Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients

Background: The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death...

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Autores principales:	Antonio Mirijello, Pamela Piscitelli, Angela de Matthaeis, Michele Inglese, Maria Maddalena D’Errico, Valentina Massa, Antonio Greco, Andrea Fontana, Massimiliano Copetti, Lucia Florio, Maurizio Angelo Leone, Michele Antonio Prencipe, Filippo Aucella, Salvatore De Cosmo
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	chronic kidney disease glomerular filtration rate respiratory failure cardiovascular comorbidities Medicine R
Acceso en línea:	https://doaj.org/article/15c9b394005c4fcdb8003b924bd4ed41
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spelling	oai:doaj.org-article:15c9b394005c4fcdb8003b924bd4ed412021-11-25T18:00:38ZLow eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients10.3390/jcm102252242077-0383https://doaj.org/article/15c9b394005c4fcdb8003b924bd4ed412021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5224https://doaj.org/toc/2077-0383Background: The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. Methods: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or <60 mL/min/1.73 m<sup>2</sup>. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. Results: Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (<i>p</i> < 0.0001). Age (<i>p</i> < 0.001), SpO2 (<i>p</i> < 0.001), previous anti-platelet treatment (<i>p</i> = 0.006), Charlson’s Comorbidities Index (<i>p</i> < 0.001), serum creatinine (<i>p</i> < 0.001), eGFR (<i>p</i> = 0.003), low eGFR (<i>p</i> < 0.001), blood glucose levels (<i>p</i> < 0.001), and LDH (<i>p</i> = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02–2.63, <i>p</i> = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10–1.36, <i>p</i> < 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (<i>p</i> = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (<i>p</i> < 0.001). Conclusions: Patients with reduced eGFR at admission should be considered at high risk for clinical deterioration and death, requiring the best supportive treatment in order to prevent the worst outcome.Antonio MirijelloPamela PiscitelliAngela de MatthaeisMichele IngleseMaria Maddalena D’ErricoValentina MassaAntonio GrecoAndrea FontanaMassimiliano CopettiLucia FlorioMaurizio Angelo LeoneMichele Antonio PrencipeFilippo AucellaSalvatore De CosmoMDPI AGarticlechronic kidney diseaseglomerular filtration raterespiratory failurecardiovascular comorbiditiesMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5224, p 5224 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	chronic kidney disease glomerular filtration rate respiratory failure cardiovascular comorbidities Medicine R
spellingShingle	chronic kidney disease glomerular filtration rate respiratory failure cardiovascular comorbidities Medicine R Antonio Mirijello Pamela Piscitelli Angela de Matthaeis Michele Inglese Maria Maddalena D’Errico Valentina Massa Antonio Greco Andrea Fontana Massimiliano Copetti Lucia Florio Maurizio Angelo Leone Michele Antonio Prencipe Filippo Aucella Salvatore De Cosmo Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients
description	Background: The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. Methods: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or <60 mL/min/1.73 m<sup>2</sup>. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. Results: Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (<i>p</i> < 0.0001). Age (<i>p</i> < 0.001), SpO2 (<i>p</i> < 0.001), previous anti-platelet treatment (<i>p</i> = 0.006), Charlson’s Comorbidities Index (<i>p</i> < 0.001), serum creatinine (<i>p</i> < 0.001), eGFR (<i>p</i> = 0.003), low eGFR (<i>p</i> < 0.001), blood glucose levels (<i>p</i> < 0.001), and LDH (<i>p</i> = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02–2.63, <i>p</i> = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10–1.36, <i>p</i> < 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (<i>p</i> = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (<i>p</i> < 0.001). Conclusions: Patients with reduced eGFR at admission should be considered at high risk for clinical deterioration and death, requiring the best supportive treatment in order to prevent the worst outcome.
format	article
author	Antonio Mirijello Pamela Piscitelli Angela de Matthaeis Michele Inglese Maria Maddalena D’Errico Valentina Massa Antonio Greco Andrea Fontana Massimiliano Copetti Lucia Florio Maurizio Angelo Leone Michele Antonio Prencipe Filippo Aucella Salvatore De Cosmo
author_facet	Antonio Mirijello Pamela Piscitelli Angela de Matthaeis Michele Inglese Maria Maddalena D’Errico Valentina Massa Antonio Greco Andrea Fontana Massimiliano Copetti Lucia Florio Maurizio Angelo Leone Michele Antonio Prencipe Filippo Aucella Salvatore De Cosmo
author_sort	Antonio Mirijello
title	Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients
title_short	Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients
title_full	Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients
title_fullStr	Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients
title_full_unstemmed	Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients
title_sort	low egfr is a strong predictor of worse outcome in hospitalized covid-19 patients
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/15c9b394005c4fcdb8003b924bd4ed41
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Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients

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