Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu; Corresponding Author.
Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu.
J Assoc Physicians India. 2021 Jun;69(6):11-12.
Acute Kidney Injury (AKI) is a dreaded complication of Covid-19 infection with high morbidity and mortality. Limited data exists on Indian experience. In a tertiary care hospital situated in South India, we analysed the incidence, clinical profile and outcomes of patients diagnosed with AKI due to COVID-19.
Retrospective data of Adult cases admitted with COVID-19 over a 8 month period from April - November 2020 was collected. Incidence, Demographics, Clinical profile, Management and Outcomes of COVID-19 associated AKI were analysed. Primary outcome was In- hospital mortality. Secondary outcomes were Dialysis Requirement and Renal Recovery.
52 (7%) out of a total 718 patients with COVID-19 developed AKI. Mean Age was 58 years (IQR 51-69) with a striking male predominance of 92%.(Male:Female -9.4:1) (P< 0.001). Co morbidities seen were Diabetes in 38 (73%) and Hypertension in 31(59%) and Coronary Artery Disease in 17(32%). Fever with myalgia was seen in 29 (46%), Respiratory symptoms in 31(59%), Oliguria in 26(50%) and Diarrhea in 2 (3%) patients. At admission, Hypoxemia and Hypotension were seen in 27 (51%) and 16 (30%) patients respectively. Urinalysis revealed > 2+ dipstick Proteinuria in 24 (46%) and Microscopic hematuria in 16(34%) patients. 25 (48%) were admitted in Stage 3 AKI with a mean S.Creatinine level of 4.4 + 3.4 mg/dl. CT chest showed > 50% lung involvement in 23 patients (44%). Mechanical ventilation was required in 20(38%). Hemodialysis was required in 12 (23%). The median duration of hospitalisation was 10 + 5 days. Primary Outcome of Mortality occurred in 44% of AKI cohort in comparison to 7% in Non AKI cohort (Relative Risk[RR]6.2; 95% Confidence Interval[CI], 4.1 to 9.4) (P= 0.001). Hypoxemia [RR,3.76;95% CI,1.4-9.5], Hypotension [RR 2.54; CI,1.5-4 ], Low Serum albumin [RR1.6;CI,1.1 - 2.3] and Requirement for mechanical ventilation [RR,11.3; CI, 2.9 - 23 ] were significant risk factors for mortality. All 5 patients who required both mechanical ventilation and Dialysis died. 31 patients (59%) were treated with Remdesivir therapy without survival benefit. Significantly higher C-Reactive Protein, Interleukin -6, D-Dimer levels and lower serum albumin levels were seen in those who died. Among the 29 patients who survived, the estimated GFR (e GFR) had recovered in 12 (41%) at discharge. After further followup of 4-6 weeks, the total number of patients who recovered renal function rose to 21 (72%).
Mortality in COVID associated AKI stood at 44%. Multiple factors contributed to high mortality such as Severe disease with hypotension and extensive pulmonary involvement, High Neutrophil to Lymphocyte Ratio, Absolute Monocyte Count, inflammatory markers, d-Dimer and low serum albumin. It was encouraging to note that 72% of survivors recovered renal function by 4-6 weeks after discharge from hospital which means that it is worth the struggle to treat AKI in COVID-19.
急性肾损伤（AKI）是 COVID-19 感染的一种可怕并发症，具有高发病率和死亡率。关于印度的经验，数据有限。在印度南部的一家三级保健医院，我们分析了因 COVID-19 导致 AKI 的患者的发病率、临床特征和结局。
回顾性分析了 2020 年 4 月至 11 月期间 8 个月内因 COVID-19 住院的成年患者的数据。分析了 COVID-19 相关 AKI 的发病率、人口统计学、临床特征、管理和结局。主要结局是院内死亡率。次要结局是透析需求和肾功能恢复。
在总共 718 例 COVID-19 患者中，有 52 例（7%）发生 AKI。平均年龄为 58 岁（IQR 51-69），男性占 92%（男：女为 9.4:1）（P<0.001）。合并症为糖尿病 38 例（73%）、高血压 31 例（59%）和冠心病 17 例（32%）。29 例（46%）有发热伴肌痛，31 例（59%）有呼吸道症状，26 例（50%）有少尿，2 例（3%）有腹泻。入院时，27 例（51%）患者有低氧血症，16 例（30%）患者有低血压。尿液分析显示 24 例（46%）有>2+ 尿蛋白和 16 例（34%）有镜下血尿。25 例（48%）为 AKI 3 期，平均血肌酐水平为 4.4+3.4mg/dl。胸部 CT 显示 23 例（44%）有>50%的肺部受累。20 例（38%）需要机械通气。12 例（23%）需要血液透析。中位住院时间为 10+5 天。AKI 组的主要结局死亡率为 44%，而非 AKI 组为 7%（相对风险[RR]6.2；95%置信区间[CI]，4.1-9.4）（P=0.001）。低氧血症（RR，3.76；95%CI，1.4-9.5）、低血压（RR 2.54；CI，1.5-4）、低血清白蛋白（RR 1.6；CI，1.1-2.3）和需要机械通气（RR，11.3；CI，2.9-23）是死亡的显著危险因素。所有需要机械通气和透析的 5 例患者均死亡。31 例（59%）患者接受了瑞德西韦治疗，但无生存获益。死亡患者的 C 反应蛋白、白细胞介素-6、D-二聚体水平显著升高，血清白蛋白水平显著降低。在 29 例存活患者中，12 例（41%）在出院时估计肾小球滤过率（eGFR）恢复。进一步随访 4-6 周后，肾功能恢复的患者总数增加到 21 例（72%）。
COVID 相关 AKI 的死亡率为 44%。低血压和广泛的肺部受累等严重疾病、高中性粒细胞与淋巴细胞比值、绝对单核细胞计数、炎症标志物、D-二聚体和低血清白蛋白等多种因素导致死亡率较高。令人鼓舞的是，出院后 4-6 周，21 例（72%）幸存者的肾功能恢复，这意味着治疗 COVID-19 相关 AKI 是值得的。
