lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

The Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury in Critically Ill Patients with COVID-19: A Multicenter Study

20 Pages Posted: 23 Apr 2020

See all articles by Xin Zhang

Xin Zhang

Government of the People's Republic of China - Department of Pulmonary and Critical Care Medicine

Wei Guo

Peking University - Trauma Center

Jing Hua

Tongji University - Department of Pulmonary and Critical Care Medicine

Zhibing Luo

Tongji University - Department of Pulmonary and Critical Care Medicine

Shaoyong Gao

Tongji University - Department of Pulmonary and Critical Care Medicine

Linyu Ran

Tongji University - Department of Pulmonary and Critical Care Medicine

Shengyun Wang

Government of the People's Republic of China - Department of Emergency and Critical Care Medicine

Chenchen Qian

UPMC Pinnacle Hospital - Department of Internal Medicine

Zhe Ge

Government of the People's Republic of China - Department of Infectious Disease and Tuberculosis

Rongzhang Chen

Tongji University - Department of Pulmonary and Critical Care Medicine

Liming Zhao

Tongji University - Department of Pulmonary and Critical Care Medicine

Xiaodong Wu

Tongji University - Department of Respiratory and Critical Care Medicine

Qian Guo

Tongji University - Department of Pulmonary and Critical Care Medicine

Chunfeng He

Tongji University - Department of Pulmonary and Critical Care Medicine

Tian Li

Tongji University - Department of Pulmonary and Critical Care Medicine

Xiaoyu Ren

Tongji University - Department of Pulmonary and Critical Care Medicine

Weibo Gao

Peking University - Department of Emergency

Zhongmin Liu

Tongji University - Department of Pulmonary and Critical Care Medicine

Qiang Li

Tongji University - Department of Respiratory and Critical Care Medicine

Feilong Wang

Tongji University - Department of Pulmonary and Critical Care Medicine

More...

Abstract

Background Acute kidney injury (AKI) is associated with worse outcome in patients with infection. However, the epidemiological feature of AKI among patients with COVID-19 is poorly understood.

Methods: In this multicenter retrospective study, we recruited consecutive adult patients who had died or been discharged in 11 designated ICUs for caring for COVID-19 in Wuhan, China. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria and the primary outcome was in-hospital mortality. Potential risk factors of AKI as well as the association between AKI and in-hospital mortality were analyzed.

Results: A total of 282ICU patients with COVID-19 were included in the study and 43.6% (123/282) of them had AKI. In comparison with patients without AKI, patients who developed AKI tended to be older, had higher proportion of chronic kidney disease (CKD), more likely to develop acute organ dysfunction and had higher SOFA score. Multivariate analysis showed that medical history of CKD and SOFA score were independently associated with occurrence of AKI. Increasing AKI severity was associated with hospital mortality when adjusted for other potential variables: odds ratio of stage 1 = 3.766 (95% CI1.599–8.870; p = 0.002), stage 2 = 4.858 (95% CI1.269–18.597; p = 0.021), and stage 3 = 25.635 (95% CI8.240–79749; p<0.001).

Conclusion: In this large-scale, multicenter study, we found that more than 2 in 5 critically ill patients with COVID-19 experienced AKI during their hospital stay. Increasing AKI severity was strongly associated with increased in-hospital mortality.

Funding Statement: This work was supported by the National Key Research and Development Project of the Ministry of Science and Technology, China (2018YFC1313700), “Gaoyuan” project of Pudong Health and Family Planning Commission (PWYgy2018-6) and the research Foundation of shanghai science and technology commission (No.18140904100).

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: This study was approved by the Shanghai East Hospital Ethics Committee and carried out in accordance with the Declaration of Helsinki.

Keywords: COVID-19, SARS-CoV-2, Acute kidney injury, mortality, Risk factors:

Suggested Citation

Zhang, Xin and Guo, Wei and Hua, Jing and Luo, Zhibing and Gao, Shaoyong and Ran, Linyu and Wang, Shengyun and Qian, Chenchen and Ge, Zhe and Chen, Rongzhang and Zhao, Liming and Wu, Xiaodong and Guo, Qian and He, Chunfeng and Li, Tian and Ren, Xiaoyu and Gao, Weibo and Liu, Zhongmin and Li, Qiang and Wang, Feilong, The Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury in Critically Ill Patients with COVID-19: A Multicenter Study (4/7/2020). Available at SSRN: https://ssrn.com/abstract=3572908 or http://dx.doi.org/10.2139/ssrn.3572908

Xin Zhang

Government of the People's Republic of China - Department of Pulmonary and Critical Care Medicine

Kunming
China

Wei Guo

Peking University - Trauma Center

Beijing
China

Jing Hua

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai
China

Zhibing Luo

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai
China

Shaoyong Gao

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai
China

Linyu Ran

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai
China

Shengyun Wang

Government of the People's Republic of China - Department of Emergency and Critical Care Medicine

Shanghai
China

Chenchen Qian

UPMC Pinnacle Hospital - Department of Internal Medicine

Harrisburg, PA 17104
United States

Zhe Ge

Government of the People's Republic of China - Department of Infectious Disease and Tuberculosis

Kunming
China

Rongzhang Chen

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai
China

Liming Zhao

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai
China

Xiaodong Wu

Tongji University - Department of Respiratory and Critical Care Medicine

Shanghai
China

Qian Guo

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai
China

Chunfeng He

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai
China

Tian Li

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai
China

Xiaoyu Ren

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai
China

Weibo Gao

Peking University - Department of Emergency ( email )

Beijing
China

Zhongmin Liu

Tongji University - Department of Pulmonary and Critical Care Medicine ( email )

Shanghai
China

Qiang Li

Tongji University - Department of Respiratory and Critical Care Medicine ( email )

Shanghai
China

Feilong Wang (Contact Author)

Tongji University - Department of Pulmonary and Critical Care Medicine ( email )

Shanghai
China