Mortality Related to COVID-19 in Acute Renal Injury Patients: A Cohort Study

Abstract

Introduction: The coronavirus, SARS-CoV-2, is the pathogen responsible for an acute respiratory distress syndrome that broke out in the Wuhan region and became a pandemic in early 2020. The clinical presentation of COVID-19 is polymorphic, dominated by respiratory symptoms and may be associated with cardiovascular, digestive and renal complications. The prognosis depends mainly on the patient’s condition. Acute kidney injury (AKI) during severe SARS CoV-2 infection is frequent, multifactorial and associated with excess mortality. Its pathophysiology has not been fully elucidated, and seems to involve both direct and indirect mechanisms. The aim of our work is to describe the epidemiological, clinical, paraclinical and therapeutic profile of patients presenting with AKI and confirmed COVID-19 disease, and determine the prognostic factors associated with death. Material and Methods: This was a retrospective study conducted at IBN SINA Hospital, Rabat, between March 2020 and November 2021. We included patients with confirmed SARS-CoV-2 infection who developed AKI either on admission or during hospitalization. Results: We enrolled 95 patients with a mean age of 68 ± 13 years and a M/F sex ratio of 1.9. Diabetes was present in 33.7% of cases and hypertension in 32.6%. Most patients had influenzalike illness, lymphopenia and hyperferritinemia. Median creatinine on admission was 32 mg/l [17 - 64]. Temporary catheter hemodialysis was used in 21% of cases, with hyperkalemia for purification and ultrafiltration. There were 63 deaths, it was statically significantly related (p < 0.05) to medical management in intensive care and the need for intubation, to the extent of lung damage on chest CT ≥50%, to the presence of Stage 3 AKI, to the indication for an RRT session, and to initiation of methylprednisolone. Survival analysis was performed using the Kaplan-Meier curve, with median survival estimated at 12 days (95% confidence interval 10 - 15 days). Conclusion: AKI in COVID-19 is multifactorial, and may be secondary to sepsis, hemodynamic failure or direct viral toxicity to the kidney. In our study, mortality was secondary to viral toxicity, clinical presentation, intensive care unit management and recourse to hemodialysis.