.

Download Full-text

Development of a Prediction Score for In-Hospital Mortality in COVID-19 Patients with Acute Kidney Injury: A Machine Learning Approach

10.21203/rs.3.rs-426545/v1 ◽

2021 ◽

Author(s):

Daniela Ponce ◽

Luis Gustavo Modelli de Andrade ◽

Rolando Claure-Del Granado ◽

Alejandro Ferrero Fuentes ◽

Raul Lombardi

Keyword(s):

Machine Learning ◽

Acute Kidney Injury ◽

Latin America ◽

Hospital Mortality ◽

Validation Cohort ◽

Demographic Data ◽

Kidney Injury ◽

Learning Approach ◽

Risk Of Death ◽

Machine Learning Approach

Abstract Introduction: Acute kidney injury (AKI) is frequently associated to COVID-19, and is considered an indicator of severity of disease and is thus associated with increased mortality risk”. Objective: The aim of the study was to develop and validate a prognostic score at hospital admission for predicting in-hospital mortality in COVID-19 patients with AKI (AKI-COV score).Design: Cross-sectional multicenter prospective cohort study.Setting: The Latin America AKI COVID-19 Registry has been conducted in 57 cities in 12 countries from Latin America. Model training was performed on a cohort of patients admitted from May 1 to December 31, 2020. Participants: Eight hundred and seventy COVID-19 patients with AKI defined according KDIGO serum creatinine criteria were included between 01 May to 31 December 2020.Material and Methods: We evaluated four categories of predictor variables available at the time of AKI diagnosis: (1) demographic data; (2) comorbidities and condition at admission; (3) laboratory exams at admission; (4) characteristics and causes of AKI. We used a machine learning approach to fit models in the training set using 10-fold-cross validation. Predictors with more than 30% missing were removed. We select the best model and confirm the accuracy in a validation cohort using the area under the receiver operating characteristic curve (AUC-ROC). Main Outcome Measured: In-hospital mortality.Results: There were 544 (62.5%) in-hospital deaths. Increasing age, mechanical ventilation, use of vasopressors, leukocytes number[RC1] transaminases levels, hypertension, severe condition at admission, AKI ethiology, and need kidney replacement therapies (KRT) were associated with increased risk of death. Longer time from symptoms to hospitalization or to AKI diagnosis, and higher urine output were associated with reduced risk of death. The coefficients of the best model (Elastic Net) were used to build the predictive ImAgeS score. The final model has an AUC-ROC of 0.823 [95% CI 0.761 – 0.885] in the validation cohort. Conclusion: We developed a predictive model using only demographic data, comorbidities, hospital admission condition, laboratory variables and causes of AKI that shows good accuracy and is easily applicable. The use of AKI-COV score may assist health-care workers in identifying hospitalized COVID-19 patients with AKI that may require more intensive monitoring and can be used for resource allocation.

Download Full-text

Kidney function on admission predicts in-hospital mortality in COVID-19

10.1101/2020.06.18.20134627 ◽

2020 ◽

Cited By ~ 1

Author(s):

Sinan Trabulus ◽

Cebrail Karaca ◽

İlker İnanç Balkan ◽

Mevlüt Tamer Dincer ◽

Ahmet Murt ◽

...

Keyword(s):

