Factors associated with unfavourable outcomes in COVID-19 patients with acute kidney injury: A single centre retrospective observational study

MIDHUN RAMESH; ANASWARA VANNARATTA; Sarang Pramod; Fathima Naseeha; Rashidha Vellali; Anesh Ashok; Amjed Pathirammal Agadi Purayil

doi:10.21804/25-1-4824

Midhun Ramesh Consultant Nephrologist, GIMCARE Hospital , Kannur, Kerala
Anaswara Vannaratta Pharm.D Intern , GIMCARE Hospital, Kannur, Kerala
Sarang Pramod Pharm.D Intern , GIMCARE Hospital, Kannur, Kerala
Fathima Naseeha Pharm.D Intern , GIMCARE Hospital, Kannur, Kerala
Rashidha Vellali Pharm.D Intern , GIMCARE Hospital, Kannur, Kerala
Anesh Ashok Consultant Physician , GIMCARE Hospital, Kannur, Kerala
Amjed Pathirammal Agadi Purayil Consultant Physician , GIMCARE Hospital, Kannur, Kerala

Keywords: COVID-19, acute kidney injury, Severe Acute Respiratory Syndrome, coronavirus

Abstract

Background: COVID-19 infection adversely affects all nephron segments to cause acute kidney injury (AKI), leading to greater mortality.

Methods: A retrospective analysis was conducted of patients (age >18 years) with COVID-19-related AKI admitted at a quaternary-level multispeciality hospital between September 2020 and April 2021. Data regarding various clinical, radiological, biochemical and haematological parameters were analysed and their association with clinical outcomes concerning mortality or survival was determined.

Results: We included 67 patients (46 males) with a mean age of 68.2 ± 12.17 years, of whom 45 patients were haemodynamically unstable, and 52 had hypoxaemia at the time of presentation. Overall, 53% of the cases were discharged from the hospital and 46% succumbed to the illness; females had higher mortality (67%, P = 0.024). The mean neutrophil/lymphocyte ratio (P = 0.014), HbA1c (P = 0.011), LDH (P = 0.002), D-dimer (P = 0.034) and C-reactive protein (P = 0.001) levels at admission were higher in patients with unfavourable outcomes. Increased mortality was present in patients who had a higher clinical category of illness (P = 0.014), advanced AKI stage (P = 0.001), haemodynamic instability at presentation (P < 0.001), required some form of KRT (P = 0.009), oxygen (P = 0.047), ventilatory (P = 0.028) or inotropic support (P = <0.001), were on calcium channel blockers at the time of admission (P = 0.024) or required antifungal agents (P = 0.003) or insulin therapy (P = 0.041).

Conclusions: Female COVID-19 patients with AKI, presenting with advanced disease and chest pain, having preexisting comorbidities, had increased mortality.