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Joseph A, Zafrani L, Mabrouki A, et al. Acute kidney injury in patients with SARS-CoV-2 infection. Ann Intensive Care. 2020;10(1):117doi: 10.1186/s13613-020-00734-z.
Joseph, A., Zafrani, L., Mabrouki, A., Azoulay, E., & Darmon, M. (2020). Acute kidney injury in patients with SARS-CoV-2 infection. Annals of intensive care, 10(1), 117. https://doi.org/10.1186/s13613-020-00734-z
Joseph, Adrien, et al. "Acute kidney injury in patients with SARS-CoV-2 infection." Annals of intensive care vol. 10,1 (2020): 117. doi: https://doi.org/10.1186/s13613-020-00734-z
Joseph A, Zafrani L, Mabrouki A, Azoulay E, Darmon M. Acute kidney injury in patients with SARS-CoV-2 infection. Ann Intensive Care. 2020 Sep 03;10(1):117. doi: 10.1186/s13613-020-00734-z. PMID: 32880774; PMCID: PMC7471244.
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Ann Intensive Care. 2020 Sep 03;10(1):117. doi: 10.1186/s13613-020-00734-z.

Acute kidney injury in patients with SARS-CoV-2 infection.

Annals of intensive care

Adrien Joseph, Lara Zafrani, Asma Mabrouki, Elie Azoulay, Michael Darmon

Affiliations

  1. Service de médecine Intensive et de réanimation médicale, Hôpital Saint-Louis, Assistance-Publique Hôpitaux de Paris, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France.
  2. Service de médecine Intensive et de réanimation médicale, Hôpital Saint-Louis, Assistance-Publique Hôpitaux de Paris, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France. [email protected].
  3. INSERM U976, Université de Paris, Paris, France. [email protected].
  4. ECSTRA Team, UMR 1153, Center of Epidemiology and Biostatistics, INSERM, Université de Paris, Paris, France.

PMID: 32880774 PMCID: PMC7471244 DOI: 10.1186/s13613-020-00734-z

Abstract

BACKGROUND: Acute Kidney Injury (AKI) is a frequent complication of severe SARS-CoV-2 infection. Multiple mechanisms are involved in COVID-19-associated AKI, from direct viral infection and secondary inflammation to complement activation and microthrombosis. However, data are limited in critically-ill patients. In this study, we sought to describe the prevalence, risk factors and prognostic impact of AKI in this setting.

METHODS: Retrospective monocenter study including adult patients with laboratory confirmed SARS-CoV-2 infection admitted to the ICU of our university Hospital. AKI was defined according to both urinary output and creatinine KDIGO criteria.

RESULTS: Overall, 100 COVID-19 patients were admitted. AKI occurred in 81 patients (81%), including 44, 10 and 27 patients with AKI stage 1, 2 and 3 respectively. The severity of AKI was associated with mortality at day 28 (p = 0.013). Before adjustment, the third fraction of complement (C3), interleukin-6 (IL-6) and ferritin levels were higher in AKI patients. After adjustment for confounders, both severity (modified SOFA score per point) and AKI were associated with outcome. When forced in the final model, C3 (OR per log 0.25; 95% CI 0.01-4.66), IL-6 (OR per log 0.83; 95% CI 0.51-1.34), or ferritin (OR per log 1.63; 95% CI 0.84-3.32) were not associated with AKI and did not change the model.

CONCLUSION: In conclusion, we did not find any association between complement activation or inflammatory markers and AKI. Proportion of patients with AKI during severe SARS-CoV-2 infection is higher than previously reported and associated with outcome.

Keywords: Acute kidney injury; COVID-19; Complement system proteins; Intensive care units; Interleukin-6; Outcome

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