Nirmala Manjappachar, MD
Internal Medicine Resident Physician
Anne Arundel Medical Center
Annapolis, MD
Disclosure information not submitted.
Adrien Mazer, MD
Intensivist
Anne Arundel Medical Center, United States
Disclosure information not submitted.
Mitchell Karpman, PhD
Biostatistician
Luminis Health Anne Arundel Medical Center, United States
Disclosure information not submitted.
Jennifer Grover, DHSc, MMS, PA-C
Program Lead, Clinical Effectiveness
Anne Arundel Medical Center, United States
Disclosure information not submitted.
Joseph Nates, MBA, MD
Professor, Deputy Chair, Director ICUs
University of Texas MD Anderson Center
Bellaire, Texas, United States
Disclosure information not submitted.
Dereddi Raja Reddy, MD, FACP FCCP
Assistant Professor, Program Director MS4 McGovern Medical School
MD Anderson Cancer Care Center
Houston, Texas
Disclosure information not submitted.
Nargiz Muganlinskaya, MD, MMS, FACP
Program Director, IM
Anne Arundel Medical Center, United States
Disclosure information not submitted.
Title: Comparative Outcomes of Acute Kidney Injury (AKI) in Critically ill Patients with Covid-19 Infection
Introduction/Hypothesis: Severe COVID-19 is associated with multiple organ dysfunction and commonly results in acute kidney injury (AKI). However, comparative outcomes have not been well described between AKI and non-AKI group in this population. Our aim was to describe the clinical characteristics and comparative outcomes between these two groups of COVID-19 patients admitted to the Intensive care Unit (ICU)
Methods: This is a retrospective cohort study of COVID-19 positive patients with AKI admitted to the ICU at Anne Arundel Medical Center (AAMC) between March 2020 and June 2020. We collected baseline characteristics, clinical data, interventions, and outcomes. Descriptive statistics were implemented. AKI was defined per defined per Kidney Disease Outcomes Quality Initiative guidelines
Results: We included 121 COVID-19 confirmed patients admitted to ICU. Of them, 50/120 (41.66%) developed AKI during their ICU stay. There were no significant differences in age, sex, except for African American race (44% Vs 27%; P= 0.05) and BMI (31.15 vs 29.2; P= 0.018) between AKI and non-AKI group. Their median admission and maximum SOFA score were 11 vs 7; p=0.0014 and 14 vs 11, p < 0.0001 respectively. The need for mechanical ventilation (88% vs 70.4%; p = 0.02), and number of patients on vasopressors (68% vs 26.7%; p < 0.0001) was also higher. The days on the ventilator were not significant (9.5 vs 7.5; p=0.24). There were no significant difference in ICU length of stay (LOS) (10 vs 8; p=0.51), and hospital LOS (17 vs 16; p= 0.77) between AKI vs non-AKI. ICU mortality rates were higher in patient with AKI (70% vs 21.1%; p< 0.0001). Fifty percent of the patients in AKI required renal replacement therapy (RRT); had longer ICU LOS 14 vs 7 days; p= 0.043 and higher maximum SOFA scores (16 vs 13; p=0.002) than the AKI patients who did not need RRT. However, the mortality rates were similar (68% vs 72%; p=0.76) in AKI with and without RRT. They had longer ICU LOS (14 vs 7 days; p= 0.043) and higher maximum SOFA scores (16 vs 13; p=0.002) than the AKI patients who did not need RRT.
Conclusions: AKI was common in critically ill COVID-19 patients, particularly among African American and obese patients. It was also associated with higher severity of illness, ICU utilization, and mortality rates.