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

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

Abstract 196: Acute Kidney Injury in Aneurysmal Subarachnoid Hemorrhage: Incidence, Risk Factors, and Outcomes

Stroke ◽

10.1161/str.47.suppl_1.196 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Kavelin Rumalla ◽

Adithi Reddy ◽

Rajiv Gummadi ◽

Manoj Mittal

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Subarachnoid Hemorrhage ◽

Chronic Renal Disease ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Hospital Costs ◽

Kidney Injury ◽

Hospital Death ◽

Age Group ◽

Incidence Risk

Introduction: Acute kidney injury (AKI) increases morbidity and mortality in several acute illnesses. Here, we examine the incidence, risk factors, and in-hospital outcomes of AKI in patients hospitalized for aneurysmal subarachnoid hemorrhage (aSAH). Methods: The Nationwide Inpatient Sample was queried from 2002 and 2011 for all emergency hospitalizations (age≥18) with a primary diagnosis of aSAH and a secondary diagnosis of AKI. Patients with chronic renal disease, renal transplant, or trauma were excluded from the analysis. The effect of various patient factors on AKI incidence and its impact on length of stay (LOS), in-hospital costs, and in-hospital mortality was examined in bivariate and multivariate analyses. Results: Of 250,437 total hospitalizations for aSAH, the overall incidence of AKI was 4.0% (n=10,450) and increased from 2.1% in 2002 to 5.7% in 2011 (p<0.0001). The strongest multivariate predictors of AKI were 60-74 age group (OR: 1.43, 95% CI: 1.31-1.56), 75+ age group (OR: 1.81, 95% CI: 1.63-2.00), male gender (OR: 1.80, 95% CI: 1.69-1.87), Black race (OR: 1.45, 95% CI: 1.35-1.55), Medicaid insurance (OR: 1.29, 95% CI: 1.19-1.40), congestive heart failure (OR: 2.13, 95% CI: 1.98-2.28), liver disease (OR: 2.42, 95% CI: 2.13-2.75), fluid/electrolyte disorder (OR: 3.10, 95% CI: 2.95-3.27), and HIV (OR: 2.24, 95% CI: 1.66-3.01) (all p<0.0001). Aneurysmal coiling (OR: 0.81, 95% CI: 0.75-0.87) and clipping (OR: 0.75, 95% CI: 0.70-0.80) decreased the likelihood of suffering AKI (all p<0.0001). Cardiac arrest, septic shock, and acute lung injury were in-hospital complications that increased the odds of AKI (all p<0.0001). AKI occurrence in aSAH increased the mean LOS by 7.2 days and mean total costs by $28,813 (all p<0.0001). After adjusting for confounding factors, aSAH related AKI patients had increased likelihood of moderate to severe disability (OR: 2.03, 95% CI: 1.89-2.19, p<0.0001) and in-hospital death (OR: 2.14, 95% CI: 2.03-2.26, p<0.0001). Conclusion: The incidence of AKI in hospitalized aSAH patients has increased over the past decade and is both detrimental to hospital costs and patient prognosis. We identified patient-centered risk factors for AKI, allowing for the close surveillance of patients at the highest risk for AKI.

Download Full-text

Risk factors and prognosis for COVID-19-induced acute kidney injury: a meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-042573 ◽

2020 ◽

Vol 10 (11) ◽

pp. e042573

Author(s):

