Marcadores inflamatorios y su correlación con alteración de la función renal, estancia hospitalaria y mortalidad en pacientes con infección severa por COVID-19. Un estudio observacional de centro único.

Introduction: Introduction: SARS-CoV-2 infection is characterized by high levels of inflammation associated with a significant mortality rate. The resulting systemic compromise includes renal function in 17% of cases. This study aimed to establish the correlation between inflammatory markers and impaired renal function, hospital stay, and mortality in patients with severe COVID-19 infection treated at a sentinel hospital in Quito, Ecuador, during 2020-2021. Methods: An observational case-control study with a sample of 250 participants, distributed as 94 cases and 156 controls, from an intensive care unit, whose anonymized information was collected from the DI-22 COVID-19 Project. Results: Median CRP 19 mg/dL, Ferritin in men: 1314.5 ng/ml, Ferritin in women: 768.7 mg/dL, and LDH 848 mg/dL, with no statistical difference between the case and control groups. The elevation of these markers alone was not found to be associated with clinical outcomes: altered renal function, mortality or hospital stay; when categorized based on the median, it was found that CRP levels greater than 19 mg/dl were associated with a hospital stay of more than 10 days (P=0.002, OR 2.19 CI 1.32-3.65), while LDH values above 848 U/l were associated with mortality (P=0.041, OR 1.72 CI 1.02-2.95) and hematuria (P=0.028, OR 0.50, CI 0.27-0.93). A CRP >20-fold increase in serum creatinine levels was associated with a hospital stay of more than 10 days (P=0.010, OR 1.94, 95% CI 1.17-3.22), ferritin levels three times the normal value were associated with acute kidney injury (P=0.04, OR 1.84, 95% CI 1.01-3.36), and LDH levels greater than three times the normal value were statistically associated with mortality (P=0.033, OR 1.78, 95% CI 1.05-3.02). Renal function abnormalities associated with mortality in this study included elevated BUN at admission (P=0.02, OR 1.86, 95% CI 1.11-3.12) and the development of acute kidney injury (P<0.01, OR 2.76, 95% CI 1.6-4.74). Conclusion: A multivariate analysis found that age over 50 years, male sex, acute kidney injury, admission creatinine, discharge BUN, and LDH levels above 2n accounted for 32% of mortality, providing a sensitivity of 52% and specificity of 89%.