Risk factors and outcome of acute kidney injury in critically ill patients with SARS-CoV-2 pneumonia: a multicenter study

Iban Oliva; Cristina Ferré; Xavier Daniel; Marc Cartanyà; Christian Villavicencio; Melina Salgado; Loreto Vidaur; Elisabeth Papiol; Fj González de Molina; María Bodí; Manuel Herrera; Alejandro Rodríguez; COVID-19 SEMICYUC Working Group

doi:10.1016/j.medine.2024.06.022

Risk factors and outcome of acute kidney injury in critically ill patients with SARS-CoV-2 pneumonia: a multicenter study

Med Intensiva (Engl Ed). 2024 Jul 12:S2173-5727(24)00176-0. doi: 10.1016/j.medine.2024.06.022. Online ahead of print.

Affiliations

¹ Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain. Electronic address: iban_84@hotmail.com.
² Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain.
³ Critical Care Department, Donostia University Hospital, San Sebastian, Spain.
⁴ Critical Care Department, Vall d'Hebron Hospital, Barcelona, Spain.
⁵ Critical Care Department, Mútua Terrasa University Hospital, Terrasa, Spain.
⁶ Critical Care Department, Regional University Hospital of Malaga, Malaga, Spain.

PMID: 39003118
DOI: 10.1016/j.medine.2024.06.022

Abstract

Objective: To assess incidence, risk factors and impact of acute kidney injury(AKI) within 48 h of intensive care unit(ICU) admission on ICU mortality in patients with SARS-CoV-2 pneumonia. To assess ICU mortality and risk factors for continuous renal replacement therapy (CRRT) in AKI I and II patients.

Design: Retrospective observational study.

Setting: Sixty-seven ICU from Spain, Andorra, Ireland.

Patients: 5399 patients March 2020 to April 2022.

Main variables of interest: Demographic variables, comorbidities, laboratory data (worst values) during the first two days of ICU admission to generate a logistic regression model describing independent risk factors for AKI and ICU mortality. AKI was defined according to current international guidelines (kidney disease improving global outcomes, KDIGO).

Results: Of 5399 patients included 1879 (34.8%) developed AKI. These patients had higher ICU mortality and AKI was independently associated with a higher ICU mortality (HR 1.32 CI 1.17-1.48; p < 0.001). Male gender, hypertension, diabetes, obesity, chronic heart failure, myocardial dysfunction, higher severity scores, and procalcitonine were independently associated with the development of AKI. In AKI I and II patients the need for CRRT was 12.6% (217/1710). In these patients, APACHE II, need for mechanical ventilation in the first 24 h after ICU admission and myocardial dysfunction were associated with risk of needing CRRT. AKI I and II patients had a high ICU mortality (38.5%), especially if CRRT were required (64.1% vs. 34,8%; p < 0.001).

Conclusions: Critically ill patients with SARS-CoV-2 pneumonia and AKI have a high ICU mortality. Even AKI I and II stages are associated with high risk of needing CRRT and ICU mortality.

Keywords: Acute kidney injury; Continuous renal replacement therapy; Insuficiencia renal aguda; Intensive care unit; Neumonía por SARS-CoV-2; SARS-CoV-2 pneumonia; Técnicas continuas de reemplazo renal; Unidad de cuidados intensivos.