Lirong Lin ◽

Xiang Wang ◽

Jiangwen Ren ◽

Yan Sun ◽

Rongjie Yu ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Meta Analysis ◽

Evaluation Criteria ◽

Kidney Injury ◽

Hospital Death ◽

Risk Of Death ◽

Study Selection ◽

Incidence Risk ◽

Independent Risk Factors

ObjectiveTo analyse the incidence, risk factors and impact of acute kidney injury (AKI) on the prognosis of patients with COVID-19.DesignMeta-analysis.Data sourcesPubMed, Embase, CNKI and MedRxiv of Systematic Reviews from 1 January 2020 to 15 May 2020.Study selectionStudies examining the following demographics and outcomes were included: patients’ age; sex; incidence of and risk factors for AKI and their impact on prognosis; COVID-19 disease type and incidence of continuous renal replacement therapy (CRRT) administration during COVID-19 infection.ResultsA total of 79 research articles, including 49 692 patients with COVID-19, met the systemic evaluation criteria. The mortality rate and incidence of AKI in patients with COVID-19 in China were significantly lower than those in patients with COVID-19 outside China. A significantly higher proportion of patients with COVID-19 from North America were aged ≥65 years and also developed AKI. European patients with COVID-19 had significantly higher mortality and a higher CRRT rate than patients from other regions. Further analysis of the risk factors for COVID-19 combined with AKI showed that age ≥60 years and severe COVID-19 were independent risk factors for AKI, with an OR of 3.53, 95% CI (2.92–4.25) and an OR of 6.07, 95% CI (2.53–14.58), respectively. The CRRT rate in patients with severe COVID-19 was significantly higher than in patients with non-severe COVID-19, with an OR of 6.60, 95% CI (2.83–15.39). The risk of death in patients with COVID-19 and AKI was significantly increased, with an OR of 11.05, 95% CI (9.13–13.36).ConclusionAKI was a common and serious complication of COVID-19. Older age and having severe COVID-19 were independent risk factors for AKI. The risk of in-hospital death was significantly increased in patients with COVID-19 complicated by AKI.

Download Full-text

Staphylococcus Aureus Bacteriuria as a Predictor of In-Hospital Mortality in Patients with Staphylococcus Aureus Bacteremia. Results of a Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm9020508 ◽

2020 ◽

Vol 9 (2) ◽

pp. 508 ◽

Cited By ~ 1

Author(s):

Tobias Siegfried Kramer ◽

Beate Schlosser ◽

Désirée Gruhl ◽

Michael Behnke ◽

Frank Schwab ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Cohort Study ◽

Hospital Mortality ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Regression ◽

University Hospital ◽

Hospital Death ◽

Cox Regression Analysis

Staphylococcus aureus bloodstream infection (SA-BSI) is an infection with increasing morbidity and mortality. Concomitant Staphylococcus aureus bacteriuria (SABU) frequently occurs in patients with SA-BSI. It is considered as either a sign of exacerbation of SA-BSI or a primary source in terms of urosepsis. The clinical implications are still under investigation. In this study, we investigated the role of SABU in patients with SA-BSI and its effect on the patients’ mortality. We performed a retrospective cohort study that included all patients in our university hospital (Charité Universitätsmedizin Berlin) between 1 January 2014 and 31 March 2017. We included all patients with positive blood cultures for Staphylococcus aureus who had a urine culture 48 h before or after the first positive blood culture. We identified cases while using the microbiology database and collected additional demographic and clinical parameters, retrospectively, from patient files and charts. We conducted univariate analyses and multivariable Cox regression analysis to evaluate the risk factors for in-hospital mortality. 202 patients met the eligibility criteria. Overall, 55 patients (27.5%) died during their hospital stay. Cox regression showed SABU (OR 2.3), Pitt Bacteremia Score (OR 1.2), as well as moderate to severe liver disease (OR 2.1) to be independent risk factors for in-hospital mortality. Our data indicates that SABU in patients with concurrent SA-BSI is a prognostic marker for in-hospital death. Further studies are needed for evaluating implications for therapeutic optimization.

Download Full-text

Acute kidney injury and mortality risk in older adults with COVID-19

Journal of Nephrology ◽

10.1007/s40620-021-01022-0 ◽

2021 ◽

Vol 34 (2) ◽

pp. 295-304

Author(s):

Hong Xu ◽

Sara Garcia-Ptacek ◽

Martin Annetorp ◽

Annette Bruchfeld ◽

Tommy Cederholm ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Acute Kidney Injury ◽

