Raised Inflammatory Markers as Predictors of Acute Kidney Injury in Hospitalized Covid-19 Patients: A Retrospective Cohort Study.

Covid-19 infection can affect the multiple-organ system. Acute kidney injury (AKI) is one of the complications and is associated with poor outcomes. Of many potential risk factors for the development of AKI, raised inflammatory markers are postulated to be responsible. A retrospective cohort study was conducted on 135 patients who were admitted in the ward and intensive care unit (ICU) from June 2020 to September 2020 in Enam Medical College and Hospital, Savar, Dhaka, Bangladesh. Patients aged ≥18 years with positive RT-PCR Covid-19 were included. AKI was defined and staged according to KDIGO criteria. We evaluated the incidence of AKI, the demographic and laboratory markers associated with AKI in Covid-19 patients and the outcome. Univariate and multivariate analyses were performed. The incidence of AKI was 27.0% (36). Most of them were in stage 1(75.0%). The mean age of the cohort was 52.19±15.55 years and 68.0% were male (n=92). Of the comorbidities, diabetes mellitus was the commonest (46.0%). On progressive multivariate logistic regression, severe/critical Covid-19 (aOR 3.1, 95% CI: 1.09-8.93, p-value 0.033), requiring mechanical ventilation (aOR 2.7, 95% CI: 1.13-6.51, p-value 0.026) and raised D-dimer (aOR 3, 95% CI: 1.07-8.22, p-value 0.036) were identified as independent risk factors associated with AKI. A higher proportion of patients who developed AKI required ICU (50.0% versus 14.1%, p<0.0001) and were intubated (39% versus 13.0%, p=0.003). Overall, in-hospital mortality was 22(16.0%). In-hospital mortality was higher in patients with AKI (39 versus 8.0%, p<0.0001). Severe Covid-19, requiring mechanical ventilation and raised d-dimer are associated with AKI in Covid-19. Early identification of risk factors can reduce the incidence of AKI and death.