Preditores de injúria renal aguda em pacientes hospitalizados por covid-19

Abstract

Acute kidney injury is one of the most complex conditions in patients hospitalized with COVID-19. However, predictors of acute kidney injury associated with COVID-19 are not yet well understood. Objective: To investigate the incidence and predictive factors for the development of acute kidney injury in patients hospitalized with moderate and severe COVID-19 during a seven-day hospitalization period at a university hospital in the countryside of São Paulo. Methods: This is a quantitative, retrospective cohort study, in a seven-day time series. Information was extracted from medical records of individuals over 18 years old (N= 360), diagnosed with COVID-19 and admitted between March 2020 and March 2021 in the hospitalization sector. Acute kidney injury was defined based on the Kidney Disease Improving Global Outcomes guidelines. Sociodemographic data (age, age range, sex, skin color, marital status and education) and clinical and laboratory conditions (severity of COVID-19, stages of acute kidney injury, Charlson comorbidity index, hypertension, diabetes mellitus, myocardial infarction, chronic lung disease, dyslipidemia, heart failure, cerebrovascular disease, diabetes mellitus with complications, dementia, cancer, peptide ulcer, mild liver disease, hemiplegia, peripheral vascular disease, rheumatoid arthritis, acquired immunodeficiency syndrome, death, peripheral oxygen saturation, supplemental oxygen on admission, urea, serum creatinine, estimated glomerular filtration rate, albumin, hemoglobin, leukocytes, lymphocytes, platelets, c-reactive protein, D-dimer) were collected. All ethical precepts were respected. Statistical analysis: The probability of developing acute kidney injury in patients hospitalized with COVID-19 was analyzed using the Kaplan-Meier survival curve, and the log-rank test was used to calculate its statistical significance. To analyze factors associated with the risk of developing acute kidney injury, Cox multivariate analysis was performed. Results: A total of 360 patients without acute kidney injury at hospital admission were included in this study. Of these, 36 (10%) developed acute kidney injury within seven days of observation. Survival analysis demonstrated that there was a significant difference in the incidence of acute kidney injury in the groups aged greater than or equal to 60 years (p=0.02), sex (p=0.04), hypertension (p<0.01), diabetes mellitus (p=0.04) and heart failure (p<0.01). Multivariate analysis confirmed that age (HR 1.027; 95%CI 1.003-1.051; p=0.03), serum creatinine levels (HR 17.795; 95%CI 4.104-77.156; p<0.01) and C-reactive protein on admission (HR 1.052; 95%CI 1.009-1.098; p=0.02) were factors associated with the risk of developing acute kidney injury in patients hospitalized with COVID-19. Conclusion: The incidence of acute kidney injury in patients hospitalized with COVID-19 was 10.0%, and age, high serum creatinine and C-reactive protein levels were factors associated with the risk of developing acute kidney injury in hospitalized patients with COVID-19. The results may assist in care strategies for patients who had COVID-19 and who developed AKI after a seven-day hospitalization period. Provides evidence of the importance of kidney health in patients with COVID-19 and the need to monitor these patients after hospital discharge, continuing this important line of investigation.