Prognostic value of kidney involvement in COVID-19

  • Guillermo Fragale Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Universidad Austral, Pilar, Buenos Aires, Argentina
  • Matías Tisi Baña Servicio de Clínica Médica, Hospital Universitario Austral, Universidad Austral, Pilar, Buenos Aires, Argentina
  • Mauro Magenta Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Universidad Austral, Pilar, Buenos Aires, Argentina
  • Vanina Beitia Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Universidad Austral, Pilar, Buenos Aires, Argentina
  • Alejandra Karl Servicio de Nefrología y Trasplante Renal, Hospital Universitario Austral, Universidad Austral, Pilar, Buenos Aires, Argentina
  • Lina Rodríguez Cortés Servicio de Clínica Médica, Hospital Universitario Austral, Universidad Austral, Pilar, Buenos Aires, Argentina
  • Victoria Pousa Unidad de Terapia Intensiva, Hospital Universitario Austral, Universidad Austral, Pilar, Buenos Aires, Argentina
Keywords: COVID-19, coronavirus, severe acute respiratory syndrome, SARS-CoV-2, acute kidney injury, prognosis

Abstract

Introduction: Acute kidney injury is a complication described in patients with SARS-CoV-2 infection that is around 0.5-7% of cases. Objective: evaluate the prognostic value of kidney involvement in patients hospitalized for COVID-19 disease. Methods: A prospective cohort of patients over 18 years with a diagnosis of COVID-19 disease in the period from May to October 2020 was analyzed. All were followed up until hospital discharge or death. Clinical and biochemical parameters, Charlson score, mortality and severity of COVID-19 disease were evaluated. Results: Four hundred twelve patients entered the study, 57% men and mean age 51 ± 16 years. Twenty percent had a Charlson score ≥3, the incidence of acute kidney injury, defined as the increase in serum creatinine 0.3 mg / dl from baseline, was 5.5% (n=23) and hospital mortality was 2.2% (n = 9). The bivariate and multivariate analysis showed that the male sex [OR=0.32 (IC 0.12-0.82), p=0.017], D-dimer> 500 ng/ml [OR=3.68 (IC 1.23-10.96), p=0.019], urinary protein/creatinine > 0.20 [OR=2.43 (CI 1.03-5.74), p=0.043], and AKI [OR=10.53 (CI 2.99-37.09), p=<0.0001] were predictors of severe COVID-19, defined as respiratory rate >30 x min, oxygen saturation <93% or PO2/FIO2 <300. The univariate analysis of mortality was associated with the development of severe COVID-19 [OR=68.76 (CI 8.39-563.36), p=<0.0001] and acute kidney injury [OR=45.41 (CI 10.45-197.22), p=<0.0001]. Conclusion: Renal involvement is associated with worse evolution and higher mortality in COVID-19. The assessment of renal function and proteinuria are accessible parameters that should be included as risk factors in the initial evaluation of these patients.

References

1) World Health Organization. Coronavirus disease 2019 (COVID-19) [Internet]. Situation Report. 2020;56. Disponible en: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200316-sitrep-56-covid-19.pdf (consulta: 15/03/2021).

2) Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5.

3) Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. doi: 10.1001/jama.2020.1585.

4) Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al.; China Medical Treatment Expert Group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. doi: 10.1056/NEJMoa2002032.

5) Wang T, Du Z, Zhu F, Cao Z, An Y, Gao Y, et al. Comorbidities and multi-organ injuries in the treatment of COVID-19. Lancet. 2020;395(10228):e52. doi: 10.1016/S0140-6736(20)30558-4.

6) Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-38. doi: 10.1016/j.kint.2020.03.005.

7) Wang L, Li X, Chen H, Yan S, Li D, Li Y, et al. Coronavirus disease 19 infection does Not result in acute kidney injury: an analysis of 116 hospitalized patients from Wuhan, China. Am J Nephrol. 2020;51(5):343-8. doi: 10.1159/000507471.

8) Abbate M, Rottoli D, Gianatti A. COVID-19 attacks the kidney: ultrastructural evidence for the presence of virus in the glomerular epithelium. Nephron. 2020;144(7):341-2. doi: 10.1159/000508430.

