ABSTRACT
Background: Coronavirus disease-2019 (COVID-19) has the highest mortality in patients with advanced age and those with pre-existing chronic medical conditions. Limited data, however, is available with regard to COVID-19 mortality in acute kidney injury (AKI). We aimed to identify risk factors associated with mortality in patients hospitalized for COVID-19 with AKI. Methods: This is a retrospective cohort study conducted at Loma Linda University Medical Center (LLUMC) from March 1st, 2020 to January 31st, 2021. Inclusion criteria included patients admitted to LLUMC with diagnosis of COVID-19 and AKI during the admission based on the Risk Injury Failure Loss ESRD (RIFLE) criteria. Univariable and multivariable logistic regression models were utilized to explore risk factors associated with in-hospital mortality. Results: A total of 320 patients (age 66.5 ± 14.4) were included in the analysis, of which 88 (28%) were deceased. Multivariable regression analysis (Figure 1) demonstrated that age greater than 70 had adjusted odds ratio (OR) with 95% confidence interval (CI) for mortality 1.10 (95% CI: 1.01, 1.20, p=0.03). An Ejection Fraction of less than 50% had OR=1.13 (95% CI: 1.03, 1.23, p=0.01), AKI-injury stage had OR=1.25 (95% CI: 1.14, 1.37, p=<0.001), positive D-dimer levels had OR=1.18 (95% CI: 1.07, 1.30, p=<0.001) and diabetes had OR=1.12 (95% CI 1.03, 1.22, p=0.01), all significant risk factors for mortality. In addition, Hispanics had a higher risk of mortality with OR=1.20 (95% CI 1.09, 1.33, p=<0.001) when compared to Caucasians. Conclusions: Diabetes, age greater than 70, Hispanic background, Heart failure with reduced ejection fraction, AKI-injury stage, and positive D-dimer level are identified as risk factors associated with higher mortality amongst patient admitted with COVID-19 and AKI.