Risk factors associated with acute kidney injury in patients in intensive care with COVID-19.

A single-center observational study.

Abstract

Introduction: Patients with COVID-19 admitted to intensive care units are at high risk of developing acute kidney injury (AKI). SARS-CoV-2 can directly infect kidney cells, causing an intense inflammatory response with lymphocytic infiltration and severe tubular necrosis. These factors, together with others not yet fully understood, contribute to the development of acute kidney failure. This study aimed to identify risk factors in this specific group of patients.

Methods: The present observational study was conducted at the Pablo Arturo Suárez Hospital Intensive Care Unit in Quito, Ecuador, from January 2020 to December 2021. With a probabilistic sample, adult patients in intensive care with COVID-19 were included. The variables were age, sex, education, body mass index, comorbidities, increase in serum creatinine, severity scales, vital signs, and the PAO2/FIO2 ratio. Presence of respiratory distress. Laboratory parameters: Interleukin 6, lactate dehydrogenase, ferritin, and serum lactate levels; blood count; days in the ICU; and mortality. The odds ratio is obtained to present the risk.

Results: A total of 294 patients were included in the study. The prevalence of AKI was 16.0% (95% CI 12.1% -20.6%). The risk factor for developing AKI was the presence of comorbidities, which presented an influential association with the development of renal failure, 8.7% vs. 20.4% (P = 0.02), indicating an OR of 2.68 (95% CI: 1.24, 5.78; P = 0.02). Female sex constituted a protective factor with an OR of 0.30 (95% CI: 0.09, 0.85; P = 0.03).

Conclusion: The leading risk factor for the development of acute kidney injury was comorbidities related to male sex, and female sex was a protective factor.