AKI linked to ‘extremely high’ in-hospital mortality rate for patients with COVID-19
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Patients infected with COVID-19 had a five times greater likelihood of in-hospital mortality if they also developed AKI, according to a study conducted at Tongi Hospital in Wuhan, China.
“AKI is uncommon but carries extremely high in-hospital mortality in patients with COVID-19,” Yichun Cheng, MD, of Tongji Medical College, and colleagues wrote of their findings.
For the study, Cheng and colleagues retrospectively evaluated a cohort of 1,392 patients hospitalized with the virus, determining that 7% developed AKI during hospitalization. Of patients with AKI, 40% developed the condition within 1 week of admission.
Researchers also examined factors that might place patients at a higher risk for AKI. These included severe disease (OR = 2.25), higher serum creatinine (OR = 2.19), lymphopenia (OR = 1.99) and elevated D-dimer (OR = 2.68).
After adjustment for confounders (including age, sex, disease severity, lymphopenia, D-dimer and ICU placement), AKI was associated with in-hospitality mortality (OR = 5.12).
Researchers further observed that in-hospital mortality rates increased with higher stages of AKI (62% of patients with stage 1 AKI died; 77% of patients with stage 2; and 80% of patients with stage 3).
“Prior to this study, there was limited information concerning epidemiological characteristics and outcomes associated with AKI in patients with COVID-19,” study author Gang Xu, PhD, said in a related press release. “Our results indicate that AKI is strongly associated with mortality, and that careful monitoring of AKI is necessary early in the course of infection.”
In an accompanying editorial Edward D. Siew, MD, MSCI, and Bethany C. Birkelo, DO, both of Vanderbilt University Medical Center, wrote that the authors should be “commended” for increasing the understanding of COVID-19 associated AKI.
However, they contended that knowledge gaps — especially regarding individual and population differences in AKI risk — remain.
According to Siew and Birkelo, the study may be limited in its applicability to Western countries, where the incidence of AKI is significantly higher than it was in this study. Further, they noted that one U.S. study examined a cohort in which one-half of the patients had diabetes and three-quarters had hypertension. Conversely, in the study conducted by Cheng and colleagues, rates of diabetes and hypertension were 17% and 36%, respectively.
“Beyond indicating that traditional AKI risk factors are relevant for COVID-AKI, these findings also suggest that the public health burden of kidney disease attributable to current and future waves of infection will parallel the underlying health of the region affected,” they elaborated. “In places such as the U.S., where one-third of the population are estimated to have underlying metabolic syndrome, efforts to prevent transmission will remain pivotal to reducing the toll of AKI associated with COVID-19.”
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