STUDYING AKI IN COVID-19 PATIENTS IN THE ICU USING NEPHROCHECK BIOMARKER

ABSTRACT

COVID-19 patients have a high incidence of acute kidney injury (AKI) and a notable increase in mortality once AKI has developed. The goal of this study is to help identify critically ill COVID-19 patients who are at higher risk of developing severe AKI and renal failure in hopes that earlier identification can lead to improved outcomes. We performed a retrospective study of COVID-19-positive patients in the intensive care unit (ICU) at a major Southwest United States quaternary hospital from March 20 to November 26, 2020whohad a Nephrocheck® test, an FDA-approved lab test that allows for assessment of AKI risk. Patients who met the criteria were put into risk groups based on theirNephrocheck®value low-risk (<0.3), intermediate-risk (0.3-2.0), and high-risk (>2.0). Patients in the study were evaluated for outcomes of mortality, ICU length of stay, need for renal replacement therapy, urinary output, and degree of AKI. Univariate analysis, primarily Fisher's exact test, was used to compare the groups. In total, 38 COVID-19 patients with Nephrocheck® values were identified. Of the 38 COVID-19 patients who had a Nephrocheck® lab obtained, 5 were low risk, 19 were intermediate risk, and 14 were high risk. The intermediate-risk (OR = 18, 95% CI =. 7540547 -1019.974, P = 0.0441) and thehigh-risk (or = 19.5, 95% CI =. 8208219 - 1098.472, P = 0.0374) groups had higher odds of developing stage 3 AKI by creatinine compared to the low-risk group.Also, the high-risk group had higher odds of developing stage 3 AKI by urinary output compared to the intermediate-risk (OR = 8.1, 95% CI = 0.97 - 97.06, P = 0.0419) and low-risk (lower limit of 95% CI of OR = 2.22, P = 0.0275;exact CI not possible with zero count cells) groups. Mortality, ICU length of stay, and need for renal replacement therapy were not statistically different between the three risk groups. Our findings suggest that Nephrocheck® is able to identify and risk stratify COVID-19 patients in the ICU who are at increased risk of developing a severe AKI. These results are limited by the small sample size and the non-uniform timing of the Nephrocheck® labs being drawn for each patient.