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Critical illness and systemic inflammation are key risk factors of severe acute kidney injury in patients with COVID-19

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Item Type:Article
Title:Critical illness and systemic inflammation are key risk factors of severe acute kidney injury in patients with COVID-19
Creators Name:Hardenberg, J.H.B. and Stockmann, H. and Aigner, A. and Gotthardt, I. and Enghard, P. and Hinze, C. and Balzer, F. and Schmidt, D. and Zickler, D. and Kruse, J. and Körner, R. and Stegemann, M. and Schneider, T. and Schumann, M. and Müller-Redetzky, H. and Angermair, S. and Budde, K. and Weber-Carstens, S. and Witzenrath, M. and Treskatsch, S. and Siegmund, B. and Spies, C. and Suttorp, N. and Rauch, G. and Eckardt, K.U. and Schmidt-Ott, K.M.
Abstract:INTRODUCTION: cute kidney injury (AKI) is an important complication in COVID-19, but its precise etiology has not fully been elucidated. Insights into AKI mechanisms may be provided by analyzing the temporal associations of clinical parameters reflecting disease processes and AKI development. METHODS: We performed an observational cohort study of 223 consecutive COVID-19 patients treated at 3 sites of a tertiary care referral center to describe the evolvement of severe AKI (Kidney Disease: Improving Global Outcomes stage 3) and identify conditions promoting its development. Descriptive statistics and explanatory multivariable Cox regression modeling with clinical parameters as time-varying covariates were used to identify risk factors of severe AKI. RESULTS: Severe AKI developed in 70 of 223 patients (31%) with COVID-19, of which 95.7% required kidney replacement therapy. Patients with severe AKI were older, predominantly male, had more comorbidities, and displayed excess mortality. Severe AKI occurred exclusively in intensive care unit patients, and 97.3% of the patients developing severe AKI had respiratory failure. Mechanical ventilation, vasopressor therapy, and inflammatory markers (serum procalcitonin levels and leucocyte count) were independent time-varying risk factors of severe AKI. Increasing inflammatory markers displayed a close temporal association with the development of severe AKI. Sensitivity analysis on risk factors of AKI stage 2 and 3 combined confirmed these findings. CONCLUSION: Severe AKI in COVID-19 was tightly coupled with critical illness and systemic inflammation and was not observed in milder disease courses. These findings suggest that traditional systemic AKI mechanisms rather than kidney-specific processes contribute to severe AKI in COVID-19.
Keywords:Acute Kidney Injury, COVID-19, COVID-Associated AKI, Kidney Failure
Source:Kidney International Reports
ISSN:2468-0249
Publisher:Elsevier
Volume:6
Number:4
Page Range:905-915
Date:April 2021
Official Publication:https://doi.org/10.1016/j.ekir.2021.01.011
PubMed:View item in PubMed

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