J Med Virol . Critical roles of cytokine storm and secondary bacterial infection in acute kidney injury development in COVID-19: A multi-center retrospective cohort study

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J Med Virol


. 2021 Jul 27.
doi: 10.1002/jmv.27234. Online ahead of print.
Critical roles of cytokine storm and secondary bacterial infection in acute kidney injury development in COVID-19: A multi-center retrospective cohort study


Xia-Qing Li ¹ , Han Liu ¹ , Hai-Yan Yin ^{2 3} , Wen-Yong Gao ⁴ , Xiao Yang ^{3 5} , Dian-Shuang Xu ^{5 6} , Xing-Dong Cai ^{5 7} , Yin Guan ⁸ , Lilach O Lerman ⁹ , Zhi-Yong Peng ^{3 5} , Hou-Rong Zhou ^{10 11} , Yu Meng ^{1 3}



Affiliations

• PMID: 34314040
• DOI: 10.1002/jmv.27234

Abstract

Acute kidney injury (AKI) may develop in patients with coronavirus disease 2019 (COVID-19) and is associated with in-hospital death.We investigated the incidence of AKI in 223 hospitalized COVID-19 patients and analyzed the influence factors of AKI. The incidence of cytokine storm syndrome and its correlation with other clinicopathologic variables were also investigated. We retrospectively enrolled adult patients with virologically-confirmed COVID-19 who were hospitalized at three hospitals in Wuhan and Guizhou, China between February 13, 2020 and April 8, 2020. We included 124 patients with moderate COVID-19 and 99 with severe COVID-19. AKI was present in 35 (15.7%) patients. The incidence of AKI was 30.3% for severe COVID-19 and 4.0% for moderate COVID-19 (P<0.001). Furthermore, cytokine storm was in 30 (13.5%) patients and only in severe group. Kidney injury at admission (OR 3.132, 95%CI 1.150-8.527; P=0.025), cytokine storm (OR 4.234, 95%CI 1.361-13.171; P=0.013) and acute respiratory distress syndrome (ARDS) (OR 7.684, 95%CI 2.622-22.523; P<0.001) were influence factors of AKI. Seventeen (48.6%) patients who received invasive mechanical ventilation developed AKI, of whom 64.7% (11/17) died. Up to 86.7% AKI patients with cytokine storm may develop secondary bacterial infection. The leukocyte counts were significantly higher in AKI patients with cytokine storm than those without (13.0×10⁹/L, IQR 11.3 vs. 8.3×10⁹/L, IQR 7.5, P=0.005). Approximately 1/6 patients with COVID-19 eventually develop AKI. Kidney injury at admission, cytokine storm and ARDS are influence factors of AKI. Cytokine storm and secondary bacterial infections may be responsible for AKI development in COVID-19 patients. This article is protected by copyright. All rights reserved.

Keywords: Acute kidney injury; COVID-19; cytokine storm; secondary bacterial infections.