Kidney involvement in patients with severe and critical COVID-19
Abstract
Introduction: acute renal injury was a frequently observed complication in critical patients during the COVID-19 pandemic.
Objectives: 1) to determine the incidence of acute renal injury associated to severe and critical COVID-19; 2) to determine prognostic implications in terms of mobimortality of renal involvement.
Method: prospective, observational and analytical study of a cohort of patients with severe and critical COVID-19 who were hospitalized in the Intensive Care Unit at Hospital Español. A descriptive and analytical study (single and multivariate) was performed using statistical significance level lower than 0.05.
Results: there were 233 patients with severe and critical COVID-19 hospitalized in the Intensive Care Unit at Hospital Español between September 9 and May 21. Acute renal injury associated to COVID-19: 47.9% (107/233), severe acute renal injury (stages KDIGO 2 and 3): 79.4% (85/107), nosocomial acute renal injury: 47.7% (52/107), acute renal injury: 41.1% (44/107), renal replacement techniques requirement: 29.9% (32/107).
Mortality upon discharge from Intensive Medicine in patients with acute renal injury was 72.9% (78/107), versus absence of acute renal injury: 48.4% (62/126) (p=0,000). The multivariate analysis showed normal renal function upon discharge from hospital was the protective predictive factor for death upon discharge from Intensive Medicine (OR 0,055, IC 95%: 0,014-0,213, p= 0,000).
Conclusions: incidence of acute renal injury associated to COVID-19 was high in Intensive Medicine, with predominance of stages 2-3, and it was related to a significantly higher mortality. Normalization of renal function was a protective predictive factor for the risk of death. The degree of multi-organ support was associated to a progressive increase of mortality.
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