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Kidney Week

Abstract: PO0667

High C-Reactive Protein and D-Dimer on Admission Predict the Development of AKI in Patients Hospitalized with COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Venkataraman, Sandheep, University of Colorado Denver School of Medicine, Aurora, Colorado, United States
  • You, Zhiying, University of Colorado Denver School of Medicine, Aurora, Colorado, United States
  • Kendrick, Jessica B., University of Colorado Denver School of Medicine, Aurora, Colorado, United States
Background

COVID-19 infection is characterized by an acute respiratory syndrome that causes severe symptoms in some patients including a high incidence of acute kidney injury (AKI), which is associated with poor prognosis. COVID-19 infection results in a complex host response including a cytokine storm and severe inflammation. We aimed to identify whether high inflammatory markers on admission predict the development of AKI.

Methods

We performed a cohort study utilizing data from 430 patients admitted with COVID-19 to the University of Colorado Hospital. We excluded patients with a known diagnosis of end stage kidney disease or chronic kidney disease or with missing data. A total of 203 patients were included in this analysis. The primary predictors were initial serum C-reactive protein (hsCRP) >100 mg/L and D-dimer >1000 ng/mL FEU on admission to the hospital. The primary outcome was AKI, defined by KDIGO definition of AKI based on serum creatinine levels. AKI diagnosis was confirmed by chart review. Multivariate logistic regression analysis was used to examine the association between CRP and D-dimer on admission and development of AKI.

Results

The mean age and body mass index of patients was 53.7 (16.9) years and 31.5 (8.4) kg/m2. Fifty-nine percent of patients were male, 40% were Hispanic and 22.7% were Black. 44.3% had hypertension, 35.0% had diabetes and 23% had underlying respiratory disease. Twenty-seven (13.3%) patients developed AKI. After adjustment for age, gender, race/ethnicity, diabetes, hypertension, respiratory disease, cardiovascular disease and ACEi/ARB use, admission CRP level >100 mg/L was associated with nearly a 4-fold increased odds of developing AKI (OR 3.8, 95% CI 1.4-9.8). After full adjustment, admission D-dimer level greater than 1000 ng/mL FEU was associated with a 5-fold increased odds of AKI (OR 5.0, 95% CI 1.8 to 13.5).

Conclusion

High CRP and D-dimer levels on admission were associated with a significantly higher risk of developing AKI, independent of underlying comorbidities. Thus, high CRP and D-dimer on admission should trigger due deliberation and avoidance of nephrotoxic medications and close monitoring for the development of AKI.

Funding

  • Other NIH Support