Acute Kidney Injury Incidence, Risk Factors and Effects on Mortality in Critically ill COVID-19 Patients: A Retrospective Cohort Study

Abstract

Objective: Acute kidney injury (AKI) is a common condition in critically ill patients, especially those with severe infections, and associated with increased morbidity and mortality. While the main features associated with COVID-19 are extensive alveolar damage and acute respiratory failure, another common complication in patients infected with SARS-CoV-2 is AKI. There is increasing evidence that it affects the kidneys in particular. It was aimed to investigate the frequency and risk factors of AKI development in critically ill COVID-19 patients. Material(s) and Method(s): Between March 15th, 2020 and June 1st, 2021, patients with COVID-19 who were admitted to the intensive care unit(ICU) for more than 24 hours were included in the study and analysed, retrospectively. Patients were grouped according to whether they developed AKI according to KDIGO criteria during the first week of their ICU stay and compared for risk factors. Result(s): There were 206 patients who met the inclusion criteria, of whom 120 had developed AKI during the first week of admission. Patients in AKI group were older with a median age of 70.5 years (p<0.001). The median APACHEII and SOFA scores were higher in the AKI group (20 and 5, respectively, p<0.001). Hypertension was the most common comorbidity and was more frequent in AKI patients (69%, p<0.001), invasive mechanical ventilation (IMV) and vasopressor requirements were more common in AKI patients (78%, p<0.001 and 66%, p<0.001, respectively). In 31 (26%) patients with AKI, renal replacement therapy was required. Mortality rate was higher in AKI patients (68%, p<0.001). Logistic regression analyses revealed hypertension (OR=2.71, %95CI=1.23-5.95, p=0.013) and IMV (OR= 8.15, %95 CI= 3.35-19.83, p< 0.001) as risk factors for AKI. Conclusion(s): AKI is a poor prognostic condition commonly seen in critically ill COVID-19 patients. The rate of AKI development is higher in patients with hypertension and those who need invasive mechanical ventilation. The development of AKI has been associated with high mortality in critically ill COVID-19 patients. Copyright © 2022 by Society of Turkish Intensivist-Available online at www.dcyogunbakim.org.