Mortality and evolution between community and hospital-acquired COVID-AKI

Mortality and evolution between community and hospital-acquired COVID-AKI

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<h4>Background</h4> Acute kidney injury (AKI) is associated with poor outcomes in COVID patients. Differences between hospital-acquired (HA-AKI) and community-acquired AKI (CA-AKI) are not well established. <h4>Methods</h4> Prospective, observational cohort study. We included...

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Autores principales: Jonathan S. Chávez-Íñiguez, José H. Cano-Cervantes, Pablo Maggiani-Aguilera, Natashia Lavelle-Góngora, Josué Marcial-Meza, Estefanía P. Camacho-Murillo, Cynthia Moreno-González, Jarumi A. Tanaka-Gutiérrez, Ana P. Villa Zaragoza, Karla E. Rincón-Souza, Sandra Muñoz-López, Olivia Montoya-Montoya, Guillermo Navarro-Blackaller, Aczel Sánchez-Cedillo, Luis E. Morales-Buenrostro, Guillermo García-García
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2021
Materias:
Medicine
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Science
Q
Acceso en línea:https://doaj.org/article/a915627a60f648929bf4ec5b05b6fa7a
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Sumario:<h4>Background</h4> Acute kidney injury (AKI) is associated with poor outcomes in COVID patients. Differences between hospital-acquired (HA-AKI) and community-acquired AKI (CA-AKI) are not well established. <h4>Methods</h4> Prospective, observational cohort study. We included 877 patients hospitalized with COVID diagnosis at two third-level hospitals in Mexico. Primary outcome was all-cause mortality at 28 days compared between COVID patients with CA-AKI and HA-AKI. Secondary outcomes included the need for KRT, and risk factors associated with the development of CA-AKI and HA-AKI. <h4>Results</h4> A total of 377 patients (33.7%) developed AKI. CA-AKI occurred in 202 patients (59.9%) and HA-AKI occurred in 135 (40.1%). Patients with CA-AKI had more significant comorbidities, including diabetes (52.4% vs 38.5%), hypertension (58.4% vs 39.2%), CKD (30.1% vs 14.8%), and COPD (5.9% vs 1.4%), than those with HA-AKI. Patients’ survival without AKI was 87.1%, with CA-AKI it was 75.4%, and with HA-AKI it was 69.6%, log-rank test p < 0.001. Only age > 60 years (OR 1.12, 95% CI 1.06–1.18, p <0.001), COVID severity (OR 1.09, 95% CI 1.03–1.16, p = 0.002), the need in mechanical lung ventilation (OR 1.67, 95% CI 1.56–1.78, p <0.001), and HA-AKI stage 3 (OR 1.16, 95% CI 1.05–1.29, p = 0.003) had a significant increase in mortality. The presence of CKD (OR 1.48, 95% CI 1.391.56, p < 0.001), serum lymphocytes < 1000 μL (OR 1.03, 95% CI 1.00–1.07, p = 0.03), the need in mechanical lung ventilation (OR 1.06, 95% CI 1.02–1.11, p = 0.003), and CA-AKI stage 3 (OR 1.37, 95% CI 1.29–1.46, p < 0.001) were the only variables associated with a KRT start. <h4>Conclusions</h4> We found that COVID patients who are complicated by CA-AKI have more comorbidities and worse biochemical parameters at the time of hospitalization than HA-AKI patients, but despite these differences, their probability of dying is similar.

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