Acute Kidney Injury ◽

Logistic Regression ◽

Regression Analysis ◽

Mortality Rate ◽

Hospital Mortality ◽

Kidney Function ◽

Cox Regression ◽

Kidney Injury ◽

Reciprocal Relationship ◽

Cox Regression Analysis

AbstractBackgroundRecent data have reinforced the concept of a reciprocal relationship between COVID-19 and kidney function. However, most studies have focused on the effect of COVID-19 on kidney function, whereas data regarding kidney function on the COVID-19 prognosis is scarce. Therefore, in this study, we aimed to investigate the association between eGFR on admission and the mortality rate of COVID-19.MethodsWe recruited 336 adult consecutive patients (male 57.1%, mean age 55.0±15.9) that were hospitalized with the diagnosis of COVID-19 in the tertiary care university hospital. Data were collected from the electronic health records of the hospital. On admission, eGFR was calculated using the CKD-EPI formula. Acute kidney injury was defined according to the KDIGO criteria. Binary logistic regression and Cox regression analyses were used to assess the relationship between eGFR on admission and in-hospital mortality of COVID-19.ResultsBaseline eGFR was under 60 mL/min/1.73m2 in 61 patients (18.2%). Acute kidney injury occurred in 29.1% of the patients. In-hospital mortality was calculated as 12.8%. Age-adjusted and multivariate logistic regression analysis (p:0.005, odds ratio:0.974, CI:0.956-0.992) showed that baseline eGFR was independently associated with mortality. Additionally, age-adjusted Cox regression analysis revealed a higher mortality rate in patients with an eGFR under 60 mL/min/1.73m2.ConclusionsOn admission eGFR seems to be a prognostic marker for mortality in patients with COVID-19; We recommend to determine eGFR in all patients on admission and use it as an additional tool for risk stratification. Close follow-up should be warranted in patients with reduced eGFR.

Download Full-text

PREDICTORS OF IN-HOSPITAL MORTALITY IN PATIENTS WITH SNAKE BITE IN POPULATION OF KARACHI, PAKISTAN

Gomal Journal of Medical Sciences ◽

10.46903/gjms/17.04.1861 ◽

2019 ◽

Vol 17 (4) ◽

pp. 107-111

Author(s):

Harish Kumar ◽

Adnan Bashir ◽

Khadijah Abid ◽

Nabeel Naeem Baig

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Medical Center ◽

Kidney Injury ◽

Hazard Ratio ◽

Snake Bite ◽

Rank Test ◽

Cross Sectional ◽

Early Management ◽

Risk Of Death

Background: Snake bite remains major public health problems worldwide. The objective of this study was to determine predictors of in-hospital mortality in patients presenting with snake bite in population of Karachi, Pakistan. Materials & Methods: It was cross-sectional study conducted at Department of General Medicine, Postgraduate Medical Center, Karachi, Pakistan from 11th June 2016 to 10th August 2017. 300 patients with snake bite were selected. Age, gender, acute kidney injury, vomiting and in-hospital mortality were variables. Except age, all variables were nominal and were analyzed by frequency and percentage. Cox-proportional-hazard regression model was applied and hazard ratios were calculated along with 95% confidence intervals (CI) to assess the strength of association between predictors i.e. age, gender, AKI and vomiting and outcome (in-hospital mortality). Kaplan-Meier and time to event plot were used to investigate all patients who were on follow-up for 7 days from admission. Log-rank test was used to identify the predictors of in-hospital mortality for significant independent influence on prognosis at alpha .05. Results: The mean age of the sample was 27.7±14.58 years. Out of a sample of 300 patients, 221 (73.7%) were males and 79 (26.3%) females. The frequency (%) of AKI was 102 (66%), vomiting 122 (40.7%) and of in-hospital mortality 31 (10.3%). The probability of survival at day 7 was 81.8%. Vomiting [hazard ratio 6.86 (95% CI: 2.78-16.93), p=<0.001] and acute kidney injury [hazard ratio 3.85 (95% CI: 1.75-8.45), p=<0.001] were associated with higher risk of death in adjusted analysis. Conclusion: Acute kidney injury and vomiting are strong predictors of mortality among patients with snake bite. These predictors can be helpful for clinicians in assessing prognosis of their patients more accurately and by early management of these factors, mortality & morbidity can be reduced.

Download Full-text

The Interplay between Anticholinergic Burden and Anemia in Relation to 1-Year Mortality among Older Patients Discharged from Acute Care Hospitals

Journal of Clinical Medicine ◽

10.3390/jcm10204650 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4650

Author(s):

Andrea Corsonello ◽

Luca Soraci ◽

Francesco Corica ◽

Valeria Lago ◽

Clementina Misuraca ◽

...

