Risk factors, predictions, and progression of acute kidney injury in hospitalized COVID-19 patients: An observational retrospective cohort study

Studies have shown that acute kidney injury (AKI) occurrence post SARS-CoV-2 infection is complex and has a poor prognosis. Therefore, more studies are needed to understand the rate and the predications of AKI involvement among hospitalized COVID-19 patients and AKI's impact on prognosis while...

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Bibliographic Details
Published in:	PloS one Vol. 16; no. 9; p. e0257253
Main Authors:	Naser, Maryam N, Al-Ghatam, Rana, Darwish, Abdulla H, Alqahtani, Manaf M, Alahmadi, Hajar A, Mohamed, Khalifa A, Hasan, Nahed K, Perez, Nuria S
Format:	Journal Article
Language:	English
Published:	San Francisco Public Library of Science 29-09-2021 Public Library of Science (PLoS)
Subjects:	Acute renal failure Age Albumin Armed forces Biology and Life Sciences Calcium-binding protein Care and treatment Cohort analysis Coronaviruses COVID-19 Creatinine Data collection Defense Development and progression Diabetes Diabetes mellitus Dimers Disease transmission Health services Hospital patients Hospitalization Hospitals Hypertension Infections Injuries Kidneys Laboratories Laboratory tests Mechanical ventilation Medical records Medical research Medicine and Health Sciences Multivariate analysis Observational studies Patients People and Places Pneumonia Prognosis Regression analysis Renal replacement therapy Risk analysis Risk factors Serum albumin Severe acute respiratory syndrome coronavirus 2 Troponin Troponin I Ventilation Bahrain
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Summary:	Studies have shown that acute kidney injury (AKI) occurrence post SARS-CoV-2 infection is complex and has a poor prognosis. Therefore, more studies are needed to understand the rate and the predications of AKI involvement among hospitalized COVID-19 patients and AKI's impact on prognosis while under different types of medications. This study is a retrospective observational cohort study conducted at Bahrain Defence Force (BDF) Royal Medical Services. Medical records of COVID-19 patients admitted to BDF hospital, treated, and followed up from April 2020 to October 2020 were retrieved. Data were analyzed using univariate and multivariate logistic regression with covariate adjustment, and the odds ratio (OR) and 95% confidence (95% CI) interval were reported. Among 353 patients admitted with COVID-19, 47.6% developed AKI. Overall, 51.8% of patients with AKI died compared to 2.2% of patients who did not develop AKI (p< 0.001 with OR 48.6 and 95% CI 17.2-136.9). Besides, deaths in patients classified with AKI staging were positively correlated and multivariate regression analysis revealed that moderate to severe hypoalbuminemia (<32 g/L) was independently correlated to death in AKI patients with an OR of 10.99 (CI 95% 4.1-29.3, p<0.001). In addition, 78.2% of the dead patients were on mechanical ventilation. Besides age as a predictor of AKI development, diabetes and hypertension were the major risk factors of AKI development (OR 2.04, p<0.01, and 0.05 for diabetes and hypertension, respectively). Also, two or more comorbidities substantially increased the risk of AKI development in COVID-19 patients. Furthermore, high levels upon hospital admission of D-Dimer, Troponin I, and ProBNP and low serum albumin were associated with AKI development. Lastly, patients taking ACEI/ARBs had less chance to develop AKI stage II/III with OR of 0.19-0.27 (p<0.05-0.01). The incidence of AKI in hospitalized COVID-19 patients and the mortality rate among AKI patients were high and correlated with AKI staging. Furthermore, laboratory testing for serum albumin, hypercoagulability and cardiac injury markers maybe indicative for AKI development. Therefore, clinicians should be mandated to perform such tests on admission and follow-up in hospitalized patients.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0257253