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

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. We performed a retrospective study on 278 hospitalized patients who were adm...

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Bibliographic Details
Published in:	PloS one Vol. 16; no. 5; p. e0251048
Main Authors:	de Almeida, Danilo Candido, Franco, Maria do Carmo Pinho, dos Santos, Davi Rettori Pardo, Santos, Marina Colella, Maltoni, Isabela Soucin, Mascotte, Felipe, de Souza, Alexandra Aparecida, Pietrobom, Paula Massaroni, Medeiros, Eduardo Alexandrino, Ferreira, Paulo Roberto Abrão, Machado, Flavia Ribeiro, Goes, Miguel Angelo
Format:	Journal Article
Language:	English
Published:	San Francisco Public Library of Science 25-05-2021 Public Library of Science (PLoS)
Subjects:	Almeida, Maria Biology and Life Sciences Blood Blood cells Cardiovascular diseases Chronic kidney failure Complications Coronary artery disease Coronaviruses COVID-19 Creatinine Diabetes Diabetes mellitus Electronic health records Electronic medical records Epithelium Funding Gas analysis Health risks Heart diseases Hospitalization Hospitals Hypertension Infections Infectious diseases Intensive care Kidney diseases Kidneys Liver diseases Mechanical ventilation Medicine and Health Sciences Mesangial cells Mortality Nephrology Patient outcomes Patients Risk analysis Risk factors Severe acute respiratory syndrome coronavirus 2 Software Ventilation Ventilators Viral infections Brazil
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Summary:	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. 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 [greater than or equal to] 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. 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. 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: No authors have competing interests. DRPS, MCS, ISM, FM, AAS, PMP, EAM, PRAF, FRM and MAG also contributed equally to this work.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0251048