Community- versus hospital-acquired acute kidney injury in hospitalised COVID-19 patients

BMC Nephrology

Saif Al-Chalabi¹  Lynne Sykes¹  Philip A Kalra²  Darren Green³  Jack S Bell⁴  Benjamin D James⁴ 

[1] Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK;Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK;Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK;Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK;Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK;Emergency Assessment Unit, Salford Royal NHS Foundation Trust, Salford, UK;Salford Royal NHS Foundation Trust, Salford, UK;

关键词: Acute kidney injury;    COVID-19;    Hospital-acquired;    Community-acquired;    Risk factors;    Mortality;   

DOI  :  10.1186/s12882-021-02471-2

来源: Springer

【 摘 要 】

BackgroundAcute kidney injury (AKI) is a recognised complication of coronavirus disease 2019 (COVID-19), yet the reported incidence varies widely and the associated risk factors are poorly understood.MethodsData was collected on all adult patients who returned a positive COVID-19 swab while hospitalised at a large UK teaching hospital between 1st March 2020 and 3rd June 2020. Patients were stratified into community- and hospital-acquired AKI based on the timing of AKI onset.ResultsOut of the 448 eligible patients with COVID-19, 118 (26.3 %) recorded an AKI during their admission. Significant independent risk factors for community-acquired AKI were chronic kidney disease (CKD), diabetes, clinical frailty score and admission C-reactive protein (CRP), systolic blood pressure and respiratory rate. Similar risk factors were significant for hospital-acquired AKI including CKD and trough systolic blood pressure, peak heart rate, peak CRP and trough lymphocytes during admission. In addition, invasive mechanical ventilation was the most significant risk factor for hospital-acquired AKI (adjusted odds ratio 9.1, p < 0.0001) while atrial fibrillation conferred a protective effect (adjusted odds ratio 0.29, p < 0.0209). Mortality was significantly higher for patients who had an AKI compared to those who didn’t have an AKI (54.3 % vs. 29.4 % respectively, p < 0.0001). On Cox regression, hospital-acquired AKI was significantly associated with mortality (adjusted hazard ratio 4.64, p < 0.0001) while community-acquired AKI was not.ConclusionsAKI occurred in over a quarter of our hospitalised COVID-19 patients. Community- and hospital-acquired AKI have many shared risk factors which appear to converge on a pre-renal mechanism of injury. Hospital- but not community acquired AKI was a significant risk factor for death.

【 授权许可】

CC BY