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Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single centre cohort study

Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single centre cohort study
Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single centre cohort study

Background: acute kidney injury (AKI) is a common manifestation among patients critically ill with SARS-CoV-2 infection (Coronavirus 2019) and is associated with significant morbidity and mortality. The pathophysiology of renal failure in this context is not fully understood, but likely to be multifactorial. The intensive care unit outcomes of patients following COVID-19 acute critical illness with associated AKI have not been fully explored. We conducted a cohort study to investigate the risk factors for acute kidney injury in patients admitted to and intensive care unit with COVID-19, its incidence and associated outcomes. 

Methods: we reviewed the medical records of all patients admitted to our adult intensive care unit suffering from SARS-CoV-2 infection from 14th March 2020 until 12th May 2020. Acute kidney injury was defined using the Kidney Disease Improving Global Outcome (KDIGO) criteria. The outcome analysis was assessed up to date as 3rd of September 2020. 

Results: a total of 81 patients admitted during this period. All patients had acute hypoxic respiratory failure and needed either noninvasive or invasive mechanical ventilatory support. Thirty-six patients (44%) had evidence of AKI (Stage I-33%, Stage II-22%, Renal Replacement Therapy (RRT)-44%). All patients with AKI stage III had RRT. Age, diabetes mellitus, immunosuppression, lymphopenia, high D-Dimer levels, increased APACHE II and SOFA scores, invasive mechanical ventilation and use of inotropic or vasopressor support were significantly associated with AKI. The peak AKI was at day 4 and mean duration of RRT was 12.5 days. The mortality was 25% for the AKI group compared to 6.7% in those without AKI. Among those received RRT and survived their illness, the renal function recovery is complete and back to baseline in all patients. 

Conclusion: acute kidney injury and renal replacement therapy is common in critically ill patients presenting with COVID-19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay. Recovery of renal function was complete in all survived patients.

APACHE, Acute Kidney Injury/epidemiology, COVID-19/complications, Cohort Studies, Critical Illness, Female, Hospital Mortality, Humans, Incidence, Intensive Care Units, Male, Middle Aged, Organ Dysfunction Scores, Recovery of Function, Renal Replacement Therapy/statistics & numerical data, Respiration, Artificial/adverse effects, Risk Factors, Water-Electrolyte Balance
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Lowe, R.
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Ferrari, M.
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Nasim-Mohi, M.
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Jackson, A.
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Beecham, R.
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Veighey, K.
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Cusack, R.
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Richardson, D.
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Grocott, Michael P.W.
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Levett, Dzh
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Dushianthan, A.
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Gupta, Sanjay
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Nixon, Julian
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Grocott, Michael P.W.
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Levett, Denny Z.H.
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Stewart, Michael
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Dushianthan, Ahilanadan
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Sparkes, David
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Chambers, Robert
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Nolan, Kathleen
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Tanser, Suzie
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Fennell, Jonathan
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Jonas, Max
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Celinski, Michael
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Richardson, Dominic
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Cusack, R.
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Skinner, Benjamin
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Nicholson-Robert, Timothy
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Wakatsuki, Mai
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Dear, Carin
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Thomas, Ben
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Wessels, Francois
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Wilkinson, Tom
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Freeman, Anna
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Burke, Hannah
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Dushianthan, Ahilanadan
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Celinski, Michael
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Batchelor, James
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Faust, Saul
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Thomas, Gareth
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Kipps, Christopher
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On behalf of the University Hospital Southampton Critical Care Team and the REACT COVID investigators
Lowe, R.
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Ferrari, M.
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Nasim-Mohi, M.
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Jackson, A.
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Beecham, R.
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Veighey, K.
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Cusack, R.
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Richardson, D.
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Grocott, Michael P.W.
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Dushianthan, A.
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Nixon, Julian
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Grocott, Michael P.W.
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Stewart, Michael
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Dushianthan, Ahilanadan
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Sparkes, David
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Chambers, Robert
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Nolan, Kathleen
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Tanser, Suzie
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Jonas, Max
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Celinski, Michael
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Cusack, R.
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Nicholson-Robert, Timothy
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Wakatsuki, Mai
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Dear, Carin
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Thomas, Ben
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Wessels, Francois
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Wilkinson, Tom
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Dushianthan, Ahilanadan
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Celinski, Michael
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Faust, Saul
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Thomas, Gareth
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Kipps, Christopher
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On behalf of the University Hospital Southampton Critical Care Team and the REACT COVID investigators (2021) Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single centre cohort study. BMC Nephrology, 22 (1), [92]. (doi:10.1186/s12882-021-02296-z).

