scholarly journals Prognostic Value of Serum Creatinine in Severe Covid-19 Patients in Wuhan, China: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Wei-yun Zhang ◽  
De-yu Xu ◽  
Chang-guo Wang ◽  
Ying-ying Liu ◽  
Jian-an Huang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Poor Prognosis ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Hospital Death ◽  
Multivariate Logistic Regression ◽  
Kaplan Meier ◽  
Independent Risk Factors ◽  
Study Laboratory ◽  
Severe Type

Abstract Objectives: Although the respiratory and immune systems are the major targets of SARS-CoV-2, increasing evidence revealed that kidney injury was not rare in coronavirus disease 2019 (COVID-19). However, the incidences of kidney abnormalities were significantly different, from 0.5 to 75.4% in several reports. The association of kidney injury with prognosis remain controversial.Methods:In this retrospective single center cohort study, laboratory confirmedCOVID-19inpatients with severe type were enrolled. Demographic, clinicaland laboratory data were collected. Association ofserum creatinine (SCr)with 28-days mortality in severe COVID-19 patients was analyzed.Results:18.79% (48/304) patients died during the first 28-days of hospitalization.Non-survivors had a significantly higher SCr levels than survivors (109.27μmol/L vs. 69.99μmol/L, P <0.001). The 28-days mortality in high SCr group (>76μmol/L) was significantly higher than that in low SCr group (31.7% vs. 7.5%, P <0.001). Multivariate logistic regression revealed that the independent risk factors of 28-days outcome included age(OR: 2.95, 95%CI: 1.08-8.05), WBC (OR: 6.09, 95%CI: 2.27-6.39), lymphopenia (OR: 3.49, 95%CI: 1.55-7.92), IL-6 (OR: 4.44, 95%CI: 1.64-11.99) and SCr (OR: 2.69, 95%CI: 1.18-6.11). Kaplan-Meier analysis demonstrated the survival disadvantage in patients with high SCr levels (>76μmol/L). ROC curve showed the SCr cut-off value for predicting 28-days death was 77.5 μmol/L, with the sensitivity of 68.8% and speciality of 74.1%.Conclusion: SCr was associated with poor prognosis and might be an independent risk factor for in-hospital death. The cut-off value of SCr for prognosis prediction was 77.5 μmol/L, with the sensitivity of 68.8% and speciality of 74.1%.

scholarly journals Declined eGFR Associated with Poor Prognosis in COVID-19 Patients in Wuhan, China: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Wei-yun Zhang ◽  
Si-jing Zhou ◽  
Ying-ying Liu ◽  
Meng-lan Zhang ◽  
Yu-ji Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Poor Prognosis ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Kaplan Meier ◽  
Lower Egfr ◽  
Independent Risk Factors ◽  
Study Laboratory

Abstract Background: Increasing evidence revealed that kidney was one of the targets of SARS-CoV-2. However, the incidences of kidney abnormalities were significantly different, from 0.5 to 75.4% in coronavirus disease 2019 (COVID-19) patients. The association of kidney injury with prognosis remain controversial.Methods: In this retrospective cohort study, laboratory confirmedCOVID-19inpatients with severe type were enrolled. Demographic, clinicaland laboratory data were collected. Association of estimated glomerular fifiltration rate (eGFR)with 28-days mortality was analyzed.Results: The total 28-days mortality of hospitalizationwas 22.3% (79/354). Non-survivors had a significantly declined eGFR levels than survivors (75.95 [IQR: 47.22,92.84] ml/min/1.73m2 vs. 96.43 [IQR: 84.11,108.47] ml/min/1.73m2, P<0.001). The 28-days mortality in declined eGFR group (<90 ml/min/1.73m2) was significantly higher than that in normal eGFR group (38.5% vs. 10.7%, P <0.001). Multivariate logistic regression revealed that the independent risk factors of 28-days outcome included lower eGFR (OR: 3.97, 95%CI: 1.42-11.11), elevated WBC (OR: 7.08, 95%CI: 3.15-15.90), lymphopenia (OR: 2.58, 95%CI: 1.21-5.49)andIL-6 (OR: 7.90, 95%CI: 2.19-28.49). Kaplan-Meier analysis indicated the survival disadvantage in patients with declined eGFR. ROC curve showed the eGFR cut-off value for predicting 28-days death was 82.2 μmol/L, with the sensitivity of 76.7% and speciality of 66.3%.Conclusion: Declined eGFR was associated with poor prognosis and could be used an independent risk factor of 28-days mortality in COVID-19 patients. Early detection and surveillance for eGFR may benefit to identify patients with high-risk ofprogression.

