Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality
Although the lungs are major targets for COVID-19 invasion, other organs-such as the kidneys-are also affected. However, the renal complications of COVID-19 are not yet well explored. This study aimed to identify the incidence of acute kidney injury (AKI) in patients with COVID-19 and to evaluate it...
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| Veröffentlicht in: | PloS one 2020-12, Vol.15 (12), p.e0243528-e0243528 |
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| creator | Paek, Jin Hyuk Kim, Yaerim Park, Woo Yeong Jin, Kyubok Hyun, Miri Lee, Ji Yeon Kim, Hyun Ah Kwon, Yong Shik Park, Jae Seok Han, Seungyeup |
| description | Although the lungs are major targets for COVID-19 invasion, other organs-such as the kidneys-are also affected. However, the renal complications of COVID-19 are not yet well explored. This study aimed to identify the incidence of acute kidney injury (AKI) in patients with COVID-19 and to evaluate its impact on patient outcomes. This retrospective study included 704 patients with COVID-19 who were hospitalized at two hospitals in Daegu, Korea from February 19 to March 31, 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The final date of follow-up was May 1, 2020. Of the 704 patients, 28 (4.0%) developed AKI. Of the 28 patients with AKI, 15 (53.6%) were found to have AKI stage 1, 3 (10.7%) had AKI stage 2, and 10 (35.7%) had AKI stage 3. Among these patients, 12 (42.9%) recovered from AKI. In the patients with AKI, the rates of admission to intensive care unit (ICU), administration of mechanical ventilator (MV), and in-hospital mortality were significantly higher than in patients without AKI. Multivariable analysis revealed that old age (Hazard ratio [HR] = 4.668, 95% confidence interval [CI] = 1.250-17.430, p = 0.022), high neutrophil-to-lymphocyte ratio (HR = 1.167, 95% CI = 1.078-1.264, p < 0.001), elevated creatinine kinase (HR = 1.002, 95% CI = 1.001-1.004, p = 0.007), and severe AKI (HR = 12.199, 95% CI = 4.235-35.141, p < 0.001) were independent risk factors for in-hospital mortality. The Kaplan-Meier curves showed that the cumulative survival rate was lowest in the AKI stage 3 group (p < 0.001). In conclusion, the incidence of AKI in patients with COVID-19 was 4.0%. Severe AKI was associated with in-hospital death. |
| doi_str_mv | 10.1371/journal.pone.0243528 |
| format | Article |
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However, the renal complications of COVID-19 are not yet well explored. This study aimed to identify the incidence of acute kidney injury (AKI) in patients with COVID-19 and to evaluate its impact on patient outcomes. This retrospective study included 704 patients with COVID-19 who were hospitalized at two hospitals in Daegu, Korea from February 19 to March 31, 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The final date of follow-up was May 1, 2020. Of the 704 patients, 28 (4.0%) developed AKI. Of the 28 patients with AKI, 15 (53.6%) were found to have AKI stage 1, 3 (10.7%) had AKI stage 2, and 10 (35.7%) had AKI stage 3. Among these patients, 12 (42.9%) recovered from AKI. In the patients with AKI, the rates of admission to intensive care unit (ICU), administration of mechanical ventilator (MV), and in-hospital mortality were significantly higher than in patients without AKI. Multivariable analysis revealed that old age (Hazard ratio [HR] = 4.668, 95% confidence interval [CI] = 1.250-17.430, p = 0.022), high neutrophil-to-lymphocyte ratio (HR = 1.167, 95% CI = 1.078-1.264, p < 0.001), elevated creatinine kinase (HR = 1.002, 95% CI = 1.001-1.004, p = 0.007), and severe AKI (HR = 12.199, 95% CI = 4.235-35.141, p < 0.001) were independent risk factors for in-hospital mortality. The Kaplan-Meier curves showed that the cumulative survival rate was lowest in the AKI stage 3 group (p < 0.001). In conclusion, the incidence of AKI in patients with COVID-19 was 4.0%. Severe AKI was associated with in-hospital death.