AUTHOR=Lu Justin Y. , Buczek Alexandra , Fleysher Roman , Hoogenboom Wouter S. , Hou Wei , Rodriguez Carlos J. , Fisher Molly C. , Duong Tim Q. 

TITLE=Outcomes of Hospitalized Patients With COVID-19 With Acute Kidney Injury and Acute Cardiac Injury

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.798897

DOI=10.3389/fcvm.2021.798897

ISSN=2297-055X

ABSTRACT=Purpose: This study investigated the incidence, disease course, risk factors, and mortality in COVID-19 patients who developed both acute kidney injury (AKI) and acute cardiac injury (ACI), and compared to those with AKI only, ACI only, and no injury (NI).

Methods: This retrospective study consisted of hospitalized COVID-19 patients at Montefiore Health System in Bronx, New York between March 11, 2020 and January 29, 2021. Demographics, comorbidities, vitals, and laboratory tests were collected during hospitalization. Predictive models were used to predict AKI, ACI and AKI-ACI onset. Longitudinal laboratory tests were analyzed with time-lock to discharge alive or death. 

Results: Of the 5,896 hospitalized COVID-19 patients, 44%, 19%, 9%, and 28% had NI, AKI, ACI and AKI-ACI, respectively. Most ACI presented very early (within a day or two) during hospitalization in contrast to AKI (p<0.05). Patients with combined AKI-ACI were significantly older, more often men and had more comorbidities, and higher levels of cardiac, kidney, liver, inflammatory and immunological markers compared to those of the AKI, ACI and NI groups. The adjusted hospital-mortality odds ratios were 17.1 [95%CI=13.6-21.7, p<0.001], 7.2 [95%CI=5.4-9.6, p<0.001], and 4.7 [95%CI=3.7-6.1, p<0.001] for AKI-ACI, ACI, and AKI, respectively, relative to NI. A predictive model of AKI-ACI onset using top predictors yielded 97% accuracy. Longitudinal laboratory data predicted mortality of AKI-ACI patients up to 5 days prior to outcome, with an area-under-the-curve, ranging from 0.68 to 0.89. 

Conclusions: COVID-19 patients with AKI-ACI had markedly worse outcome compared to those without. Common laboratory variables accurately predict AKI-ACI. The ability to identify patients at risk of AKI-ACI early on could improve early intervention and management.