scholarly journals Renal dysfunction and prognosis of COVID-19 patients: a hospital-based retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hui-Xian Xiang ◽  
Jun Fei ◽  
Ying Xiang ◽  
Zheng Xu ◽  
Ling Zheng ◽  
...  
Keyword(s):  
Cohort Study ◽  
Renal Dysfunction ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Estimated Glomerular Filtration Rate ◽  
Laboratory Data ◽  
Multivariate Logistic Regression ◽  
Follow Up Study ◽  
Independent Risk Factors

Abstract Introduction Increasing evidence indicate that coronavirus disease 2019 (COVID-19) is companied by renal dysfunction. However, the association of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)-induced renal dysfunction with prognosis remains obscure. Materials and methods All 154 patients with COVID-19 were recruited from the Second People’s Hospital of Fuyang City in Anhui, China. Demographic characteristics and laboratory data were extracted. Renal dysfunction was evaluated and its prognosis was followed up based on a retrospective cohort study. Results There were 125 (81.2%) mild and 29 (18.8%) severe cases in 154 COVID-19 patients. On admission, 16 (10.4%) subjects were accompanied with renal dysfunction. Serum creatinine and cystatin C were increased and estimated glomerular filtration rate (eGFR) was decreased in severe patients compared with those in mild patients. Renal dysfunction was more prevalent in severe patients. Using multivariate logistic regression, we found that male gender, older age and hypertension were three importantly independent risk factors for renal dysfunction in COVID-19 patients. Follow-up study found that at least one renal function marker of 3.33% patients remained abnormal in 2 weeks after discharge. Conclusion Male elderly COVID-19 patients with hypertension elevates the risk of renal dysfunction. SARS-CoV-2-induced renal dysfunction are not fully recovered in 2 weeks after discharge.

scholarly journals Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243528
Author(s):  
Jin Hyuk Paek ◽  
Yaerim Kim ◽  
Woo Yeong Park ◽  
Kyubok Jin ◽  
Miri Hyun ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Hospital Death ◽  
Kaplan Meier ◽  
Kdigo Guidelines ◽  
Independent Risk Factors ◽  
Elevated Creatinine ◽  
Stage 1

Although the lungs are major targets for COVID-19 invasion, other organs—such as the kidneys—are also affected. However, the renal complications of COVID-19 are not yet well explored. This study aimed to identify the incidence of acute kidney injury (AKI) in patients with COVID-19 and to evaluate its impact on patient outcomes. This retrospective study included 704 patients with COVID-19 who were hospitalized at two hospitals in Daegu, Korea from February 19 to March 31, 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The final date of follow-up was May 1, 2020. Of the 704 patients, 28 (4.0%) developed AKI. Of the 28 patients with AKI, 15 (53.6%) were found to have AKI stage 1, 3 (10.7%) had AKI stage 2, and 10 (35.7%) had AKI stage 3. Among these patients, 12 (42.9%) recovered from AKI. In the patients with AKI, the rates of admission to intensive care unit (ICU), administration of mechanical ventilator (MV), and in-hospital mortality were significantly higher than in patients without AKI. Multivariable analysis revealed that old age (Hazard ratio [HR] = 4.668, 95% confidence interval [CI] = 1.250–17.430, p = 0.022), high neutrophil-to-lymphocyte ratio (HR = 1.167, 95% CI = 1.078–1.264, p < 0.001), elevated creatinine kinase (HR = 1.002, 95% CI = 1.001–1.004, p = 0.007), and severe AKI (HR = 12.199, 95% CI = 4.235–35.141, p < 0.001) were independent risk factors for in-hospital mortality. The Kaplan-Meier curves showed that the cumulative survival rate was lowest in the AKI stage 3 group (p < 0.001). In conclusion, the incidence of AKI in patients with COVID-19 was 4.0%. Severe AKI was associated with in-hospital death.

scholarly journals Rhabdomyolysis is Associated with Hospital Mortality in Patients with COVID-19

2020 ◽  
Author(s):  
Yan Geng ◽  
Yong-sheng Du ◽  
Na Peng ◽  
Ting Yang ◽  
Shi-yu Zhang ◽  
...  
Keyword(s):  
Kidney Injury ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Proportional Hazard ◽  
Coagulation Activation ◽  
Virus Clearance ◽  
Cox Proportional Hazard ◽  
Independent Risk Factors ◽  
Cox Proportional Hazard Regression ◽  
Serum Myoglobin