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0243528</identifier><identifier>PMID: 33296419</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acute kidney failure ; Acute Kidney Injury - blood ; Acute Kidney Injury - etiology ; Acute Kidney Injury - mortality ; Acute Kidney Injury - therapy ; Adult ; Aged ; Aged, 80 and over ; Biology and Life Sciences ; Clinical outcomes ; Complications ; Complications and side effects ; Confidence intervals ; Coronaviruses ; COVID-19 ; COVID-19 - blood ; COVID-19 - complications ; COVID-19 - mortality ; COVID-19 - therapy ; Creatinine ; Critical Care ; Diabetes ; Disease transmission ; Disease-Free Survival ; Female ; Follow-Up Studies ; Health risks ; Hospital Mortality ; Hospital patients ; Hospitals ; Humans ; Hypertension ; Infectious diseases ; Internal medicine ; Kidney diseases ; Kidneys ; Kinases ; Laboratories ; Lymphocytes ; Male ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Nephrology ; Organs ; Patient Admission ; Patient outcomes ; Patients ; Polymerase chain reaction ; Renal replacement therapy ; Republic of Korea - epidemiology ; Respiratory diseases ; Retrospective Studies ; Risk analysis ; Risk Factors ; SARS-CoV-2 ; Severe acute respiratory syndrome coronavirus 2 ; Severity of Illness Index ; Statistics ; Survival ; Survival Rate ; Tuberculosis</subject><ispartof>PloS one, 2020-12, Vol.15 (12), p.e0243528-e0243528</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Paek et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Paek et al 2020 Paek et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-700197eb8720ee2a2cc7a13af180e54729dadb5c475d8cc5a54168f16c0043d23</citedby><cites>FETCH-LOGICAL-c692t-700197eb8720ee2a2cc7a13af180e54729dadb5c475d8cc5a54168f16c0043d23</cites><orcidid>0000-0003-2662-2898 ; 0000-0001-8875-1260 ; 0000-0002-7561-6534</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725289/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725289/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,725,778,782,862,883,2098,2917,23849,27907,27908,53774,53776,79351,79352</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33296419$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Hirst, Jennifer A.</contributor><creatorcontrib>Paek, Jin Hyuk</creatorcontrib><creatorcontrib>Kim, Yaerim</creatorcontrib><creatorcontrib>Park, Woo Yeong</creatorcontrib><creatorcontrib>Jin, Kyubok</creatorcontrib><creatorcontrib>Hyun, Miri</creatorcontrib><creatorcontrib>Lee, Ji Yeon</creatorcontrib><creatorcontrib>Kim, Hyun Ah</creatorcontrib><creatorcontrib>Kwon, Yong Shik</creatorcontrib><creatorcontrib>Park, Jae Seok</creatorcontrib><creatorcontrib>Han, Seungyeup</creatorcontrib><title>Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Although the lungs are major targets for COVID-19 invasion, other organs-such as the kidneys-are also affected. However, the renal complications of COVID-19 are not yet well explored. This study aimed to identify the incidence of acute kidney injury (AKI) in patients with COVID-19 and to evaluate its impact on patient outcomes. This retrospective study included 704 patients with COVID-19 who were hospitalized at two hospitals in Daegu, Korea from February 19 to March 31, 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The final date of follow-up was May 1, 2020. Of the 704 patients, 28 (4.0%) developed AKI. Of the 28 patients with AKI, 15 (53.6%) were found to have AKI stage 1, 3 (10.7%) had AKI stage 2, and 10 (35.7%) had AKI stage 3. Among these patients, 12 (42.9%) recovered from AKI. In the patients with AKI, the rates of admission to intensive care unit (ICU), administration of mechanical ventilator (MV), and in-hospital mortality were significantly higher than in patients without AKI. Multivariable analysis revealed that old age (Hazard ratio [HR] = 4.668, 95% confidence interval [CI] = 1.250-17.430, p = 0.022), high neutrophil-to-lymphocyte ratio (HR = 1.167, 95% CI = 1.078-1.264, p < 0.001), elevated creatinine kinase (HR = 1.002, 95% CI = 1.001-1.004, p = 0.007), and severe AKI (HR = 12.199, 95% CI = 4.235-35.141, p < 0.001) were independent risk factors for in-hospital mortality. The Kaplan-Meier curves showed that the cumulative survival rate was lowest in the AKI stage 3 group (p < 0.001). In conclusion, the incidence of AKI in patients with COVID-19 was 4.0%. Severe AKI was associated with in-hospital death.