Kidney Res Clin Pract.  2021 Jun;40(2):231-240. 10.23876/j.krcp.20.177.

Twenty-four-hour serum creatinine variation is associated with poor outcome in the novel coronavirus disease 2019 (COVID-19) patients

• Alfano G
• Ferrari A
• Fontana F
• Mori G
• Ligabue G
• Giovanella S
• Magistroni R
• Meschiari M
• Franceschini E
• Menozzi M
• Cuomo G
• Orlando G
• Santoro A
• Di Gaetano M
• Puzzolante C
• Carli F
• Bedini A
• Milic J
• Mussini C
• Cappelli G
• Guaraldi G
• for the Modena Covid-19 Working Group (MoCo19)

• KMID: 2520039
• DOI: http://doi.org/10.23876/j.krcp.20.177

Abstract

Background
The development of acute kidney injury (AKI) in patients with coronavirus disease 2019 (COVID-19) is associated with a high risk of death. Published data demonstrate the possibility of severe kidney injury in patients suffering from COVID-19. However, these data are still controversial.
Methods
A total of 1,280 patients with a proven diagnosis of COVID-19 were included in our study. COVID-19 was confirmed in all patients using reverse transcriptase polymerase chain reaction test of a nasopharyngeal swab, and based on the typical computed tomography findings. Demographic data, underlying comorbidities, and laboratory blood tests were assessed. We assessed the incidence of AKI and its associated mortality defined by survival status at discharge.
Results
Proteinuria was identified with 648 patients (50.6%) with COVID-19. AKI was identified in 371 patients (29.0%). Ten of these patients (2.7%) required dialysis. The risk factors for AKI included age of > 65 years, augmentation of C-reactive protein, ferritin and an increase in values of activated partial thromboplastin time. Overall, 162 of the 1,280 hospitalized patients (12.7%) and 111 of the 371 patients (29.9%) with AKI did not survive. The hazard ratio (HR) for mortality was 3.96 (95% confidence interval, 2.83–5.54) for patients with AKI vs. no AKI.
Conclusion
AKI was a relatively common finding among patients with COVID-19. The risk factors for AKI in COVID-19 included old age, the inflammatory response, the severity of lung involvement, and disseminated intravascular coagulation. These same factors, in addition to arterial hypertension, were found to increase the risk of mortality.

Keyword

Acute kidney injury; Biomarkers; Coronavirus; Kidney; Creatinine; Mortality