Risk factors of acute kidney injury in severe COVID-19 patients and their predictive values

Abstract

Objective To screen the risk factors of acute kidney injury （AKI）in severe COVID-19 patients, construct a predictive model and explore its predictive value. Methods From December 1,2022 to July 1, 2023, the relevant clinical data were retrospectively reviewed for 150 patients of severe COVID-19. Based upon the presence or absence of AKI, they were assigned into two groups of AKI（n=54）and non-AKI （n=96）. Multivariate Logistic regression analysis was utilized for screening the risk factors for AKI in severe COVID-19 patients. A prediction model was constructed. And predictive value of model was verified by receiver operating characteristic curve（ROC）. Results Age was significantly lower in AKI group than that in non-AKI group[74.50（63.00, 81.50） vs 75.00（70.00, 83.00） year]. Proportion of AKI plus chronic obstructive pulmonary disease（1.85%）and proportion on high-flow nasal cannula（HFNC）（38.89%）were significantly lower than those in non-AKI group（13.54%, 58.33%） （both P＜0.05）. Scores of APACHE Ⅱ[20.50（15.00, 25.00）] and sequential organ failure assessment（SOFA）[8.00（6.00, 10.00）] were significantly higher in AKI group than those in non-AKI group[16.00（13.00, 18.25）, 5.00（4.00, 6.00）]. Proportion of patients with bacterial infection（61.11%） and receiving invasive ventilation therapy（57.41%）were significantly higher in AKI group than those in non-AKI group（40.62%, 25.00%） （both P＜0.05）. Oxygenation index[109.55（75.99, 149.50）mmHg (1 mm Hg=0.133 kPa)] and hemoglobin[（109.61±24.46）g/L] were significantly lower in AKI group than those in non-AKI group[134.50（105.36, 156.57）mmHg and （121.24±21.77）g/L]. N-terminal brain natriuretic peptide [3148.28（446.42, 13572.58）ng/L], procalcitonin[1.48（0.56, 8.42）ng/L], partially activated thromboplastin time[39.80（34.42, 45.32）second] and aspartate aminotransferase[38.00（21.00, 66.50）U/L] were significantly higher in AKI group than those in non-AKI group[502.41（171.50, 1703.00）ng/L, 370（110, 1040）ng/L, 36.95（32.70, 42.20）second, 34.00（20.50, 53.00）U/L]. Blood urea nitrogen[13.86（8.68, 18.70）mmol/L], serum creatinine[177.00（90.30, 375.00）μmol/L] and cystatin C[2.67（1.77, 4.08）mg/L] were significantly higher than those in non-AKI group[7.31（5.51, 9.67）mmol/L, 62.95（51.75, 78.10）μmol/L and 1.34（1.10, 1.61）mg/L]（all P＜0.05）. Multivariate Logistic regression analysis revealed that high SOFA score, concurrent bacterial infection and elevated serum creatinine were independent risk factors for AKI（all P＜0.05）. A prediction model was constructed with the above risk factors and ROC curve analysis performed. The results indicated that area under ROC curve（AUC） of model for predicting AKI was 0.916（95%CI:0.8687-0.9633） with a sensitivity of 77.36% and a specificity of 92.63%. Conclusion Elevated serum creatinine, high SOFA score and concurrent bacterial infection are independent risk factors for severe COVID-19 AKI. The prediction model constructed by the above risk factors has some value in predicting the occurrence of AKI.

Keywords

• corona virus disease-19
• acute kidney injury
• risk factors