Kidney Function ◽

Kidney Injury ◽

Adverse Outcomes ◽

Hospital Death ◽

Incidence Risk ◽

The Difference ◽

Hospitalized Older Adults

Abstract Background Research regarding COVID-19 and acute kidney injury (AKI) in older adults is scarce. We evaluated risk factors and outcomes of AKI in hospitalized older adults with and without COVID-19. Methods Observational study of patients admitted to two geriatric clinics in Stockholm from March 1st to June 15th, 2020. The difference in incidence, risk factors and adverse outcomes for AKI between patients with or without COVID-19 were examined. Odds ratios (OR) for the risk of AKI and in-hospital death were obtained from logistic regression. Results Three hundred-sixteen older patients were hospitalized for COVID-19 and 876 patients for non-COVID-19 diagnoses. AKI occurred in 92 (29%) patients with COVID-19 vs. 159 (18%) without COVID-19. The odds for developing AKI were higher in patients with COVID-19 (adjusted OR, 1.70; 95% confidence interval [CI] 1.04–2.76), low baseline kidney function as depicted by estimated glomerular filtration rate (eGFR) [4.19 (2.48–7.05), for eGFR 30 to < 60 mL/min, and 20.3 (9.95–41.3) for eGFR < 30 mL/min], and higher C reactive protein (CRP) (OR 1.81 (1.11–2.95) in patients with initial CRP > 10 mg/L). Compared to patients without COVID-19 and without AKI, the risk of in-hospital death was highest in patients with COVID-19 and AKI [OR 80.3, 95% CI (27.3–235.6)], followed by COVID-19 without AKI [16.3 (6.28–42.4)], and by patients without COVID-19 and with AKI [10.2 (3.66–28.2)]. Conclusions Geriatric patients hospitalized with COVID-19 had a higher incidence of AKI compared to patients hospitalized for other diagnoses. COVID-19 and reduced baseline kidney function were risk factors for developing AKI. AKI and COVID-19 were associated with in-hospital death.

Download Full-text

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

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa181 ◽

2020 ◽

Cited By ~ 2

Author(s):

Qi Yan ◽

Peiyuan Zuo ◽

Ling Cheng ◽

Yuanyuan Li ◽

Kaixin Song ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Older Patients ◽

Cox Regression ◽

Demographic Data ◽

Tertiary Care ◽

Kidney Injury ◽

University Hospital ◽

Cox Regression Analysis ◽

Risk Of Death

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

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

Acute kidney injury: Incidence, risk factors, and outcomes in severe COVID-19 patients

PLoS ONE ◽

10.1371/journal.pone.0251048 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251048

Author(s):

Danilo Candido de Almeida ◽

Maria do Carmo Pinho Franco ◽

Davi Rettori Pardo dos Santos ◽

Marina Colella Santos ◽

Isabela Soucin Maltoni ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Univariate Analysis ◽

Kidney Injury ◽

University Hospital ◽

Injury Incidence ◽

Vasoactive Drugs ◽

Reactive Protein ◽

Incidence Risk ◽

Potential Risk Factors

Background COVID-19 is a multisystemic disorder that frequently causes acute kidney injury (AKI). However, the precise clinical and biochemical variables associated with AKI progression in patients with severe COVID-19 remain unclear. Methods We performed a retrospective study on 278 hospitalized patients who were admitted to the ward and intensive care unit (ICU) with COVID-19 between March 2020 and June 2020, at the University Hospital, São Paulo, Brazil. Patients aged ≥ 18 years with COVID-19 confirmed on RT-PCR were included. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the incidence of AKI, several clinical variables, medicines used, and outcomes in two sub-groups: COVID-19 patients with AKI (Cov-AKI), and COVID-19 patients without AKI (non-AKI). Univariate and multivariate analyses were performed. Results First, an elevated incidence of AKI (71.2%) was identified, distributed across different stages of the KDIGO criteria. We further observed higher levels of creatinine, C-reactive protein (CRP), leukocytes, neutrophils, monocytes, and neutrophil-to-lymphocyte ratio (NLR) in the Cov-AKI group than in the non-AKI group, at hospital admission. On univariate analysis, Cov-AKI was associated with older age (>62 years), hypertension, CRP, MCV, leucocytes, neutrophils, NLR, combined hydroxychloroquine and azithromycin treatment, use of mechanical ventilation, and vasoactive drugs. Multivariate analysis showed that hypertension and the use of vasoactive drugs were independently associated with a risk of higher AKI in COVID-19 patients. Finally, we preferentially found an altered erythrocyte and leukocyte cellular profile in the Cov-AKI group compared to the non-AKI group, at hospital discharge. Conclusions In our study, the development of AKI in patients with severe COVID-19 was related to inflammatory blood markers and therapy with hydroxychloroquine/azithromycin, with vasopressor requirement and hypertension considered potential risk factors. Thus, attention to the protocol, hypertension, and some blood markers may help assist doctors with decision-making for the management of COVID-19 patients with AKI.