Keyword(s):

Older Patients ◽

Cox Regression ◽

Effect Modifier ◽

Cox Regression Analysis ◽

Multicenter Observational Study ◽

Risk Of Death ◽

Anticholinergic Medications ◽

Relevant Effect ◽

Increased Risk ◽

Anticholinergic Burden

Anticholinergic burden (ACB) and anemia were found associated with an increased risk of death among older patients. Additionally, anticholinergic medications may contribute to the development of anemia. Therefore, we aimed at investigating the prognostic interplay of ACB and anemia among older patients discharged from hospital. Our series consisted of 783 patients enrolled in a multicenter observational study. The outcome of the study was 1 year mortality. ACB was assessed by an Anticholinergic Cognitive Burden score. Anemia was defined as hemoglobin < 13 g/dL in men and <12 g/dL in women. The association between study variables and mortality was investigated by Cox regression analysis. After adjusting for several potential confounders, ACB score = 2 or more was significantly associated with the outcome in anemic patients (HR = 1.93, 95%CI = 1.13–3.40), but not non anemic patients (HR = 1.51, 95%CI = 0.65–3.48). An additive prognostic interaction between ACB and anemia was observed (p = 0.02). Anemia may represent a relevant effect modifier in the association between ACB and mortality.

Download Full-text

COVID-19 in-hospital mortality and mode of death in a dynamic and non-restricted tertiary care model in Germany

10.21203/rs.3.rs-48983/v1 ◽

2020 ◽

Author(s):

Siegbert Rieg ◽

Maja von Cube ◽

Johannes Kalbhenn ◽

Stefan Utzolino ◽

Katharina Pernice ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Mortality ◽

Cox Regression ◽

Medical Center ◽

Tertiary Care ◽

Study Entry ◽

Hospital Death ◽

Care Model ◽

Cox Regression Analysis ◽

Hospitalised Patients

Abstract BackgroundReported mortality of hospitalised COVID-19 patients varies substantially, particularly in critically ill patients. So far COVID-19 in-hospital mortality and modes of death under optimised care conditions have not been systematically studied.MethodsThis retrospective observational monocenter cohort study was performed after implementation of a non-restricted, dynamic tertiary care model at the University Medical Center Freiburg, an experienced ARDS and ECMO referral center. All hospitalised patients with PCR-confirmed SARS-CoV-2 infection were included. The primary endpoint was in-hospital mortality, secondary endpoints included major complications and modes of death. A multistate analysis and a Cox regression analysis for competing risk models were performed. Modes of death were determined by two independent reviewers.ResultsBetween February 25, and May 8, 213 patients were included in the analysis. The median age was 65 years, 129 patients (61%) were male. 70 patients (33%) were admitted to the intensive care unit (ICU), of which 57 patients (81%) received mechanical ventilation and 23 patients (33%) extracorporeal membrane-oxygenation (ECMO) support. According to the multistate model the probability to die within 90 days after COVID-19 onset was 24% in the whole cohort. If the levels of care at time of study entry were accounted for, the probabilities to die were 16% if the patient was initially on a regular ward, 47% if in the ICU and 57% if mechanical ventilation was required at study entry. Age ≥ 65 years and male sex were predictors for in-hospital death. Predominant complications – as judged by two independent reviewers – determining modes of death were multi-organ failure, septic shock and thromboembolic and hemorrhagic complications.ConclusionIn a dynamic care model COVID-19-related in-hospital mortality remained substantial. In the absence of potent antiviral agents, strategies to alleviate or prevent the identified complications should be investigated. In this context, multistate analyses enable comparison of models-of-care and treatment strategies and allow estimation and allocation of health care resources.RegistrationGerman Clinical Trials Register (identifier DRKS00021775), retrospectively registered June 10, 2020.

