Frequency, Grades of Toxicity, and Predictors of Hepatotoxicity and Acute Kidney Injury with Remdesivir in COVID-19 Patients: A Multicenter Retrospective Cohort Study

<b>Background</b>: Remdesivir is associated with hepatotoxicity and acute kidney injury (AKI). The objective of this study was to assess the hepatotoxicity and AKI with remdesivir. <b>Method:</b> This is a multicenter, retrospective cohort study for adult patients who used remdesivir for COVID-19 from 3/2020 to 10/2021. The study was conducted at Rhode Island Hospital, Rhode Island, United States. Data were analyzed with descriptive statistics as well as logistic regression analysis using STATA 18. <b>Results:</b> A total of 1635 patients were evaluated for hepatotoxicity: 337 developed hepatotoxicity, and 1298 had normal hepatic function. The overall median frequency of hepatotoxicity occurred in 319 patients (19.5%). Patient age (OR 1.02, 95% CI: 1-1.04, <i>p</i> = 0.02) and selective serotonin reuptake inhibitors (SSRIs) use (OR 1.7, 95% CI: 1.1-2.6, <i>p</i> = 0.01) were potential risk factors for remdesivir-associated hepatotoxicity. In contrast, being male gender was protective against remdesivir-associated hepatotoxicity (OR 0.63, 95% CI: 0.47-0.87, <i>p</i> = 0.02). The frequency of AKI with remdesivir occurred in 280 patients (17.3%). <b>Conclusions:</b> The frequency of hepatotoxicity was 19.5%, and the frequency of AKI was 17.3%. Increasing age and using SSRIs were risk factors for remdesivir-associated hepatotoxicity, while male gender was a protective factor. Clinicians should vigilantly monitor hepatic and renal functions for patients using remdesivir, especially in elderly patients.