Abstract Purpose: To evaluate the clinical features and outcomes of rhabdomyolysis (RM) in patients with COVID-19. Method: A single center retrospective cohort study of 1,014 consecutive hospitalized patients with confirmed COVID-19 at the Huoshenshan hospital in Wuhan, China, between February 17 and April 12, 2020. Results: The overall incidence of RM was 2.2%. Comparing with patients without RM, patients with RM tended to have a higher risk of deterioration, representing by higher ratio to be admitted to the intensive care unit (ICU) (90.9 % vs 5.3%, P<0.001), and to undergo mechanical ventilation (86.4 % vs 2.7% P<0.001). Compared with patients without RM, patients with RM had laboratory test abnormalities, including indicators of inflammation, coagulation activation and kidney injury. Patients with RM had a higher risk of hospital death (P < 0.001). Cox proportional hazard regression model confirmed that RM indicators, including peak creatine kinase (CK) >1000 IU/L (HR=6.46, 95% CI: 3.02-13.86), peak serum myoglobin (MYO) >1000 ng/mL (HR=9.85, 95% CI: 5.04-19.28) were independent risk factors for in-hospital death. Additionally, patients with COVID-19 that developed RM tended to have a delayed virus clearance.Conclusion: RM might be an important factor contributing to adverse outcomes of patients with COVID-19. Early detection and effective intervention of RM may help reduce deaths of patients with COVID-19.

scholarly journals Defining Baseline Creatinine for Identification of Acute Kidney Injury in Population-based Laboratory Databases - A Danish Nationwide Cohort Study

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0006082021
Author(s):  
Henriette V. Graversen ◽  
Simon K. Jensen ◽  
Søren V. Vestergaard ◽  
Uffe Heide-Jorgensen ◽  
Christian F. Christiansen
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Creatinine Level ◽  
Kidney Injury ◽  
Population Based ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Baseline Creatinine ◽  
Creatinine Measurement

Background: The baseline creatinine level is central in the KDIGO criteria of acute kidney injury (AKI), but baseline creatinine is often inconsistently defined or unavailable in AKI research. We examined the rate, characteristics, and 30-day mortality of AKI in five AKI cohorts created using different definitions of baseline creatinine. Methods: This nationwide cohort study included all individuals aged ≥18 in Denmark with a creatinine measurement in year 2017. Applying the KDIGO criteria, we created four AKI cohorts using four different baseline definitions (most recent, mean, or median value of outpatient creatinine 365-8 days before, or median value 90-8 days before if available otherwise median value 365-91 days before) and one AKI cohort not using a baseline value. AKI rate and the distribution of age, sex, baseline creatinine, and comorbidity was described for each AKI cohort, and the 30-day all-cause mortality was estimated using the Kaplan-Meier method. Results: The study included 2,095,850 adults with at least one creatinine measurement in 2017. The four different baseline definitions identified between 61,189 and 62,597 AKI episodes. The AKI rate in these four cohorts was 13-14 per 1,000 person-years, and 30-day all-cause mortality was 17-18%. The cohort created without using a baseline creatinine included 37,659 AKI episodes, corresponding to an AKI rate of 8.2 per 1,000 person-years, and a 30-day mortality of 23%. All five cohorts were similar regarding age, sex, and comorbidity. Conclusions: In a population-based setting with available outpatient baseline creatinine, different baseline creatinine definitions revealed comparable AKI cohorts, while the lack of a baseline creatinine when defining AKI led to a smaller AKI cohort with a higher mortality. These findings underscore the importance of availability and consistent use of an outpatient baseline creatinine, in particular in studies of community-acquired AKI.

scholarly journals Risk factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19 in Wuhan, China

2020 ◽  
Author(s):  
Xiao-huan Ma ◽  
Fang Yin ◽  
Jie Zhang ◽  
Meng-yun Peng ◽  
Hong Guan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Myocardial Damage ◽  
Binary Logistic Regression ◽  
Male Gender ◽  
Binary Logistic Regression Analysis ◽  
Factors Associated ◽  
Independent Risk Factors ◽  
Fraction Of Inspired Oxygen

