Abstract
Background: AKI is a manifestation of COVID-19 (CoV-AKI). However, there is paucity of data from the United States, particularly from a predominantly black population. We report the phenotype and outcomes of AKI at an academic hospital in New Orleans.
Methods: We conducted an observational study in patients hospitalized at Ochsner Medical Center over a 1-month period with COVID-19 and diagnosis of AKI (KDIGO). We examined the rates of RRT and in-hospital mortality as outcome measures.
Results: Among 575 admissions (70% black) with COVID-19 [173 (30%) to an intensive care unit (ICU)], we found 161 (28%) cases of AKI (61% ICU and 14% general ward admissions). Patients were predominantly men (62%) and hypertensive (83%). Median body mass index (BMI) was higher among those with AKI (34 versus 31 kg/m 2 , P <0.0001). AKI over preexisting CKD occurred in 35%. Median follow-up was 25 (1-45) days. The in-hospital mortality rate for the AKI cohort was 50%. Vasopressors and/or mechanical ventilation were required in 105 (65%) of those with AKI. RRT was required in 89 (55%) patients. Those with AKI requiring RRT (AKI-RRT) had higher median BMI (35 versus 33 kg/m 2 , P =0.05) and younger age (61 versus 68, P =0.0003). Initial values of ferritin, C-reactive protein, procalcitonin, and lactate dehydrogenase were higher among those with AKI; and among them, values were higher for those with AKI-RRT. Ischemic acute tubular injury (ATI) and rhabdomyolysis accounted for 66% and 7% of causes, respectively. In 13%, no obvious cause of AKI was identified aside from COVID-19 diagnosis.
Conclusions: CoV-AKI is associated with high rates of RRT and death. Higher BMI and inflammatory marker levels are associated with AKI as well as with AKI-RRT. Hemodynamic instability leading to ischemic ATI is the predominant cause of AKI in this setting.
Keywords: COVID-19; ICU; New Orleans; SARS; SARS-CoV-2; United States; acute kidney injury; acute kidney injury and ICU nephrology; black; dialysis; hospital mortality; obesity; phenotype; proteinuria; renal replacement therapy.
【저자키워드】 COVID-19, SARS-CoV-2, obesity, SARS, Acute kidney injury, ICU, dialysis, Hospital mortality, New Orleans, Proteinuria, phenotype, United States, Renal replacement therapy., acute kidney injury and ICU nephrology, black, 【초록키워드】 intensive care, mechanical ventilation, hospital, Diagnosis, C-reactive protein, ferritin, procalcitonin, outcome, lactate dehydrogenase, Cohort, body mass index, AKI, COVID-19 diagnosis, death, age, Follow-up, BMI, Admission, patients, in-hospital mortality, outcome measures, marker, renal replacement therapy, Inflammatory, Injury, CKD, paucity of data, Admissions, Ischemic, RRT, Vasopressor, in-hospital mortality rate, causes, hypertensive, center, Median BMI, KDIGO, The United States, men, occurred, examined, required, conducted, accounted, predominant, New, acute kidney, patients hospitalized, with COVID-19, 【제목키워드】 urban, New Orlean,