</description><subject>Acute kidney failure</subject><subject>Acute Kidney Injury - blood</subject><subject>Acute Kidney Injury - etiology</subject><subject>Acute Kidney Injury - mortality</subject><subject>Acute Kidney Injury - therapy</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biology and Life Sciences</subject><subject>Clinical outcomes</subject><subject>Complications</subject><subject>Complications and side effects</subject><subject>Confidence intervals</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - blood</subject><subject>COVID-19 - complications</subject><subject>COVID-19 - mortality</subject><subject>COVID-19 - therapy</subject><subject>Creatinine</subject><subject>Critical Care</subject><subject>Diabetes</subject><subject>Disease transmission</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health risks</subject><subject>Hospital Mortality</subject><subject>Hospital patients</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Infectious diseases</subject><subject>Internal medicine</subject><subject>Kidney diseases</subject><subject>Kidneys</subject><subject>Kinases</subject><subject>Laboratories</subject><subject>Lymphocytes</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nephrology</subject><subject>Organs</subject><subject>Patient Admission</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Polymerase chain reaction</subject><subject>Renal replacement therapy</subject><subject>Republic of Korea - epidemiology</subject><subject>Respiratory diseases</subject><subject>Retrospective Studies</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>SARS-CoV-2</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Severity of Illness Index</subject><subject>Statistics</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Tuberculosis</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11v0zAUhiMEYmPwDxBEQkJwkeKv2PEN0lS-Kk2qxGDiznKdk9YljYvtDPrvcddsatAukC-OZT_nPfZrnyx7jtEEU4HfrV3vO91Otq6DCSKMlqR6kJ1iSUnBCaIPj-Yn2ZMQ1giVtOL8cXZCKZGcYXma_biEa_CQa9NHyH_auoNdbrt17_chn86vZh8KLPOtjha6GHIbch2CM1ZHqPPfNq4SV6xc2Nqo23zjfAo27p5mjxrdBng2xLPs-6eP36Zfiov559n0_KIwXJJYCISwFLCoBEEARBNjhMZUN7hCUDJBZK3rRWmYKOvKmFKXDPOqwdwgxGhN6Fn28qC7bV1QgylBEcYrnjxBOBGzA1E7vVZbbzfa75TTVt0sOL9U2kdrWlBCUIMbUWreNAy0qTBr8IJwjClCkjVJ6_1QrV9soDbJEq_bkeh4p7MrtXTXSZmk95FJ4M0g4N2vHkJUGxsMtK3uwPU355ZIcM5QQl_9g95_u4Fa6nQB2zUu1TV7UXXOGaOyRFIkanIPlUYNG2vSD2psWh8lvB0lJCbCn7jUfQhqdvn1_9n51Zh9fcSuQLdxFVzbR-u6MAbZATTeheChuTMZI7VvgFs31L4B1NAAKe3F8QPdJd3-ePoX_mT_Ag</recordid><startdate>20201209</startdate><enddate>20201209</enddate><creator>Paek, Jin Hyuk</creator><creator>Kim, Yaerim</creator><creator>Park, Woo Yeong</creator><creator>Jin, Kyubok</creator><creator>Hyun, Miri</creator><creator>Lee, Ji Yeon</creator><creator>Kim, Hyun Ah</creator><creator>Kwon, Yong Shik</creator><creator>Park, Jae Seok</creator><creator>Han, Seungyeup</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-2662-2898</orcidid><orcidid>https://orcid.org/0000-0001-8875-1260</orcidid><orcidid>https://orcid.org/0000-0002-7561-6534</orcidid></search><sort><creationdate>20201209</creationdate><title>Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality</title><author>Paek, Jin Hyuk ; Kim, Yaerim ; Park, Woo Yeong ; Jin, Kyubok ; Hyun, Miri ; Lee, Ji Yeon ; Kim, Hyun Ah ; Kwon, Yong Shik ; Park, Jae Seok ; Han, Seungyeup</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-700197eb8720ee2a2cc7a13af180e54729dadb5c475d8cc5a54168f16c0043d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acute