ABSTRACT
Background: Global reports on the rates, risk factors and outcomes of acute kidney injury (AKI) with COVID-19 exhibit high variability. We evaluated all patients admitted with AKI to our centre where COVID-19 status was determined by PCR, and assessed risk factors for poor outcomes including death. Methods: Retrospective study of all patients admitted with AKI between 13/03/2020 and 13/05/2020. All variables including COVID-19 status, demographics, co-morbidities and laboratory parameters were collected from electronic patient records. We used competing risk-regression models to assess association with mortality by subdistribution hazards ratio (SHR). Results: Of 576 patients admitted with AKI, 257 (43.6%) were positive for COVID-19. Demographics and clinical characteristics of our cohort included: mean age 66.7 years, 58% male, 40.5% Caucasian, 56.3% hypertension, 33.1% diabetes. Overall 52.5% patients had AKI stage 1, 18.6% AKI stage 2, and 28.8% AKI stage 3. Patients with AKI stage 3 were 3.4 (95% CI 2.27-5.02) times more likely to be diagnosed with COVID-19 than those with AKI stage 1. Other factors associated with an increased likelihood of COVID-19 diagnosis adjusted for AKI stage were young age (p=0.004), non-Caucasian ethnicity (p=0.001), low lymphocyte count (p=0.002) and raised CRP, ferritin and D-dimer (p=0.001). Case fatality percentage of this cohort was 32.5% (10%, 19% and 35% mortality in COVID-19 negative patients with AKI stages 1, 2 and 3 respectively, compared with 33%, 52% and 71% in the COVID-19 positive counterparts). Patients with COVID-19 were 3.6 (95% CI 2.2-4.3) times more likely to die than those negative for COVID-19 (p<0.001). Furthermore, death in patients with COVID-19 and AKI stage 3 occurred rapidly, with 50% of patients dying within 10 days, 70% within 15 days and 95% within 21 days of admission. Those in the same group who survived had prolonged recovery, with 50% remaining inpatients in hospital for over 31 days. Conclusions: In patients with AKI, those who were positive for COVID-19 was associated with severe AKI, younger age, non-Caucasian ethnicity, raised inflammatory markers, and suffered from high case fatality. Severity of AKI in conjunction with COVID-19 was associated with high and rapid death rates, or prolonged hospital admission with increased morbidity.
ABSTRACT
Background: Dialysis patients, with frequent co-morbidities, advanced age and frailty, visiting treatment facilities frequently are perhaps more prone to SARS-Cov-2 infection and related death - the risk-factors and dynamics of which are unknown. The aim of this study was to investigate the hospital outcomes in SARS-CoV-2 infected dialysis patients. Methods: This prospective, observational, multi-centre study collected data on SARS-CoV-2 infected HD patients between 29/02/2020 and 15/05/2020. Data was collected on demographics, comorbidities, WHO performance status, clinical symptoms, laboratory parameters, hospital management and outcomes. Treatment was predominantly supportive, unless patients were part of an approved clinical trial. The study was approved by NHS Research Ethics Committee 20/SW/0077 and Heath Research Authority IRAS 283130. Results: Of 1737 HD patients at the 3 renal centres, 224 (13%) were COVID-19 positive over the study period. The characteristics of the COVID-19 HD patients were: mean age 65.8;59% male;38% Caucasian;81% hypertension;54% diabetes;25% chronic lung disease;29% ischaemic heart disease and 22% cerebrovascular disease. The most common symptoms at presentation were fever (62%) and cough (53%). About 143 (64%) patients were managed as an inpatient and 81 (36%) as an outpatient. Of 9 patients that required mechanical ventilation: 6 died, 1 patient was discharged and 2 are still under clinical care. Overall 51 patients died (23%), 154 (69%) were discharged alive and 19 (8%) were still under clinical care as of 15/05/2020. Preliminary analyses suggested that those that died were significantly older (p=0.0028), more likely to have ischaemic heart disease (p=0.003), cerebrovascular disease (p=0.019), smoking history (p=0.006), WHO performance status 3-4 (p=0.004), higher neutrophil: lymphocyte ratio at presentation (p=0.0001) and higher CRP at presentation (p=0.0021). Conclusions: This large cohort of COVID-19 positive haemodialysis demonstrates a high case fatality ratio, which increased significantly with age, cardiovascular disease, smoking history, frailty and markers of inflammation.