Background Initial reports indicate a high incidence of acute kidney injury (AKI) in Coronavirus Disease 2019 (COVID-19), but more data are required to clarify if COVID-19 is an independent risk factor for AKI and how COVID-19–associated AKI may differ from AKI due to other causes. We therefore sought to study the relationship between COVID-19, AKI, and outcomes in a retrospective cohort of patients admitted to 2 acute hospitals in Derby, United Kingdom. Methods and findings We extracted electronic data from 4,759 hospitalised patients who were tested for COVID-19 between 5 March 2020 and 12 May 2020. The data were linked to electronic patient records and laboratory information management systems. The primary outcome was AKI, and secondary outcomes included in-hospital mortality, need for ventilatory support, intensive care unit (ICU) admission, and length of stay. As compared to the COVID-19–negative group ( n = 3,374), COVID-19 patients ( n = 1,161) were older (72.1 ± 16.1 versus 65.3 ± 20.4 years, p < 0.001), had a greater proportion of men (56.6% versus 44.9%, p < 0.001), greater proportion of Asian ethnicity (8.3% versus 4.0%, p < 0.001), and lower proportion of white ethnicity (75.5% versus 82.5%, p < 0.001). AKI developed in 304 (26.2%) COVID-19–positive patients (COVID-19 AKI) and 420 (12.4%) COVID-19–negative patients (AKI controls). COVID-19 patients aged 65 to 84 years (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.11 to 2.50), needing mechanical ventilation (OR 8.74, 95% CI 5.27 to 14.77), having congestive cardiac failure (OR 1.72, 95% CI 1.18 to 2.50), chronic liver disease (OR 3.43, 95% CI 1.17 to 10.00), and chronic kidney disease (CKD) (OR 2.81, 95% CI 1.97 to 4.01) had higher odds for developing AKI. Mortality was higher in COVID-19 AKI versus COVID-19 patients without AKI (60.5% versus 27.4%, p < 0.001), and AKI was an independent predictor of mortality (OR 3.27, 95% CI 2.39 to 4.48). Compared with AKI controls, COVID-19 AKI was observed in a higher proportion of men (58.9% versus 51%, p = 0.04) and lower proportion with white ethnicity (74.7% versus 86.9%, p = 0.003); was more frequently associated with cerebrovascular disease (11.8% versus 6.0%, p = 0.006), chronic lung disease (28.0% versus 19.3%, p = 0.007), diabetes (24.7% versus 17.9%, p = 0.03), and CKD (34.2% versus 20.0%, p < 0.001); and was more likely to be hospital acquired (61.2% versus 46.4%, p < 0.001). Mortality was higher in the COVID-19 AKI as compared to the control AKI group (60.5% versus 27.6%, p < 0.001). In multivariable analysis, AKI patients aged 65 to 84 years, (OR 3.08, 95% CI 1.77 to 5.35) and ≥85 years of age (OR 3.54, 95% CI 1.87 to 6.70), peak AKI stage 2 (OR 1.74, 95% CI 1.05 to 2.90), AKI stage 3 (OR 2.01, 95% CI 1.13 to 3.57), and COVID-19 (OR 3.80, 95% CI 2.62 to 5.51) had higher odds of death. Limitations of the study include retrospective design, lack of urinalysis data, and low ethnic diversity of the region. Conclusions We observed a high incidence of AKI in patients with COVID-19 that was associated with a 3-fold higher odds of death than COVID-19 without AKI and a 4-fold higher odds of death than AKI due to other causes. These data indicate that patients with COVID-19 should be monitored for the development of AKI and measures taken to prevent this. Trial registration ClinicalTrials.gov NCT04407156 Author summary Why was this study done? Recent reports have suggested that some patients with Coronavirus Disease 2019 (COVID-19) develop acute kidney injury (AKI). There is a need to better understand risk factors for AKI in patients with COVID-19. It is also unclear if AKI in patients with COVID-19 differs from AKI due to other causes. What did the researchers do and find? In this study, we examined risk factors for AKI in patients with COVID-19 and also compared AKI in COVID-19 with AKI due to other causes. We found that males and patients of nonwhite ethnicity as well as those with comorbidities were at increased risk of developing AKI in COVID-19. AKI was associated with a 3-fold increase in mortality in COVID-19 patients. Patients with COVID-19 and AKI had higher mortality (60.5% versus 27.6%) than patients with AKI due to other causes, and COVID-19 was an independent predictor of mortality associated with an almost 4-fold odds of death. What do these findings mean? COVID-19 frequently causes AKI, and when it does, it is associated with a higher mortality than COVID-19 without AKI or AKI due to other causes. Patients with COVID-19 should be monitored for early evidence of AKI so that preventive measures can be taken to avoid AKI.
【초록키워드】 COVID-19, Mortality, intensive care, mechanical ventilation, hospital, Lung disease, Acute kidney injury, Chronic kidney disease, outcome, risk factor, ICU, Laboratory, AKI, Urinalysis, management, male, Patient, death, age, incidence, information, United Kingdom, Admission, in-hospital mortality, COVID-19 patients, Evidence, retrospective, Odds ratio, chronic liver disease, Cerebrovascular disease, COVID-19 patient, CKD, preventive measure, ventilatory support, cardiac failure, Asian, Older, Primary outcome, 95% CI, 95% confidence interval, increased risk, causes, multivariable analysis, measure, secondary outcome, limitation, independent risk factor, retrospective cohort, researcher, men, recent, Prevent, controls, independent, greater, tested, lack, develop, examined, include, proportion, required, suggested, increase in, hospitalised patient, cause, diabete, AKI patient, COVID-19–negative patient, electronic patient record, higher odd, patients with AKI, patients with COVID-19, those with comorbidity, with COVID-19, 【제목키워드】 Kidney injury, retrospective cohort study,