Factors associated with acute kidney injury (AKI) and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit: a single-center prospective study
Creators: name: Nlandu, Yannick
name: Makulo, Jean-Robert
name: Essig, Marie
name: Sumaili, Ernest
name: Lumaka, Aimé
name: Engole, Yannick
name: Mboliasa, Marie-France
name: Mokoli, Vieux
name: Tshiswaka, Trésor
name: Nkodila, Aliocha
name: Bukabau, Justine
name: Longo, Augustin
name: Kajingulu, François
name: Zinga, Chantal
name: Nseka, Nazaire
Publisher: name: Taylor & Francis
Year: 2023
Subjects: subject: Cell Biology
subject: Genetics
subject: FOS: Biological sciences
subject: Biotechnology
subject: Developmental Biology
subject: Marine Biology
subject: Science Policy

description: Acute kidney injury (AKI) is a complication of severe coronavirus disease 2019 (COVID-19). Kidney damage associated with COVID-19 could take specific features due to environmental and socio-cultural factors. This study evaluates the incidence of AKI, the associated factors, and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit. In a prospective cohort study conducted in the intensive care unit (ICU) of the Centre Médical de Kinshasa (CMK), consecutive patients admitted for COVID-19 were screened for the presence of AKI between 27 March, 2020 and 27 January 2022. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. The primary outcome was occurrence of AKI. The secondary outcome was 48 days’ mortality and recovery of the renal function at intensive care unit (ICU) discharge. Survival (time-to death) curves were built using the Kaplan Meier methods. Multivariate analyses were performed by logistic regression to identify factors associated with AKI and Cox regression to explore the association between AKI and in-hospital mortality. The significance level of the <i>p</i>-value was set at 0.05. The median(IQR) sequential organ failure assessment score (SOFA) score and mean age of patients (215) including in our cohort were respectively 3(2-4) and 58.9 ± 14.9 years. The incidence of AKI was 28.4% with stages 1, 2, or 3 AKI accounted for 39.3%, 11.5%, and 49.2%, respectively. Hemodialysis was required in 16 out 215 (7.4%) patients. Dyspnea (adjusted odds ratio (aOR):2.27 [1.1–-4.57] <i>p</i> = 0.021), SOFA ≥5 (aOR:3.11[1.29–7.53] <i>p</i> = 0.012), AST/ALT ratio (aOR: 1.53 [1.09–1.79] <i>p</i> = 0.015), N/L ratio (aOR:2.09 [1.09–3.20] <i>p</i> = 0.016), mechanical ventilation (aOR: 3.20 [1.66–10.51] <i>p</i> = 0.005) and Amikacin (aOR: 2.91 [1.37–6.18] <i>p</i> = 0.006) were the main factors associated with AKI. Patients with AKI had a mortality rate of 52.5% and 67.2% of the survivors did not recover kidney function at the end of hospitalization. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (HR:2.96 [1.93–4.65] <i>p</i> = 0.013) compared to non-AKI patients. AKI was present in three out of ten COVID-19 patients. The most significant factors associated with AKI were dyspnea, SOFA ≥ 5, AST/ALT and N/L ratio, mechanical ventilation and Amikacin. AKI has been associated with an almost threefold increase in overall mortality and seven out of ten survivors did not recover kidney function after AKI.