Neutrophil-lymphocyte ratio and systemic immune-inflammation index as risk factors for acute kidney injury in hospitalized patients with COVID-19

ABSTRACT

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 is high and is associated with a worse prognosis. The objective of this study is to determine the risk factors associated with AKI in hospitalized patients with COVID-19. Method(s) In this retrospective, single-center study, we analyzed data from electronic medical records of 494 hospitalized patients with COVID-19 pneumonia. We collected clinical and analytical data of baseline characteristics. Multivariable logistic regression was performed to identify factors associated with AKI. Result(s) During the study period, 129 (26.1%) out of 494 COVID-19 patients, developed AKI. The proportions with stages 1, 2, 3, 3D AKI were 46.5%, 30.2%, 10.9%, and 12.4%, respectively. In-hospital AKI mortality was 35.7%. The risk factors for AKI were previous chronic kidney disease (CKD) (OR = 2.8, 95% CI 1.4-5.2, p= 0.003);admission to intensive care unit (ICU) (OR = 4.8, 95% CI 1.5- 10.2, p= <0.001);neutrophil-lymphocyte ratio (NLR) >6.3 (OR = 2.28, 95% CI 1.5-3.4, p= 0.001);and systemic immune-inflammation index (SII) >1220 (OR= 1.2, 95% CI 1.01-2.1, p= 0.019). Among AKI survivors, 74 (91.36%) patients had renal recovery at discharge. Patients who recovered had median of NLR and SII on admission significantly lower than renal non-recovery and deceased patients, p < 0.001. Conclusion(s) NLR and SII are risk factors associated with AKI in addition to previous CKD, and admission to ICU. AKI is common among hospitalized patients with COVID-19, which is associated with higher mortality. The majority of AKI survivors at discharge recovered renal function. Further studies are needed to determine if lower levels of NLR and SII on admission are predictors of recovery of kidney function in patients with COVID-19.