Abstract Methods: In this single-center, retrospective, observational study, we enrolled patients with confirmed severe COVID-19 admitted to Renmin Hospital of Wuhan university (Wuhan, China) from 1 February 2020 to 26 March 26 2020. Epidemiological, clinical, and laboratory data, and treatments and outcomes upon hospital admission, were obtained from electronic medical records. Sequential organ failure assessment (SOFA) scores were calculated.Results: Of 54 patients with severe COVID-19, HFNC was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC failure was seen more commonly in patients aged ≥60 years and in men. In addition, compared with patients successfully treated with HFNC, patients with HFNC failure had the following characteristics: higher percentage of fatigue and anorexia as well as cardiovascular disease; increased time from onset to diagnosis and SOFA scores; elevated body temperature, respiratory rate, and heart rate; more complications including ARDS, septic shock, myocardial damage, and acute kidney injury; increased neutrophil counts and prothrombin time; and decreased arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (all P < 0.05). However, binary logistic regression analysis showed that only male gender and PaO2/FiO2 were independent risk factors significantly associated with HFNC failure (both, P < 0.05). Conclusion: Patients with severe COVID-19 had a high HFNC treatment failure rate. Male gender and decreased PaO2/FiO2 were independent risk factors associated with HFNC failure in severe COVID-19 patients.

scholarly journals Mortality predictors of hospitalized patients with COVID-19: Retrospective cohort study from Nur-Sultan, Kazakhstan

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261272
Author(s):  
Yuriy Pya ◽  
Makhabbat Bekbossynova ◽  
Abduzhappar Gaipov ◽  
Timur Lesbekov ◽  
Timur Kapyshev ◽  
...  
Keyword(s):  
Cohort Study ◽  
Respiratory Rate ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Laboratory Data ◽  
Disease Onset ◽  
Tertiary Hospital ◽  
Hospital Death ◽  
Factors Associated ◽  
Predictors Of Mortality

Background First reported case of Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) in Kazakhstan was identified in March 2020. Many specialized tertiary hospitals in Kazakhstan including National Research Cardiac Surgery Center (NRCSC) were re-organized to accept coronavirus disease 2019 (COVID-19) infected patients during summer months of 2020. Although many studies from worldwide reported their experience in treating patients with COVID-19, there are limited data available from the Central Asia countries. The aim of this study is to identify predictors of mortality associated with COVID-19 in NRCSC tertiary hospital in Nur-Sultan, Kazakhstan. Methods This is a retrospective cohort study of patients admitted to the NRCSC between June 1st–August 31st 2020 with COVID-19. Demographic, clinical and laboratory data were collected from electronic records. In-hospital mortality was assessed as an outcome. Patients were followed-up until in-hospital death or discharge from the hospital. Descriptive statistics and factors associated with mortality were assessed using univariate and multivariate logistic regression models. Results Two hundred thirty—nine admissions were recorded during the follow-up period. Mean age was 57 years and 61% were males. Median duration of stay at the hospital was 8 days and 34 (14%) patients died during the hospitalization. Non-survivors were more likely to be admitted later from the disease onset, with higher fever, lower oxygen saturation and increased respiratory rate compared to survivors. Leukocytosis, lymphopenia, anemia, elevated liver and kidney function tests, hypoproteinemia, elevated inflammatory markers (C-reactive protein (CRP), ferritin, and lactate dehydrogenase (LDH)) and coagulation tests (fibrinogen, D-dimer, international normalized ratio (INR), and activated partial thromboplastin time (aPTT)) at admission were associated with mortality. Age (OR 1.2, CI:1.01–1.43), respiratory rate (OR 1.38, CI: 1.07–1.77), and CRP (OR 1.39, CI: 1.04–1.87) were determined to be independent predictors of mortality. Conclusion This study describes 14% mortality rate from COVID-19 in the tertiary hospital. Many abnormal clinical and laboratory variables at admission were associated with poor outcome. Age, respiratory rate and CRP were found to be independent predictors of mortality. Our finding would help healthcare providers to predict the risk factors associated with high risk of mortality. Further investigations involving large cohorts should be provided to support our findings.

scholarly journals Risk Factors for Mortality in 220 Patients With COVID-19 in Wuhan, China: A Single-Center, Retrospective Study

2020 ◽  
pp. 014556132097260
Author(s):  
Shuliang Zhou ◽  
Sulin Mi ◽  
Shuilian Luo ◽  
Ying Wang ◽  
Bin Ren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Respiratory Rate ◽  
Sofa Score ◽  
Laboratory Data ◽  
Older Age ◽  
Univariable Analysis ◽  
Multivariate Logistic Regression ◽  
Failure Assessment ◽  
Independent Risk Factors

