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Kidney Week

Abstract: PO0691

Kidney Injury in ICU Adults with Severe COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Qian, Jing, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Ni, Li, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Wang, Mengjing, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Zhang, Weichen, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Wang, Kangjie, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Yuan, Li, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Chen, Jing, Huashan Hospital Fudan University, Shanghai, Shanghai, China
Background

The SARS-CoV-2 infected humans through the angiotensin converting enzyme (ACE-2) receptor. Kidney, which highly expressed ACE-2, became one of the main target organs attacked by SARS-CoV-2. In this cross-sectional study, we aimed to explore renal injury in ICU adults with severe coronavirus disease 2019 (Covid-19).

Methods

Fifty-three severe Covid-19 adults, admitted into ICU (Tongji Hospital, Wuhan, China) from Feb.9.2020 to Mar.24.2020, were finally included in analysis. Baseline demographic, clinical characteristics, laboratory examination data and prognosis were all recorded.

Results

Mean age of 53 patients was 67.5±15.2 yrs, including 34 men and 19 women. The predominant comorbid conditions were as follows: hypertension in 26 patients (50.0%), diabetes mellitus in 11 patients (21.2%), cardiovascular diseases in 5 patients (9.6%) and chronic kidney disease in 2 patients (3.8%). The mean serum creatinine at baseline was 67.2±26.7 μmol/L, while the baseline urine routine before hospitalization was uninformed. In the period of whole ICU stay, most patients presented abnormal urine routine: 93.2% of patients had proteinuria (+/- 9.1%, 1+ 40.9%, 2+ 31.8% and 3+ 11.4%, respectively) and 97.7% had hematuria. 20 of 53 patients (37.7%) with mean age of 72.2±9.9 yrs diagnosed as hospital-acquired acute kidney injury, according to KDIGO 2012 AKI diagnosis creatinine criteria. In those AKI patients, 5(25%), 7(35.0%) and 8(40%) reached AKI stage I, II and III, respectively. AKI was diagnosed after 25.0±12.8 days since onset of Covid-19 and after 7.8±5.6 days since ICU admission. The mean duration of AKI course was 7.9±7.1 days. Finally, 16 of 20 patients with AKI (80.0%) died in ICU. The survival time of AKI patients was 32.9±14.6 days since onset of Covid-19 and 15.7±9.4 days since ICU admission. The in-hospital all-cause mortality of AKI patients was higher than non-AKI patients (80.0% vs 29.4%, p=0.004). Only one (5.0%) patient recovered from AKI during ICU stay (serum creatinine reduced ≥50%).

Conclusion

Kidney injury including abnormal urine routine and increased serum creatinine presented in almost all severe Covid-19 patients. AKI event could predict poor prognosis with severe Covid-19. We should increase awareness of kidney injury in patients with severe COVID-19.