Incidence, risk factors and outcome of acute kidney injury in critically ill COVID-19 patients in Tyrol, Austria: a prospective multicenter registry study

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Abstract

Introduction

Acute kidney injury is a frequent complication in critically ill patients with and without COVID-19. The aim of this study was to evaluate the incidence of, and risk factors for, acute kidney injury and its effect on clinical outcomes of critically ill COVID-19 patients in Tyrol, Austria.

Methods

This multicenter prospective registry study included adult patients with a SARS-CoV-2 infection confirmed by polymerase chain reaction, who were treated in one of the 12 dedicated intensive care units during the COVID-19 pandemic from February 2020 until May 2022.

Results

In total, 1042 patients were included during the study period. The median age of the overall cohort was 66 years. Of the included patients, 267 (26%) developed acute kidney injury during their intensive care unit stay. In total, 12.3% ( n = 126) required renal replacement therapy with a median duration of 9 (IQR 3–18) days. In patients with acute kidney injury the rate of invasive mechanical ventilation was significantly higher with 85% ( n = 227) compared to 41% ( n = 312) in the no acute kidney injury group ( p < 0.001). The most important risk factors for acute kidney injury were invasive mechanical ventilation (OR = 4.19, p < 0.001), vasopressor use ( OR = 3.17, p < 0.001) and chronic kidney disease (OR = 2.30, p < 0.001) in a multivariable logistic regression analysis. Hospital and intensive care unit mortality were significantly higher in patients with acute kidney injury compared to patients without acute kidney injury (Hospital mortality: 52.1% vs. 17.2%, p < 0.001, ICU-mortality: 47.2% vs. 14.7%, p < 0.001).

Conclusion

As in non-COVID-19 patients, acute kidney injury is clearly associated with increased mortality in critically ill COVID-19 patients. Among known risk factors, invasive mechanical ventilation has been identified as an independent and strong predictor of acute kidney injury.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40620-023-01760-3.

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Most cited references 51

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data capture tools to support clinical and translational research. We present: (1) a brief description of the REDCap metadata-driven software toolset; (2) detail concerning the capture and use of study-related metadata from scientific research teams; (3) measures of impact for REDCap; (4) details concerning a consortium network of domestic and international institutions collaborating on the project; and (5) strengths and limitations of the REDCap system. REDCap is currently supporting 286 translational research projects in a growing collaborative network including 27 active partner institutions.

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Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

Dawei Wang, Bo Hu, Fangfang Zhu … (2020)

In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.

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Author and article information

Contributors

Michael Joannidis:

ORCID: http://orcid.org/0000-0002-6996-0881

michael.joannidis@i-med.ac.at

Journal

Journal ID (nlm-ta): J Nephrol

Journal ID (iso-abbrev): J Nephrol

Title: Journal of Nephrology

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1121-8428

ISSN (Electronic): 1724-6059

Publication date (Electronic): 14 October 2023

Publication date PMC-release: 14 October 2023

Publication date (Print): 2023

Volume: 36

Issue: 9

Pages: 2531-2540

Affiliations

[1 ]GRID grid.5361.1, ISNI 0000 0000 8853 2677, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, , Medical University Innsbruck, ; Anichstrasse 35, 6020 Innsbruck, Austria

[2 ]GRID grid.459695.2, Internal Medicine II, Gastroenterology, Hepatology and Rheumatology, , Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, ; St. Pölten, Austria

[3 ]GRID grid.5361.1, ISNI 0000 0000 8853 2677, Department of Anesthesia and Critical Care Medicine, , Medical University Innsbruck, ; Innsbruck, Austria

[4 ]Department of Anesthesia and Intensive Care Medicine, Hospital Hall, Hall, Austria

[5 ]GRID grid.5361.1, ISNI 0000 0000 8853 2677, Department of General and Surgical Intensive Care Medicine, , Medical University Innsbruck, ; Innsbruck, Austria

[6 ]Department of Anesthesia and Intensive Care Medicine, Hospital Kufstein, Kufstein, Austria

[7 ]Department of Anesthesiology and Critical Care Medicine, Hospital St. Vinzenz Zams, Zams, Austria

[8 ]GRID grid.5361.1, ISNI 0000 0000 8853 2677, Department of Neurology, , Medical University Innsbruck, ; Innsbruck, Austria

[9 ]Department of Anesthesia and Critical Care Medicine, Hospital Schwaz, Schwaz, Austria

[10 ]Department of Internal Medicine, Hospital St. Vinzenz Zams, Zams, Austria

[11 ]Department of Anesthesia and Intensive Care Medicine, Hospital Reutte, Reutte, Austria

[12 ]Department of Anesthesia and Intensive Care Medicine, Hospital Lienz, Lienz, Austria

[13 ]GRID grid.5361.1, ISNI 0000 0000 8853 2677, Department of Neurosurgery, , Medical University Innsbruck, ; Innsbruck, Austria

[14 ]Department of Anesthesia and Intensive Care Medicine, Hospital St. Johann in Tyrol, St. Johann in Tyrol, Austria

[15 ]GRID grid.5361.1, ISNI 0000 0000 8853 2677, Department of Pediatrics, , Medical University Innsbruck, ; Innsbruck, Austria

[16 ]Department of Internal Medicine, Hospital Hall, Hall, Austria

[17 ]Department of Internal Medicine, Hospital Lienz, Lienz, Austria

[18 ]Department of Neurology, Johannes Kepler University Linz, ( https://ror.org/052r2xn60) Linz, Austria

[19 ]Faculty of Medicine and Dentistry, Danube Private University, ( https://ror.org/054ebrh70) Krems, Austria

Author information

Michael Joannidis http://orcid.org/0000-0002-6996-0881

Article

Publisher ID: 1760

DOI: 10.1007/s40620-023-01760-3

PMC ID: 10703973

PubMed ID: 37837501

SO-VID: 55c5e08f-b7c2-4508-ab1a-68ad51b26d97

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 26 March 2023

Date accepted : 6 August 2023

Funding

Funded by: Land Tirol

Funded by: University of Innsbruck and Medical University of Innsbruck

Open Access :

Open access funding provided by University of Innsbruck and Medical University of Innsbruck.

Custom metadata

Keywords: sars-cov-2,intensive care unit,renal,critical care,pandemic

Data availability:

Keywords: sars-cov-2, intensive care unit, renal, critical care, pandemic

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Incidence, risk factors and outcome of acute kidney injury in critically ill COVID-19 patients in Tyrol, Austria: a prospective multicenter registry study

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Abstract

Introduction

Methods

Results

Conclusion

Graphical abstract

Supplementary Information

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 51

Clinical Characteristics of Coronavirus Disease 2019 in China

Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

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Cited by 4

Most referenced authors 2,426