Renal Function Implications on COVID-19 Intensive Care Unit Patient Outcomes in Saudi Arabia: A Retrospective Analysis
Authors: Aleid Ahmed Fadeil , Alomari Amal Saad , Jurays Najwa Saeed N. , Alharbi Ali , Alqahtani Hamzah , Alshehri Reema , Qader Ali , Alhodibi Mostafa 
Published: December 2024

Abstract

Introduction:
The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, particularly in managing critically ill patients in intensive care units (ICUs). Among these patients, acute kidney injury has emerged as a common complication, with severe implications for patient outcomes. This study aims to investigate the impact of renal function on the prognosis of COVID-19 ICU patients in Saudi Arabia.

Methods:
This was a retrospective cohort study, carried out in tertiary hospitals of Saudi Arabia from 22 June 2020 to 22 October 2020. Medical records of adult COVID-19 patients admitted to ICUs were reviewed. Patients with incomplete data or hospital stay <48 h were excluded. Demographics, laboratory/radiological parameters, treatments and outcomes were retrieved. The first study endpoint to be assessed was in-hospital mortality (INH) all-cause in-hospital mortality. The secondary objectives were microbiological cure which is two negative SARS-CoV-2 polymerase chain reaction in a row; ICU/hospital stay duration; and WAS days on mechanical ventilation (MV). The patients were grouped according to their diabetes mellitus (DM) diagnosis result. The relationship between DM and outcomes was determined using Chi-square and Mann–Whitney tests. Binary logistic regression for mortality and extended ICU stay determined independent predictor variables; covariates included. Ethical clearance from the local Institutional Review Board was sought before carrying out the study. Variables were reported using frequencies, percentages, means and standard deviation or medians and interquartile range based on the type of data. P < 0.05 indicated statistical significance.

Results:
An investigation was done on the 1102 severely ill mechanically ventilated, and invasively monitored, adult COVID-19 patients in ICUs. The mean age was 56 ± 15 years, with males accounting for 74.6% of patients. 51.2% had a documented history of DM. The overall mean hospital length of stay (LOS) was 22 ± 19 days, while the mean ICU LOS was 15 ± 14 days. MV was required by 13.84 ± 14.14 days on average. Diabetes was significantly associated with prolonged ICU stay, but not other clinical outcomes. After adjusting for covariates, DM remained a significant predictor. Among patients still requiring MV support at 28 days of ICU admission, diabetics comprised a significantly higher proportion of 70.4% compared to 29.6% without diabetes. These findings suggest that DM may influence the clinical course and recovery timelines in critically ill COVID-19 patients.

Conclusion:
In severely sick COVID-19 patients, this study showed that DM had a minor effect on recovery time in the ICU, rather than only having an impact on survival. Diabetes patients accounted for the majority of those remaining in need of ventilator after 28 days. For this high-risk population, targeted treatment approaches that take concomitant DM into consideration may improve patient management and resource use.