Download Full-text

Acute Kidney Injury Outcomes of Elderly and Nonelderly Patients in the Medical Intensive Care Unit of a University Hospital in a Developing Country

Critical Care Research and Practice ◽

10.1155/2020/2391683 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Wanjak Pongsittisak ◽

Kashane Phonsawang ◽

Solos Jaturapisanukul ◽

Surazee Prommool ◽

Sathit Kurathong

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Mortality Rate ◽

Hospital Mortality ◽

Medical Intensive Care Unit ◽

Kidney Injury ◽

The Elderly ◽

University Hospital ◽

Medical Intensive Care

Background. Aging is associated with a high risk of acute kidney injury (AKI), and the elderly with AKI show a higher mortality rate than those without AKI. In this study, we compared AKI outcomes between elderly and nonelderly patients in a university hospital in a developing country. Materials and Methods. This retrospective cohort study included patients with AKI who were admitted to the medical intensive care unit (ICU) between January 1, 2012, and December 31, 2017. The patients were divided into the elderly (eAKI; age ≥65 years; n = 158) and nonelderly (nAKI; n = 142) groups. Baseline characteristics, comorbidities, principle diagnosis, renal replacement therapy (RRT) requirement, hospital course, and in-hospital mortality were recorded. The primary outcome was in-hospital mortality. Results. The eAKI group included more females, patients with higher Acute Physiology and Chronic Health Evaluation II scores, and patients with more comorbidities than the nAKI group. The etiology and staging of AKI were similar between the two groups. There were no significant differences in in-hospital mortality (p=0.338) and RRT requirement (p=0.802) between the two groups. After adjusting for covariates, the 28-day mortality rate was similar between the two groups (p=0.654), but the 28-day RRT requirement was higher in the eAKI group than in the nAKI group (p=0.042). Conclusion. Elderly and nonelderly ICU patients showed similar survival outcomes of AKI, although the elderly were at a higher risk of requiring RRT.

Download Full-text

Peritoneal dialysis with a lower dosage versus conventional intermittent hemodialysis in acute kidney injury: A propensity-matched study

Peritoneal Dialysis International ◽

10.1177/0896860820970851 ◽

2020 ◽

pp. 089686082097085

Author(s):

Watanyu Parapiboon ◽

Thosapol Chumsungnern ◽

Treechada Chamradpan

Keyword(s):

Acute Kidney Injury ◽

Peritoneal Dialysis ◽

Mortality Rate ◽

Hospital Mortality ◽

Kidney Injury ◽

Apache Ii ◽

Apache Ii Score ◽

Intermittent Hemodialysis ◽

Risk Of Death ◽

Risk Of Mortality

Background: Literature regarding the outcomes of lower dosage peritoneal dialysis (PD) in treating acute kidney injury (AKI) among resource-limited setting is sparse. This study aims to compare the risk of mortality in patients with AKI receiving lower PD dosage and conventional intermittent hemodialysis (IHD) in Thailand. Methods: In a tertiary center in Thailand, a matched case–control study using propensity scores in patients with AKI was conducted to compare the outcomes between lower PD dosage (18 L per day for first two sessions, weekly Kt/ V 2.2) and IHD (three times a week) from February 2015 to January 2016. The primary outcome was a 30-day in-hospital mortality rate. Secondary outcomes included dialysis dependence at 90 days. Results: Eighty-four patients were included (28 PD and 56 IHD). Patient characteristics were comparable between two treatment groups. Overall, the mean age was 58 years. Most of the patients were critically ill (87% need mechanical ventilator; mean acute physiological and chronic health evaluation (APACHE II) score: 25). The 30-day in-hospital mortality rate was similar between the PD and IHD patients (57% vs. 46%, p = 0.36). The dialysis dependence rate was also comparable at 90 days. The risk of death among AKI patients was higher in those with respiratory failure, higher APACHE II score, and starting dialysis with blood urea nitrogen greater than 70 mg dL−1. Conclusion: Clinical outcomes, including risk of mortality and 90-day dialysis dependence among patients with AKI, appear to be comparable between lower dosage PD and IHD.

Download Full-text