The Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury in Critically Ill Patients with COVID-19: A Multicenter Study

Background Acute kidney injury (AKI) is associated with worse outcome in patients with infection. However, the epidemiological feature of AKI among patients with COVID-19 is poorly understood. Methods: In this multicenter retrospective study, we recruited consecutive adult patients who had died or been discharged in 11 designated ICUs for caring for COVID-19 in Wuhan, China. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria and the primary outcome was in-hospital mortality. Potential risk factors of AKI as well as the association between AKI and in-hospital mortality were analyzed. Results: A total of 282ICU patients with COVID-19 were included in the study and 43.6% (123/282) of them had AKI. In comparison with patients without AKI, patients who developed AKI tended to be older, had higher proportion of chronic kidney disease (CKD), more likely to develop acute organ dysfunction and had higher SOFA score. Multivariate analysis showed that medical history of CKD and SOFA score were independently associated with occurrence of AKI. Increasing AKI severity was associated with hospital mortality when adjusted for other potential variables: odds ratio of stage 1 = 3.766 (95% CI1.599–8.870; p = 0.002), stage 2 = 4.858 (95% CI1.269–18.597; p = 0.021), and stage 3 = 25.635 (95% CI8.240–79749; p<0.001). Conclusion: In this large-scale, multicenter study, we found that more than 2 in 5 critically ill patients with COVID-19 experienced AKI during their hospital stay. Increasing AKI severity was strongly associated with increased in-hospital mortality.Funding Statement: This work was supported by the National Key Research and Development Project of the Ministry of Science and Technology, China (2018YFC1313700), "Gaoyuan" project of Pudong Health and Family Planning Commission (PWYgy2018-6) and the research Foundation of shanghai science and technology commission (No.18140904100).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was approved by the Shanghai East Hospital Ethics Committee and carried out in accordance with the Declaration of Helsinki.