Record type: Article

Abstract

Background: acute kidney injury (AKI) is a common manifestation among patients critically ill with SARS-CoV-2 infection (Coronavirus 2019) and is associated with significant morbidity and mortality. The pathophysiology of renal failure in this context is not fully understood, but likely to be multifactorial. The intensive care unit outcomes of patients following COVID-19 acute critical illness with associated AKI have not been fully explored. We conducted a cohort study to investigate the risk factors for acute kidney injury in patients admitted to and intensive care unit with COVID-19, its incidence and associated outcomes. 

Methods: we reviewed the medical records of all patients admitted to our adult intensive care unit suffering from SARS-CoV-2 infection from 14th March 2020 until 12th May 2020. Acute kidney injury was defined using the Kidney Disease Improving Global Outcome (KDIGO) criteria. The outcome analysis was assessed up to date as 3rd of September 2020. 

Results: a total of 81 patients admitted during this period. All patients had acute hypoxic respiratory failure and needed either noninvasive or invasive mechanical ventilatory support. Thirty-six patients (44%) had evidence of AKI (Stage I-33%, Stage II-22%, Renal Replacement Therapy (RRT)-44%). All patients with AKI stage III had RRT. Age, diabetes mellitus, immunosuppression, lymphopenia, high D-Dimer levels, increased APACHE II and SOFA scores, invasive mechanical ventilation and use of inotropic or vasopressor support were significantly associated with AKI. The peak AKI was at day 4 and mean duration of RRT was 12.5 days. The mortality was 25% for the AKI group compared to 6.7% in those without AKI. Among those received RRT and survived their illness, the renal function recovery is complete and back to baseline in all patients. 

Conclusion: acute kidney injury and renal replacement therapy is common in critically ill patients presenting with COVID-19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay. Recovery of renal function was complete in all survived patients.

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e-pub ahead of print date: 15 March 2021
Additional Information: Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: APACHE, Acute Kidney Injury/epidemiology, COVID-19/complications, Cohort Studies, Critical Illness, Female, Hospital Mortality, Humans, Incidence, Intensive Care Units, Male, Middle Aged, Organ Dysfunction Scores, Recovery of Function, Renal Replacement Therapy/statistics & numerical data, Respiration, Artificial/adverse effects, Risk Factors, Water-Electrolyte Balance

Identifiers

Local EPrints ID: 450714
URI: http://eprints.soton.ac.uk/id/eprint/450714
ISSN: 1471-2369
PURE UUID: 19c7754d-19fd-469f-a3bb-1e124f4a7ca5
ORCID for A. Jackson: ORCID iD orcid.org/0000-0002-3153-9231
ORCID for Michael P.W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581
ORCID for A. Dushianthan: ORCID iD orcid.org/0000-0002-0165-3359
ORCID for Michael P.W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581
ORCID for Ben Thomas: ORCID iD orcid.org/0000-0001-5240-7521
ORCID for James Batchelor: ORCID iD orcid.org/0000-0002-5307-552X
ORCID for Saul Faust: ORCID iD orcid.org/0000-0003-3410-7642

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Date deposited: 09 Aug 2021 16:30
Last modified: 10 Aug 2021 01:54

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Contributors

Author: R. Lowe
Author: M. Ferrari
Author: M. Nasim-Mohi
Author: A. Jackson ORCID iD
Author: R. Beecham
Author: K. Veighey
Author: R. Cusack
Author: D. Richardson
Author: Dzh Levett
Author: A. Dushianthan ORCID iD
Author: Sanjay Gupta
Author: Julian Nixon
Author: Denny Z.H. Levett
Author: Michael Stewart
Author: Ahilanadan Dushianthan
Author: David Sparkes
Author: Robert Chambers
Author: Kathleen Nolan
Author: Suzie Tanser
Author: Jonathan Fennell
Author: Max Jonas
Author: Michael Celinski
Author: Dominic Richardson
Author: R. Cusack
Author: Benjamin Skinner
Author: Timothy Nicholson-Robert
Author: Mai Wakatsuki
Author: Carin Dear
Author: Ben Thomas ORCID iD
Author: Francois Wessels
Author: Tom Wilkinson
Author: Anna Freeman
Author: Hannah Burke
Author: Ahilanadan Dushianthan
Author: Michael Celinski
Author: James Batchelor ORCID iD
Author: Saul Faust ORCID iD
Author: Gareth Thomas
Author: Christopher Kipps
Corporate Author: On behalf of the University Hospital Southampton Critical Care Team and the REACT COVID investigators

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