Factors associated with acute kidney injury (AKI) and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit: a single-center prospective study.

Autor: Nlandu Y; Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.; Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo., Makulo JR; Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo., Essig M; Nephrology Department, Ambroise Paré Hospital, AP-HP University Paris-Saclay, Boulogne-Billancourt, France., Sumaili E; Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo., Lumaka A; Center for Human Genetics, Department of Pediatrics, University of Kinshasa, Kinshasa, Democratic Republic of Congo., Engole Y; Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.; Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo., Mboliasa MF; Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.; Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo., Mokoli V; Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo., Tshiswaka T; Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo., Nkodila A; Department of Family Medicine and Primary Care, Protestant University in Congo, Kinshasa, Democratic Republic of Congo., Bukabau J; Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.; Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo., Longo A; Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo., Kajingulu F; Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo., Zinga C; Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo., Nseka N; Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
Jazyk: angličtina
Zdroj: Renal failure [Ren Fail] 2023; Vol. 45 (2), pp. 2263583. Date of Electronic Publication: 2023 Oct 23.
DOI: 10.1080/0886022X.2023.2263583
Abstrakt: Introduction: Acute kidney injury (AKI) is a complication of severe coronavirus disease 2019 (COVID-19). Kidney damage associated with COVID-19 could take specific features due to environmental and socio-cultural factors. This study evaluates the incidence of AKI, the associated factors, and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit.
Methods: In a prospective cohort study conducted in the intensive care unit (ICU) of the Centre Médical de Kinshasa (CMK), consecutive patients admitted for COVID-19 were screened for the presence of AKI between 27 March, 2020 and 27 January 2022. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. The primary outcome was occurrence of AKI. The secondary outcome was 48 days' mortality and recovery of the renal function at intensive care unit (ICU) discharge. Survival (time-to death) curves were built using the Kaplan Meier methods. Multivariate analyses were performed by logistic regression to identify factors associated with AKI and Cox regression to explore the association between AKI and in-hospital mortality. The significance level of the p -value was set at 0.05.
Results: The median(IQR) sequential organ failure assessment score (SOFA) score and mean age of patients (215) including in our cohort were respectively 3(2-4) and 58.9 ± 14.9 years. The incidence of AKI was 28.4% with stages 1, 2, or 3 AKI accounted for 39.3%, 11.5%, and 49.2%, respectively. Hemodialysis was required in 16 out 215 (7.4%) patients. Dyspnea (adjusted odds ratio (aOR):2.27 [1.1--4.57] p  = 0.021), SOFA ≥5 (aOR:3.11[1.29-7.53] p  = 0.012), AST/ALT ratio (aOR: 1.53 [1.09-1.79] p  = 0.015), N/L ratio (aOR:2.09 [1.09-3.20] p  = 0.016), mechanical ventilation (aOR: 3.20 [1.66-10.51] p  = 0.005) and Amikacin (aOR: 2.91 [1.37-6.18] p  = 0.006) were the main factors associated with AKI. Patients with AKI had a mortality rate of 52.5% and 67.2% of the survivors did not recover kidney function at the end of hospitalization. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (HR:2.96 [1.93-4.65] p  = 0.013) compared to non-AKI patients.
Conclusions: AKI was present in three out of ten COVID-19 patients. The most significant factors associated with AKI were dyspnea, SOFA ≥ 5, AST/ALT and N/L ratio, mechanical ventilation and Amikacin. AKI has been associated with an almost threefold increase in overall mortality and seven out of ten survivors did not recover kidney function after AKI.
Databáze: MEDLINE
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