ABSTRACT
Background: Critically ill patients with the SARS-CoV-2 virus (COVID-19) infection have diverse clinical manifestations including renal dysfunction which can determine their short-term outcomes. We assess if renal dysfunction on day one of hospital admission is associated with increased mortality risk of patients with severe COVID-19 infection. Methods: We conducted a retrospective review of records of patients with severe COVID-19 infection admitted to the Intensive Care Unit between March 4 and April 11, 2020. Patients were divided into two groups based on serum creatinine level on day one of hospital admission. Group 1 included patients with normal serum creatinine (SCr) 1.10 mg/dl while group 2 included patients with high SCr > 1.10 mg/dl. The primary outcome was mortality. Secondary outcomes were the need for renal replacement therapy (RRT), duration of RRT, development of adult respiratory distress syndrome (ARDS) and need for mechanical ventilation. Comparisons between groups were done using Mann-Whitney U-tests for continuous variables and chi-square tests for categorical variables. Mortality was evaluated with a Kaplan-Meier Survival Analysis. Results: A total of 47 patients were included: 27 in group 1 and 20 in group 2. Patients in group 2 compared to group 1 were older (67 vs. 56, p=0.04), more frequently African Americans (11% vs 45%, p=0.02), hypertensives (80% vs 52%, p=0.05) with chronic kidney disease (25% vs 0%, p=0.01), without significant differences sex, diabetes mellitus, smoking status or use of renin-angiotensin antagonists. 8 patients in group 2 and 3 patients in group 1 died, with significant difference in cumulative survival (Figure 1). Need for RRT (55% vs 41%, p=0.33), duration of RRT (6 vs 3 days, p=0.08), development of ARDS (85% vs 81%, p=0.75) and need for mechanical ventilation (65% vs 61%, p=0.89) were not significantly different between groups 2 and 1. Conclusions: The presence of renal dysfunction on the day of hospital admission is associated with increased hospital mortality in patients with severe COVID-19 infection.