INTRODUCTION: Acute kidney injury (AKI) has been reported in patients with COVID-19 pneumonia and is a marker of severe disease and associated with higher mortality The aim of our study is to describe clinical characteristics, outcomes and 60 day hospital mortality of patients with COVID-19 pneumonia and AKI in the ICU setting METHODS: We conducted a retrospective observational study where all adult patients with confirmed COVID-19 infection admitted to ICUs of Montefiore Medical Center and developing AKI were included The study period was from 3/10- 4/11/2020 We did 60 day follow up on all patients till 6/11/2020 RESULTS: Out of 300 adult admissions in the ICUs with COVID-19 pneumonia, 224 patients developed AKI with the incidence of 74 6% The mean (+- SD) age was 60 (+-11 78) years and 140 (62%) were males By the end of our follow up period on June 11th, 149 (66 5%) patients expired, 75 (33 5%) survived (67 discharged alive, 8 still in hospital) 218 (97%) patients needed invasive mechanical ventilation for moderate to severe ARDS 113 (50 45%) patients had AKI on day 1 of ICU admission and rest developed later Peak AKI stage was 1 in 49 (21 8%) patients, 2 in 35 (15 6%) and 3 in 140 (62 5%) patients 114 patients (50 8%) required renal replacement therapy, median number of days of RRT was 7 days Of all patients requiring RRT, 80 (70%) expired Of the 34 survivors on RRT, 25 (73 5%) were able to be weaned off RRT completely before hospital discharge Non-survivors had significantly higher admission and peak creatinine levels, admission hemoglobin and peak phosphate levels compared to survivors Higher median peak levels of inflammatory markers (C-reactive protein (CRP) and procalcitonin) was seen amongst non-survivors compared to survivors but no difference in levels of other inflammatory markers like serum ferritin, LDH The 60 day hospital mortality was 66 5% CONCLUSIONS: COVID-19 infection in ICU is associated with extremely high incidence of severe AKI, many needing renal replacement therapy Majority of COVID-19 patients with severe AKI in ICU have moderate to severe ARDS and need invasive mechanical ventilation Timing or severity of AKI did not affect outcomes 60 day hospital mortality is high AKI patients requiring RRT have high mortality but survivors have good rates of RRT recovery
Characteristics, outcomes, and 60-day mortality of acute kidney injury in COVID-19 patients in ICU