AKI in COVID-19 Associated Respiratory Failure (C-19RF) and Other Etiologies: Implications for Distinction in Clinical Characteristics, a Retrospective Analysis of the NU SCRIPTS Study

Background: Differences in the development of AKI in patients with C-19RF and other causes of severe respiratory failure (RF) may exist, which could have implications for clinical management. We retrospectively analyzed the NU SCRIPTS data to compare AKI's clinical characteristics and outcomes in C-19RF patients and RF attributable to other causes. Methods: We evaluated 368 mechanically ventilated patients (pts.) from the NU SCRIPT study. AKI was defined as a ≥ 0.3mg/dl increase in serum creatinine within 48 hrs. Clinical and laboratory values obtained on admission were analyzed. We employed stepwise forward logistic analysis (LR) to determine those variables associated with C-19RF. In addition, we used logistic regression analysis LR to compare independent predictors of mortality in C-19RF and RF pts. Those variables found to be statistically significant in univariate analysis (p < 0.05) were included in the LR analysis. Results: A total of 250 pts developed AKI, consisting of 81 patients with C-19RF and 169 RF pts. There was no significant difference in mortality between C-19RF and RF groups (43 vs 47%). Likewise, there was no difference between groups in the need for renal replacement therapy. Stepwise LR demonstrated that increased days on mechanical ventilation, non-Caucasian race, hemoglobin, and increased platelet white blood cell ratio (Plt./WBC) were associated with C-19RF. LR demonstrated that SOFA score, higher O2 saturation and a higher Plt./WBC were associated with increased mortality in C-19RF patients. In contrast, in the RF pts. increased age, Sofa score, vasopressor requirement, and the need for renal replacement therapy were independently associated with mortality. Conclusion: There are significant differences in clinical outcomes between C-19RF and RF pts developing AKI. These findings suggest a different clinical course and phenotype in the groups. These findings emphasize tailored management strategies based on respiratory failure etiology for better outcomes in C19RF and RF populations. Reference: Markov, N., Gao and SCRIPT researchers (2023) SCRIPT CarpeDiem Dataset: PhysioNet. https://doi.org/10.13026/5phr-4r89. This Work Does Not Reflect the Opinions of the NU-Script Investigators.