Sci Rep . Clinical outcomes of hospitalized COVID-19 patients with renal injury: a multi-hospital observational study from Wuhan

[tetano]

Sci Rep


. 2021 Jul 26;11(1):15205.
doi: 10.1038/s41598-021-94570-1.
Clinical outcomes of hospitalized COVID-19 patients with renal injury: a multi-hospital observational study from Wuhan


Kehong Chen ^{# 1 2} , Yu Lei ^{# 3 4} , Yani He ¹ , Fei Xiao ¹ , Yan Yu ^{1 2} , Xiaodong Lai ^{5 6} , Yang Liu ^{7 8} , Jiang Wang ^{9 10} , Huanzi Dai ^{11 12}



Affiliations

• PMID: 34312430
• DOI: 10.1038/s41598-021-94570-1

Abstract

Renal injury is common in patients with coronavirus disease 2019 (COVID-19). We aimed to determine the relationship of estimated glomerular filtration rate (eGFR) and acute kidney injury (AKI) with the characteristics, progression, and prognosis of COVID-19 in-patients. We retrospectively reviewed 1851 COVID-19 patients admitted to 3 hospitals in Wuhan, China. Clinical, laboratory, radiological, treatment, complication, and outcome data were analyzed. Patients were stratified according to levels of eGFR (≥ 90 vs. 60-89 vs. < 60 mL/min/1.73 m²). The risk of reaching the composite endpoint-intensive care unit admission, invasive ventilation, or death-was compared. On admission, 25.5% patients had renal impairment (eGFR < 90 mL/min/1.73 m²), but only 2.6% patients had chronic kidney disease (CKD). The overall in-hospital AKI incidence was 6.7%. Severe illness and comorbidities (hypertension, diabetes, CKD, and cardiovascular/cerebrovascular diseases) were more common among patients with low eGFR (< 90 mL/min/1.73 m²). Despite the more frequent use of intensive oxygen therapy, continuous blood purification, and glucocorticoid treatment, the prognosis of these patients was unsatisfactory, with the incidence of the composite endpoint (15.4% vs. 19.6% vs. 54.5%; P = 0.000) and complications (AKI, respiratory failure, cardiac injury, coagulation disorders, sepsis, etc.) increasing with decreasing eGFR. Kaplan-Meier survival analysis revealed that patients with eGFR < 90 mL/min/1.73 m² or AKI had significantly escalated risks of reaching the composite endpoint. Multivariate regression analysis showed that renal insufficiency (eGFR < 60 mL/min/1.73 m²) on admission and in-hospital AKI independently predicted poor prognosis among COVID-19 in-patients. And renal impairment on admission was a greater predictor of poor prognosis in non-elderly patients than that in elderly patients. Early and continuous renal-function monitoring and early AKI diagnosis are necessary to predict and prevent the progression of COVID-19.