Acute kidney injury (AKI) is associated with increased mortality in most critical settings. However, it is unclear whether its mild form (i.e. AKI stage 1) is associated with increased mortality also in non-critical settings. Here we conducted an international study in patients hospitalized with SARS-CoV-2 infection aiming 1. to estimate the incidence of AKI at each stage and its impact on mortality 2. to identify AKI risk factors at admission (susceptibility) and during hospitalization (exposures) and factors contributing to AKI-associated mortality. We included 939 patients from medical departments in Moscow (Russia) and Padua (Italy). In-hospital AKI onset was identified in 140 (14.9%) patients, mainly with stage 1 (65%). Mortality was remarkably higher in patients with AKI compared to those without AKI (55 [39.3%] vs. 34 [4.3%], respectively). Such association remained significant after adjustment for other clinical conditions at admission (relative risk [RR] 5.6; CI 3.5- 8.8) or restricting to AKI stage 1 (RR 3.2; CI 1.8–5.5) or to subjects with AKI onset preceding deterioration of clinical conditions. After hospital admission, worsening of hypoxic damage, inflammation, hyperglycemia, and coagulopathy were identified as hospital-acquired risk factors predicting AKI onset. Following AKI onset, the AKI-associated worsening of respiratory function was identified as the main contributor to AKI-induced increase in mortality risk. In conclusion, AKI is a common complication of Sars-CoV2 infection in non-intensive care settings where it markedly increases mortality risk also at stage 1. The identification of hospital-acquired risk factors and exposures might help prevention of AKI onset and of its complications.
【저자키워드】 Outcomes research, kidney, 【초록키워드】 Inflammation, Mortality, Hospitalization, Respiratory function, SARS-COV-2 infection, susceptibility, Russia, Infection, risk, Italy, risk factor, Coagulopathy, Kidney injury, Deterioration, AKI, International, Patient, Mild, complications, Hospital admission, incidence, hyperglycemia, Admission, Care, Critical, patients, association, mortality risk, Factor, subject, worsening, help, increased mortality, clinical conditions, clinical condition, hypoxic damage, identify, remained, conducted, increase, increase in, contributing to, patients hospitalized, patients with AKI, 【제목키워드】 hospital, Acute kidney injury, risk factor, Patient,