Download Full-text

Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: A prospective multicenter study*

Critical Care Medicine ◽

10.1097/ccm.0b013e31821201d3 ◽

2011 ◽

Vol 39 (6) ◽

pp. 1493-1499 ◽

Cited By ~ 234

Author(s):

Simon Li ◽

Catherine D. Krawczeski ◽

Michael Zappitelli ◽

Prasad Devarajan ◽

Heather Thiessen-Philbrook ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Multicenter Study ◽

Kidney Injury ◽

Pediatric Cardiac Surgery ◽

Prospective Multicenter Study ◽

Incidence Risk

Download Full-text

Abstract TP161: Gastrointestinal Bowel Obstruction in Acute Ischemic Stroke: Incidence, Risk Factors, and Outcomes

Stroke ◽

10.1161/str.47.suppl_1.tp161 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Kavelin Rumalla ◽

Adithi Y Reddy ◽

Vijay Letchuman ◽

Paul A Berger ◽

Manoj K Mittal

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Bowel Obstruction ◽

Kidney Injury ◽

Hospital Death ◽

Stroke Incidence ◽

Black Race ◽

Electrolyte Disorder ◽

Incidence Risk

Introduction: The prognosis of patients suffering acute ischemic stroke (AIS) is worsened by medical complications that occur during subsequent hospitalization. The incidence, risk factors, and outcomes of gastrointestinal bowel obstruction (GIBO) in AIS have not been previously reported. Methods: We employed the Nationwide Inpatient Sample from 2002 to 2011 to identify all patients admitted with a primary diagnosis of AIS and subsets with and without a secondary diagnosis of GIBO without hernia. Multivariate logistic regression was utilized to analyze predictors of GIBO in AIS patients and the association between GIBO, in-hospital complications, and outcomes. Results: We identified 16,987 patients with GIBO (425 per 100,000) among 3,988,667 AIS hospitalizations and 4.2% of patients of these patients underwent repair surgery for intestinal obstruction. Multivariate predictors of GIBO included: age 55-64 (OR: 1.52, 95% CI: 1.40-1.64), age 65-74 (OR: 1.69, 95% CI: 1.56-1.84), age 75+ (OR: 1.97, 95% CI: 1.81-2.13), black race (OR: 1.42, 95% CI: 1.36-1.49), coagulopathy (OR: 1.39, 95% CI: 1.29-1.50), cancer (OR: 1.59, 95% CI: 1.44-1.75), blood loss anemia (OR: 2.51, 95% CI: 2.22-2.84), fluid/electrolyte disorder (OR: 2.91, 95% CI: 2.81-3.02), weight loss (OR: 3.08, 95% CI: 2.93-3.25), and thrombolytic therapy (OR: 1.30, 95% CI: 1.20-1.42) (all p<0.0001). Patients with GIBO had a greater likelihood of suffering intubation (OR: 1.79, 95% CI: 1.70-1.90), deep vein thrombosis (OR: 1.35, 95% CI: 1.25-1.46), pulmonary embolism (OR: 1.84, 95% CI: 1.53-2.21), sepsis (OR: 2.39, 95% CI: 2.22-2.56), acute kidney injury (OR: 1.85, 95% CI: 1.76-1.95), gastrointestinal hemorrhage (OR: 2.82, 95% CI: 2.63-3.03), and blood transfusions (OR: 2.02, 95% CI: 1.90-2.15) (all p<0.0001). In adjusted analyses, AIS patients with GIBO were 284% and 39% more likely to face moderate to severe disability and in-hospital death, respectively (p<0.0001). GIBO occurrence increased length of stay and total costs by an average of 9.7 days and $22,342 (p<0.0001). Conclusion: Advanced age, black race, and several pre-existing comorbidities increase the likelihood of post-AIS GIBO, which is an independent predictor of in-hospital complications, disability, and mortality.

Download Full-text