Background: An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 infection occurred in Wuhan, China, in December 2019. To date, the analysis of fatal cases and the risk factors for death have rarely been reported. Methods: In this study, 220 adult patients with confirmed and suspected COVID-19 were enrolled. Clinical characteristics, laboratory data, treatments, and complications were compared between 168 survivors and 52 nonsurvivors. Univariable analysis and multivariable logistic regression were used to investigate the risk factors for mortality. Results: A total of 220 patients (168 were discharged and 52 died in the hospital) were enrolled in the study. The median age of all patients was 59.5 (47.0-69.0) years, and the median age of patients who died was significantly older than that of patients who survived (70.5 vs 56.0 years, respectively; P < .001). According to multivariate logistic regression, older age (odds ratio: 1.09, 95% CI: 1.03-1.15; P = .001), initial Sequential Organ Failure Assessment (SOFA) score >2 (37.4, 9.4-148.0; P = .011), and respiratory rate >24 per minute (10.89, 1.47-80.67; P = .019) were independent risk factors for mortality. Conclusion: Clinical and laboratory parameters predicting poor prognosis including older age, baseline SOFA score >2, and respiratory rate >24 per minute were identified.

scholarly journals Evaluation of Early Prognostic Factors of Mortality in Patients with Acute Pancreatitis: A Retrospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Wenzheng Zhang ◽  
Jiang Hu ◽  
Bihui Yao ◽  
Xvsheng Yang ◽  
Lei Song ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Clinical Investigation ◽  
Laboratory Data ◽  
Area Under The Curve ◽  
Red Cell ◽  
Cell Distribution ◽  
Multivariate Logistic Regression ◽  
Predictive Values ◽  
Independent Risk Factors ◽  
Early Indicators

Early and accurate assessment of severity in acute pancreatitis (AP) is of great importance to provide effective disease management and prevent mortality. In this study, we aim to evaluate early indicators that predict the mortality of AP. We retrospectively analyzed 24-hour clinical characteristics and laboratory data in 166 AP patients recruited between January 2014 and November 2015 in Baotou Central Hospital. In total, 18 patients did not survive the disease. Multivariate logistic regression showed that red cell distribution (RDW) (OR = 2.965, P=0.001) and creatinine (OR = 1.025, P=0.005) were early independent risk factors of AP mortality while albumin (OR = 0.920, P=0.032) levels reduced AP mortality. The corresponding optimal cut-off values were 14.45, 125.5, and 34.95, respectively. The positive predictive values of the AP mortality were 80.1%, 54.5%, and 69.5%. In combined measurement, the area under the curve of RDW, creatinine, and albumin was 0.964 (95% CI: 0.924 to 1.000, P<0.001). RDW ≥ 14.45%, creatinine ≥ 125.5 μmol/l, and albumin ≤ 34.95 g/l indicated a good predictive value for mortality in AP patients with a sensitivity of 100% and specificity of 64.2%. RDW, creatinine, and albumin may serve as early indicators for AP mortality which warrants further clinical investigation.

Development of a prediction model for 1-year poor prognosis in patients with acute ischemic stroke

2019 ◽  
Vol 67 (6) ◽  
pp. 957-963 ◽  
Author(s):  
Xia Ling ◽  
Bo Shen ◽  
Kangzhi Li ◽  
Lihong Si ◽  
Xu Yang
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Ischemic Stroke ◽  
Prediction Model ◽  
Acute Ischemic Stroke ◽  
Poor Prognosis ◽  
Multivariate Logistic Regression ◽  
Lemeshow Test ◽  
Independent Risk Factors ◽  
Auc Value

The goals of this study were to develop a new prediction model to predict 1-year poor prognosis (death or modified Rankin scale score of ≥3) in patients with acute ischemic stroke (AIS) and to compare the performance of the new prediction model with other prediction scales. Baseline data of 772 patients with AIS were collected, and univariate and multivariate logistic regression analyses were performed to identify independent risk factors for 1-year poor prognosis in patients with AIS. The area under the receiver operating characteristics curve (AUC) value of the new prediction model and the THRIVE, iScore and ASTRAL scores was compared. The Hosmer-Lemeshow test was used to assess the goodness of fit of the model. We identified 196 (25.4%) patients with poor prognosis at 1-year follow-up, and of these 68 (68/196, 34.7%) had died. Multivariate logistic regression and receiver operating characteristic curve analyses showed that age ≥70 years, consciousness (lethargy or coma), history of stroke or transient ischemic attack, cancer, abnormal fasting blood glucose levels ≥7.0 mmol/L, and National Institutes of Health Stroke Scale score were independent risk factors for 1-year poor prognosis in patients with AIS. Scores were assigned for each variable by rounding off β coefficient to the integer score, and a new prediction model with a maximum total score of 9 points was developed. The AUC value of the new prediction model was higher than the THRIVE score (p<0.05). The χ2 value for the Hosmer-Lemeshow test was 7.337 (p>0.05), suggesting that the prediction model had a good fit. The new prediction model can accurately predict 1-year poor prognosis in Chinese patients with AIS.

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