Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients

Background: The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death...

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Published in:Journal of clinical medicine 2021-11, Vol.10 (22), p.5224
Main Authors: Mirijello, Antonio, Piscitelli, Pamela, de Matthaeis, Angela, Inglese, Michele, D’Errico, Maria Maddalena, Massa, Valentina, Greco, Antonio, Fontana, Andrea, Copetti, Massimiliano, Florio, Lucia, Leone, Maurizio Angelo, Prencipe, Michele Antonio, Aucella, Filippo, De Cosmo, Salvatore
Format: Article
Language:English
Subjects:
Age
Chronic illnesses
Clinical deterioration
Clinical medicine
Consent
Coronaviruses
COVID-19
Creatinine
Dementia
Diabetes
Epidemiology
Hypertension
Infections
Kidney diseases
Metabolism
Severe acute respiratory syndrome coronavirus 2
Statistical analysis
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container_issue 22
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container_title Journal of clinical medicine
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creator Mirijello, Antonio
Piscitelli, Pamela
de Matthaeis, Angela
Inglese, Michele
D’Errico, Maria Maddalena
Massa, Valentina
Greco, Antonio
Fontana, Andrea
Copetti, Massimiliano
Florio, Lucia
Leone, Maurizio Angelo
Prencipe, Michele Antonio
Aucella, Filippo
De Cosmo, Salvatore
description Background: The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. Methods: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or
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Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. Methods: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or <60 mL/min/1.73 m2. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. Results: Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (p < 0.0001). Age (p < 0.001), SpO2 (p < 0.001), previous anti-platelet treatment (p = 0.006), Charlson’s Comorbidities Index (p < 0.001), serum creatinine (p < 0.001), eGFR (p = 0.003), low eGFR (p < 0.001), blood glucose levels (p < 0.001), and LDH (p = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02–2.63, p = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10–1.36, p < 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (p = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (p < 0.001). Conclusions: Patients with reduced eGFR at admission should be considered at high risk for clinical deterioration and death, requiring the best supportive treatment in order to prevent the worst outcome.]]></description><identifier>ISSN: 2077-0383</identifier><identifier>EISSN: 2077-0383</identifier><identifier>DOI: 10.3390/jcm10225224</identifier><identifier>PMID: 34830506</identifier><language>eng</language><publisher>Basel: MDPI AG</publisher><subject>Age ; Chronic illnesses ; Clinical deterioration ; Clinical medicine ; Consent ; Coronaviruses ; COVID-19 ; Creatinine ; Dementia ; Diabetes ; Epidemiology ; Hypertension ; Infections ; Kidney diseases ; Metabolism ; Severe acute respiratory syndrome coronavirus 2 ; Statistical analysis</subject><ispartof>Journal of clinical medicine, 2021-11, Vol.10 (22), p.5224</ispartof><rights>2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). 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Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. Methods: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or <60 mL/min/1.73 m2. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. Results: Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (p < 0.0001). Age (p < 0.001), SpO2 (p < 0.001), previous anti-platelet treatment (p = 0.006), Charlson’s Comorbidities Index (p < 0.001), serum creatinine (p < 0.001), eGFR (p = 0.003), low eGFR (p < 0.001), blood glucose levels (p < 0.001), and LDH (p = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02–2.63, p = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10–1.36, p < 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (p = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (p < 0.001). 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Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. Methods: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or <60 mL/min/1.73 m2. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. Results: Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (p < 0.0001). Age (p < 0.001), SpO2 (p < 0.001), previous anti-platelet treatment (p = 0.006), Charlson’s Comorbidities Index (p < 0.001), serum creatinine (p < 0.001), eGFR (p = 0.003), low eGFR (p < 0.001), blood glucose levels (p < 0.001), and LDH (p = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02–2.63, p = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10–1.36, p < 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (p = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (p < 0.001). Conclusions: Patients with reduced eGFR at admission should be considered at high risk for clinical deterioration and death, requiring the best supportive treatment in order to prevent the worst outcome.]]></abstract><cop>Basel</cop><pub>MDPI AG</pub><pmid>34830506</pmid><doi>10.3390/jcm10225224</doi><orcidid>https://orcid.org/0000-0002-6660-5315</orcidid><orcidid>https://orcid.org/0000-0002-6339-5738</orcidid><orcidid>https://orcid.org/0000-0003-3932-3803</orcidid><oa>free_for_read</oa></addata></record>
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subjects Age
Chronic illnesses
Clinical deterioration
Clinical medicine
Consent
Coronaviruses
COVID-19
Creatinine
Dementia
Diabetes
Epidemiology
Hypertension
Infections
Kidney diseases
Metabolism
Severe acute respiratory syndrome coronavirus 2
Statistical analysis
title Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients
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