Abstract
Introduction: Acute kidney injury (AKI) in coronavirus infection disease (COVID-19) is associated with disease severity. We aimed to evaluate risk factors associated with AKI beyond COVID-19 severity.
Methods: A retrospective observational study of COVID-19 patients admitted to a tertiary hospital in Singapore. Logistic regression was used to evaluate associations between risk factors and AKI (based on Kidney Disease Improving Global Outcomes criteria). Dominance analysis was performed to evaluate the relative importance of individual factors.
Results: Seven hundred seven patients were included. Median age was 46 years (interquartile range [IQR]: 29-57) and 57% were male with few comorbidities (93%, Charlson Comorbidity Index [CCI] <1). AKI occurred in 57 patients (8.1%); 39 were in AKI stage 1 (68%), 9 in stage 2 (16%), and 9 in stage 3 (16%). Older age (adjusted odds ratio [aOR] 1.04; 95% confidence interval [CI]: 1.01-1.07), baseline use of angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) (aOR 2.86; 95% CI: 1.20-6.83), exposure to vancomycin (aOR 5.84; 95% CI: 2.10-16.19), use of nonsteroidal anti-inflammatory drugs (NSAIDs) (aOR 3.04; 95% CI: 1.15-8.05), and severe COVID-19 with hypoxia (aOR 13.94; 95% CI: 6.07-31.98) were associated with AKI in the multivariable logistic regression model. The 3 highest ranked predictors were severe COVID-19 with hypoxia, vancomycin exposure, and age, accounting for 79.6% of the predicted variance (41.6, 23.1, and 14.9%, respectively) on dominance analysis.
Conclusion: Severe COVID-19 is independently associated with increased risk of AKI beyond premorbid conditions and age. Appropriate avoidance of vancomycin and NSAIDs are potentially modifiable means to prevent AKI in patients with COVID-19.
Keywords: Acute renal failure; Chronic kidney disease; Creatinine.
【저자키워드】 Chronic kidney disease, acute renal failure, Creatinine., 【초록키워드】 COVID-19, severe COVID-19, hypoxia, disease severity, hospital, COVID-19 severity, Comorbidity, risk factor, Kidney injury, kidney, NSAIDS, ARB, AKI, male, Patient, Factors, age, predictor, Singapore, association, angiotensin receptor blocker, angiotensin-converting enzyme inhibitor, NSAID, retrospective, Analysis, COVID-19 patient, criteria, chronic, interquartile range, adjusted odds ratio, nonsteroidal anti-inflammatory drug, 95% confidence interval, increased risk, multivariable logistic regression, Charlson Comorbidity Index, avoidance, renal, coronavirus infection disease, dominance, Prevent, Seven, highest, predicted, was used, evaluate, occurred, was performed, condition, Appropriate, baseline, Improving, patients with COVID-19, premorbid, 【제목키워드】 COVID-19, development, Factor,