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MO326: Factors Influencing Death Rate in COVID-19-Associated Acute Kidney Injury

Abstract BACKGROUND AND AIMS During a 2-year pandemic, COVID-19 proved to be a condition with a high potential to affect various organs other than the lungs. Acute kidney injury (AKI) in hospitalized COVID-19 patients is associated with a poor prognosis. The aim of this study was to identify factors influencing in-hospital mortality. METHOD In a retrospective analysis, we included 268 adult patients with RT-PCR-confirmed SARS-CoV-2 infection and AKI admitted to two Emergency University Hospitals during a 6-month period, between 1 November 2020 and 30 April 2021. Data were retrieved from the electronic databases of the two hospitals. We analysed kidney and patient outcomes at discharge and the potential risk factors for mortality in AKI patients. We defined and staged AKI according to KDIGO 2012 creatinine criteria. RESULTS In our cohort the mean age was 72.28 years, 169 (63%) patients were men, and 111 (41.4%) had previously known chronic kidney disease. 81 patients were classified as having stage 1 AKI, 79 patients had stage 2 AKI and 108 had stage 3 AKI. A total of 135 (50.37%) patients died during hospitalization. Statistic analysis using the Mann–Whitney U-test revealed significant differences (P < .01) between survivors and non-survivors regarding peak values of serum urea (137.9 versus 190.9 mg/dL), creatinine (2.88 versus 3.94 mg/dL), procalcitonin (3.56 versus 15.86 ng/mL), C-reactive protein (92.32 versus 176.09 mg/L), interleukin-6 (243 versus 9552 pg/mL), ferritin (1331 versus 5189 ng/ml) and d-dimers (3.68 versus 6.88 mcg/ml). No significant differences were found between survivors and non-survivors regarding peak values of erythrocyte sedimentation rate (69 versus 71 mm/1 h; P = .35) and fibrinogen (629 versus 645 mg/dL; P = .24) and also regarding the lowest lymphocyte count during hospitalization (519 versus 649/mmc; P = .80). The analysis using Fisher’s exact test showed that deceased patients were significantly more associated with AKI KDIGO stage 2 or 3 (51.9%/63% versus 32.1%), with higher need for renal replacement theraphy (RRT) (68.8% versus 47.9%), with ICU (intensive care unit) admission (90.1% versus 22.3%) (Table 1). Moreover, death was associated more frequently with partial or absent renal function recovery (20%/50% versus 6.4%) (P < .05) (Table 1). In a logistic regression model (using KDIGO stages, serum urea and need for RRT), it was proved that only serum urea had a significant prediction power (P = .001): every increase of serum urea with 1 unit increases the risk of death by 1.007 times (95% confidence interval 1.003–1.011). CONCLUSION Mortality of COVID-19 patients associating AKI is proportionally augmented by both markers of severity of SarS-CoV-2 and also by severity of AKI. In our study, the peak value of serum urea during hospitalization was the best predictor for death in COVID-19.


BACKGROUND AND AIMS:
During a 2-year pandemic, COVID-19 proved to be a condition with a high potential to affect various organs other than the lungs. Acute kidney injury (AKI) in hospitalized COVID-19 patients is associated with a poor prognosis. The aim of this study was to identify factors influencing in-hospital mortality.

METHOD:
In a retrospective analysis, we included 268 adult patients with RT-PCRconfirmed SARS-CoV-2 infection and AKI admitted to two Emergency University Hospitals during a 6-month period, between 1 November 2020 and 30 April 2021. Data were retrieved from the electronic databases of the two hospitals. We analysed kidney and patient outcomes at discharge and the potential risk factors for mortality in AKI patients. We defined and staged AKI according to KDIGO 2012 creatinine criteria.  (Table 1). Moreover, death was associated more frequently with partial or absent renal function recovery (20%/50% versus 6.4%) (P < .05) ( Table 1).

RESULTS
In a logistic regression model (using KDIGO stages, serum urea and need for RRT), it was proved that only serum urea had a significant prediction power (P = .001): every increase of serum urea with 1 unit increases the risk of death by 1.007 times (95% confidence interval 1.003-1.011). CONCLUSION: Mortality of COVID-19 patients associating AKI is proportionally augmented by both markers of severity of SarS-CoV-2 and also by severity of AKI. In our study, the peak value of serum urea during hospitalization was the best predictor for death in COVID-19.

BACKGROUND AND AIMS:
Liver transplantation is a mandatory treatment for many cirrhotic patients worldwide. Nonetheless, frequently there is high systemic morbidity and considerable mortality in post transplantation [1].
Our aim was to calculate acute kidney injury incidence (KDIGO), need of renal replacement therapy, early liver graft dysfunction (first week post transplantation: Bilirubin > 10 mg/dL, INR > 1.5, ALT or AST > 2000 UI) and calculate mortality between liver transplantation and end of evaluation. METHOD: We reviewed clinical registries from our transplantation service in La Cardio Hospital in Bogotá, Colombia, and included adult patients with diagnosis of cirrhosis and liver transplantation (Ltx) between 1 January 2005 and 31 July 2021. We excluded patients with acute liver failure without indication of transplantation, previous transplant or multiorganic transplantation (e.g. liver-kidney), heart failure and GFR < 30 mL/min/1.73 (CKD EPI).

RESULTS:
We had 550 Ltx patients, of whom 397 (54.4% male) were included according to our inclusion criteria. Mean age of population was 56 year old at the moment of Ltx. Medical history of comorbidity was hypertension (15.8%), diabetes (24.1%) and smoking (25.44%). Mean Charlson index was 4.4 (Ds ± 1.5). Main etiologies of cirrhosis were alcohol (17.8%), idiopathic (16%), hepatitis C virus (15.3%). In terms of cirrhosis severity, 52.3% had CHILD B, and 26% CHILD C. Average MELD-Na was 16 (Ds ± 6). Anhepatic time was 57 min (RIQ: 47-69). Mean time in ICU was 2 days. There was early graft dysfunction in 32 patients (8%). AKI was diagnosed in 21% of patients. Renal replacement therapy was initiated in 29 patients. Global mortality was 15.1% during the time of study. We performed a classification and regression tree (CART) analysis, using mortality, graft dysfunction and AKI as variables. In CART for mortality, patients with BMI < 19 had 56% of probability of death. The absence of RRT need was related to a 95% probability of being alive at the end of the follow-up. A BMI > 19 and < 24 in need of RRT was associated to a 55% of probability of death (Graphic 1). In terms of graft dysfunction, it was present in 8% of patients. Patients taken to RRT had 55% of probability to death. Acute kidney injury was diagnosed in 21% of patients, classified according to KDIGO: 1: 38%, 2: 32% and 3: 30%. Patients who needed RRT showed a higher prevalence of diastolic dysfunction (88%). The majority of KDIGO 3 patients did not need RRT (Graphic 2). CONCLUSION: Acute kidney injury was present in almost one quarter of liver transplantation patients and was related to an increase in mortality. We consider that those results highlight the importance of kidney function evaluation from the early post-operative state in a nephrology rapid response team scheme aligned with transplantation surgery, ICU and anaesthesia to improve AKI prevalence.