Mortality among Patients with COVID-19 and Acute Kidney Injury in the Intensive Care Unit of the Infectious and Tropical Diseases Department of the Teaching Hospital of Treichville

Abstract

Background: The development of acute kidney injury (AKI) is a negative prognostic indicator for survival in patients with COVID-19 infection. Objective: To identify risk factors for mortality among patients with COVID-19 and acute kidney injury. The study focused on patients admitted for COVID-19 infection who presented with acute kidney injury and whose hospitalization resulted in death. Methods: This was a retrospective, analytical study focusing on acute kidney injury in patients with COVID-19 admitted to the intensive care unit (ICU) of the Infectious and Tropical Diseases Department. The study was conducted between March 2020 and December 2021. Renal function was defined using the KDIGO classification of AKI. Diuresis was monitored from the first 6 hours of admission. Patients whose creatinine, urea, and albumin levels at admission, as well as their urine output/time period, were not available upon admission were excluded from the study. Similarly, incomplete records were those with incomplete sociodemographic, clinical, and paraclinical data. Results: The study included 289 patients who tested positive for COVID-19. Among them, acute kidney injury was observed in 107 cases, representing a prevalence of 37%. The mean age of patients with AKI was 61.3 ± 13.6 years, and 45.7% were aged 65 years or older. Male predominance was noted, with a male-to-female ratio of 2.68. The primary reasons for ICU admission were acute respiratory distress (ARD) in 71% of cases and dyspnea in 12.1%. Comorbidities included hypertension (67.2%), diabetes mellitus (41.1%), and obesity (14.9%). According to KDIGO criteria, AKI was classified as stage 3 in 52.3% of patients, stage 2 in 16.8%, and stage 1 in 30.5%. AKI was identified prior to hospital admission in 40.1% of cases, between 24 and 72 hours after admission in 42.9%, and more than 72 hours after admission in 16.8%. Hemodialysis was performed in 36.4% of patients. The clinical course was marked by death in 68 patients (63.5%). Multivariate analysis identified the following factors as independently associated with increased risk of mortality in the context of COVID-19: acute respiratory distress (OR = 5.06; p = 0.006), KDIGO stage 3 AKI (OR = 5.15; p = 0.003), orotracheal intubation (OR = 4.37; p = 0.0001), and mechanical ventilation (OR = 4.01; p = 0.0001). Conclusion: Acute kidney injury (AKI) is an adverse prognostic factor in the context of COVID-19. Mortality appears to be more closely related to the severity of SARS-CoV-2 infection than to respiratory support.