Risk factors and outcome of acute kidney injury in critically ill patients with SARS-CoV-2 pneumonia: a multicenter study

Med Intensiva (Engl Ed). 2025 Jan;49(1):15-24. doi: 10.1016/j.medine.2024.06.022. Epub 2024 Jul 12.

Abstract

Objective: To assess incidence, risk factors and impact of acute kidney injury(AKI) within 48 h of intensive care unit(ICU) admission on ICU mortality in patients with SARS-CoV-2 pneumonia. To assess ICU mortality and risk factors for continuous renal replacement therapy (CRRT) in AKI I and II patients.

Design: Retrospective observational study.

Setting: Sixty-seven ICU from Spain, Andorra, Ireland.

Patients: 5399 patients March 2020 to April 2022.

Main variables of interest: Demographic variables, comorbidities, laboratory data (worst values) during the first two days of ICU admission to generate a logistic regression model describing independent risk factors for AKI and ICU mortality. AKI was defined according to current international guidelines (kidney disease improving global outcomes, KDIGO).

Results: Of 5399 patients included 1879 (34.8%) developed AKI. These patients had higher ICU mortality and AKI was independently associated with a higher ICU mortality (HR 1.32 CI 1.17-1.48; p < 0.001). Male gender, hypertension, diabetes, obesity, chronic heart failure, myocardial dysfunction, higher severity scores, and procalcitonine were independently associated with the development of AKI. In AKI I and II patients the need for CRRT was 12.6% (217/1710). In these patients, APACHE II, need for mechanical ventilation in the first 24 h after ICU admission and myocardial dysfunction were associated with risk of needing CRRT. AKI I and II patients had a high ICU mortality (38.5%), especially if CRRT were required (64.1% vs. 34,8%; p < 0.001).

Conclusions: Critically ill patients with SARS-CoV-2 pneumonia and AKI have a high ICU mortality. Even AKI I and II stages are associated with high risk of needing CRRT and ICU mortality.

Keywords: Acute kidney injury; Continuous renal replacement therapy; Insuficiencia renal aguda; Intensive care unit; Neumonía por SARS-CoV-2; SARS-CoV-2 pneumonia; Técnicas continuas de reemplazo renal; Unidad de cuidados intensivos.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Acute Kidney Injury* / epidemiology
  • Acute Kidney Injury* / etiology
  • Acute Kidney Injury* / mortality
  • Acute Kidney Injury* / therapy
  • Aged
  • COVID-19* / complications
  • COVID-19* / mortality
  • COVID-19* / therapy
  • Comorbidity
  • Continuous Renal Replacement Therapy
  • Critical Illness*
  • Female
  • Hospital Mortality
  • Humans
  • Incidence
  • Intensive Care Units / statistics & numerical data
  • Ireland / epidemiology
  • Male
  • Middle Aged
  • Pneumonia* / complications
  • Pneumonia* / virology
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Spain / epidemiology