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The Predictors of Cardio-renal Syndrome among Patients with ‎COVID-19 Infection‎ ‎

Background and study aim: ‎: Several reports showed that some Covid-19 patients tend to have serious and fatal ‎complications related to the kidney and heart. Rationale and mechanisms inducing this ‎pathogenesis is unclear, but it’s more common to happen in patients with hemodynamic ‎instability and refractory severe hypotension related to cytokine storm. It represents an ‎irreversible stage of a sepsis-like illness that induces simultaneous damage to various organs as ‎the myocardium and renal tubules alike the cardio-renal syndrome. The predictors for this ‎injurious effect of COVID-19 on both myocardium and renal tissues might be related to the co-‎morbidities, late presentation and other factors which need further evaluation‎.The aim of this article is to study the predictors of cardio-renal syndrome in COVID-19 patients‎ 
Patients and Methods: Our study is a prospective observational study conducted upon confirmed 160 COVID-19 ICU ‎patients admitted from 15th March till 20th May 2020. ‎All patients were subjected to clinical assessment, full laboratory evaluation including PCR for ‎COVID-19 from nasopharyngeal swab and full radiological evaluation.‎. 
Results: As regards the predictors for cardio-renal syndrome [15-17]; Age showed high statistically ‎significance (P <0.0004). Furthermore, serum creatinine and serum K were statistically ‎significant in patients with cardio-renal affection (P= 0.015, 0.021) whereas GFR, D-dimer, ‎need for mechanical ventilation and vasopressors were highly statistically significant with ‎cardio-renal affected patients (P <0.001)‎‎. 
Conclusion: Cardio-renal syndrome was common in COVID-19 ICU patients. Hypokalemia, lower ‎GFR on admission, mechanical ventilation, vasopressors, age and D-dimer were significant ‎independent predictors for CRS. Moreover,CRS during hospitalization was associated with an ‎increased risk of in-hospital death‎‎.