"Acute kidney injury in critically ill patients with COVID-19: The AKICOV multicenter study in Catalonia"

• Published in: PloS one Vol. 18; no. 4; p. e0284248
• Main Authors: Sánchez, Arsenio De La Vega, Pérez, Ana Navas, Pérez-Carrasco, Marcos, Sonet, María Torrens, Buendia, Yolanda Diaz, Ballujera, Patricia Ortiz, López, Miguel Rodríguez, Riera, Joan Sabater, Olmo-Isasmendi, Aitor, Torra, Ester Vendrell, García-Pumarino, María Álvarez, Villamayor, Mercedes Ibarz, Catalán Ibars, Rosa María, Zelaya, Iban Oliva, Chica, Javier Pardos, Anglès, Conxita Rovira, Tomasa-Irriguible, Teresa M, Serra, Anna Baró, Casanova, Edward J, De Molina, Francisco J González
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.04.2023; Public Library of Science (PLoS)
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Acute Kidney Injury - therapy; Acute respiratory distress syndrome; Analysis; Asthma; Biology and Life Sciences; Care and treatment; China; Chronic kidney failure; Chronic obstructive pulmonary disease; Comorbidity; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - epidemiology; Creatinine; Critical Illness; Demographics; Female; Health aspects; Hemodynamics; Hospitals; Humans; Hypertension; Hypotension; Intensive care; Intensive Care Units; Kidney diseases; Kidneys; Laboratories; Male; Mechanical ventilation; Medical research; Medical treatment; Medicine and Health Sciences; Medicine, Experimental; Middle Aged; Mortality; Nosocomial infection; Pandemics; Patient outcomes; Patients; Physiological aspects; Pneumonia; Prognosis; Prone position; Prospective Studies; Regression analysis; Renal Replacement Therapy; Respiratory distress syndrome; Retrospective Studies; Risk Factors; Severe acute respiratory syndrome coronavirus 2; Spain; Spain - epidemiology; Statistical analysis; Steroids; Streptococcus infections; Tazobactam; United Kingdom; Urine; Ventilation; Ventilators; Spain; United Kingdom; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0284248

This study describes the incidence, evolution and prognosis of acute kidney injury (AKI) in critical COVID-19 during the first pandemic wave. We performed a prospective, observational, multicenter study of confirmed COVID-19 patients admitted to 19 intensive care units (ICUs) in Catalonia (Spain). Data regarding demographics, comorbidities, drug and medical treatment, physiological and laboratory results, AKI development, need for renal replacement therapy (RRT) and clinical outcomes were collected. Descriptive statistics and logistic regression analysis for AKI development and mortality were used. A total of 1,642 patients were enrolled (mean age 63 (15.95) years, 67.5% male). Mechanical ventilation (MV) was required for 80.8% and 64.4% of these patients, who were in prone position, while 67.7% received vasopressors. AKI at ICU admission was 28.4% and increased to 40.1% during ICU stay. A total of 172 (10.9%) patients required RRT, which represents 27.8% of the patients who developed AKI. AKI was more frequent in severe acute respiratory distress syndrome (ARDS) ARDS patients (68% vs 53.6%, p<0.001) and in MV patients (91.9% vs 77.7%, p<0.001), who required the prone position more frequently (74.8 vs 61%, p<0.001) and developed more infections. ICU and hospital mortality were increased in AKI patients (48.2% vs 17.7% and 51.1% vs 19%, p <0.001) respectively). AKI was an independent factor associated with mortality (IC 1.587-3.190). Mortality was higher in AKI patients who required RRT (55.8% vs 48.2%, p <0.04). Conclusions There is a high incidence of AKI in critically ill patients with COVID-19 disease and it is associated with higher mortality, increased organ failure, nosocomial infections and prolonged ICU stay.