9) Su H, Yang M, Wan C, Yi LX, Tang F, Zhu HY, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 2020;98(1):219-27. doi: 10.1016/j.kint.2020.04.003.

10) Lim JH, Park SH, Jeon Y, Cho JH, Jung HY, Choi JY, et al. Fatal outcomes of COVID-19 in patients with severe acute kidney injury. J Clin Med. 2020;9(6):1718. doi: 10.3390/jcm9061718.

11) Peng S, Wang HY, Sun X, Li P, Ye Z, Li Q, et al. Early versus late acute kidney injury among patients with COVID-19-a multicenter study from Wuhan, China. Nephrol Dial Transplant. 2020;35(12):2095-102. doi: 10.1093/ndt/gfaa288.

12) Diagnosis and treatment protocol for novel coronavirus pneumonia (trial version 7). Chin Med J (Engl). 2020;133(9):1087-95. doi: 10.1097/CM9.0000000000000819.

13) Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. doi: 10.1016/0021-9681(87)90171-8.

14) Kellum JA, Lameire N, Aspelin P, MacLeod AM, Barsoum RS, Mehta RL, et al. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Workgroup. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1-138.

15) Argentina. Ministerio de Salud. Recomendaciones condicionales para el abordaje terapéutico de COVID-19 [Internet]. Disponible en: https://www.argentina.gob.ar/salud/coronavirus/abordaje-terapeutico (consulta: 15/03/2021).

16) Robbins-Juarez SY, Qian L, King KL, Stevens JS, Husain SA, Radhakrishnan J, et al. Outcomes for patients with COVID-19 and acute kidney injury: a systematic review and meta-analysis. Kidney Int Rep. 2020;5(8):1149-60. doi: 10.1016/j.ekir.2020.06.013.

17) Yan R, Zhang Y, Li Y, Xia L, Guo Y, Zhou Q. Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2. Science. 2020;367(6485):1444-8. doi: 10.1126/science.abb2762.

18) Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631-7. doi: 10.1002/path.1570.

19) Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-38. doi: 10.1016/j.kint.2020.03.005.

20) Moreno G, Carbonell R, Bodí M, Rodríguez A. Systematic review of the prognostic utility of D-dimer, disseminated intravascular coagulation, and anticoagulant therapy in COVID-19 critically ill patients. Med Intensiva (Engl Ed). 2021;45(1):42-55. doi: 10.1016/j.medin.2020.06.006.

21) Sultan S, Altayar O, Siddique SM, Davitkov P, Feuerstein JD, Lim JK, et al. AGA Institute rapid review of the gastrointestinal and liver manifestations of COVID-19, meta-analysis of international data, and recommendations for the consultative management of patients with COVID-19. Gastroenterology. 2020;159(1):320-334.e27. doi: 10.1053/j.gastro.2020.05.001.

22) Hundt MA, Deng Y, Ciarleglio MM, Nathanson MH, Lim JK. Abnormal liver tests in COVID-19: a retrospective observational cohort study of 1,827 patients in a Major U.S. Hospital Network. Hepatology. 2020;72(4):1169-76. doi: 10.1002/hep.31487.

23) Mendizabal M, Piñero F, Ridruejo E, Anders M, Silveyra MD, Torre A, et al. Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission. Ann Hepatol. 2021;21:100298. doi: 10.1016/j.aohep.2020.100298.

24) Su H, Yang M, Wan C, Yi LX, Tang F, Zhu HY, Yi F, Yang HC, Fogo AB, Nie X, Zhang C. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 2020;98(1):219-27. doi: 10.1016/j.kint.2020.04.003.
Published
2022-03-11
How to Cite
1.
Fragale G, Tisi Baña M, Magenta M, Beitia V, Karl A, Rodríguez Cortés L, Victoria Pousa. Prognostic value of kidney involvement in COVID-19. Rev Nefrol Dial Traspl. [Internet]. 2022Mar.11 [cited 2024Sep.1];42(1):4-10. Available from: http://revistarenal.org.ar/index.php/rndt/article/view/752
Issue
Vol. 42 No. 1 (2022): Jan.-March
Section
Original Article

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