kidney failure</topic><topic>Acute Kidney Injury - 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Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Paek, Jin Hyuk</au><au>Kim, Yaerim</au><au>Park, Woo Yeong</au><au>Jin, Kyubok</au><au>Hyun, Miri</au><au>Lee, Ji Yeon</au><au>Kim, Hyun Ah</au><au>Kwon, Yong Shik</au><au>Park, Jae Seok</au><au>Han, Seungyeup</au><au>Hirst, Jennifer A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-12-09</date><risdate>2020</risdate><volume>15</volume><issue>12</issue><spage>e0243528</spage><epage>e0243528</epage><pages>e0243528-e0243528</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Although the lungs are major targets for COVID-19 invasion, other organs-such as the kidneys-are also affected. However, the renal complications of COVID-19 are not yet well explored. This study aimed to identify the incidence of acute kidney injury (AKI) in patients with COVID-19 and to evaluate its impact on patient outcomes. This retrospective study included 704 patients with COVID-19 who were hospitalized at two hospitals in Daegu, Korea from February 19 to March 31, 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The final date of follow-up was May 1, 2020. Of the 704 patients, 28 (4.0%) developed AKI. Of the 28 patients with AKI, 15 (53.6%) were found to have AKI stage 1, 3 (10.7%) had AKI stage 2, and 10 (35.7%) had AKI stage 3. Among these patients, 12 (42.9%) recovered from AKI. In the patients with AKI, the rates of admission to intensive care unit (ICU), administration of mechanical ventilator (MV), and in-hospital mortality were significantly higher than in patients without AKI. Multivariable analysis revealed that old age (Hazard ratio [HR] = 4.668, 95% confidence interval [CI] = 1.250-17.430, p = 0.022), high neutrophil-to-lymphocyte ratio (HR = 1.167, 95% CI = 1.078-1.264, p < 0.001), elevated creatinine kinase (HR = 1.002, 95% CI = 1.001-1.004, p = 0.007), and severe AKI (HR = 12.199, 95% CI = 4.235-35.141, p < 0.001) were independent risk factors for in-hospital mortality. The Kaplan-Meier curves showed that the cumulative survival rate was lowest in the AKI stage 3 group (p < 0.001). In conclusion, the incidence of AKI in patients with COVID-19 was 4.0%. Severe AKI was associated with in-hospital death.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33296419</pmid><doi>10.1371/journal.pone.0243528</doi><tpages>e0243528</tpages><orcidid>https://orcid.org/0000-0003-2662-2898</orcidid><orcidid>https://orcid.org/0000-0001-8875-1260</orcidid><orcidid>https://orcid.org/0000-0002-7561-6534</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-12, Vol.15 (12), p.e0243528-e0243528 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2468643501 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acute kidney failure Acute Kidney Injury - blood Acute Kidney Injury - etiology Acute Kidney Injury - mortality Acute Kidney Injury - therapy Adult Aged Aged, 80 and over Biology and Life Sciences Clinical outcomes Complications Complications and side effects Confidence intervals Coronaviruses COVID-19 COVID-19 - blood COVID-19 - complications COVID-19 - mortality COVID-19 - therapy Creatinine Critical Care Diabetes Disease transmission Disease-Free Survival Female Follow-Up Studies Health risks Hospital Mortality Hospital patients Hospitals Humans Hypertension Infectious diseases Internal medicine Kidney diseases Kidneys Kinases Laboratories Lymphocytes Male Medicine Medicine and Health Sciences Middle Aged Mortality Nephrology Organs Patient Admission Patient outcomes Patients Polymerase chain reaction Renal replacement therapy Republic of Korea - epidemiology Respiratory diseases Retrospective Studies Risk analysis Risk Factors SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Severity of Illness Index Statistics Survival Survival Rate Tuberculosis |
| title | Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality |
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