Study of the Treatment and Outcomes in Critically Ill Patients With COVID-19 and High Risk of Acute Kidney Injury

Study Overview
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Brief Summary
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The aim is to describe the epidemiology and determine the independent risk factors for mortality and acute organ injury in AKI and to assess the impact of different treatment strategies on survival. This will allow the development of prevention strategies and design of appropriately powered intervention studies.

Detailed Description
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Since the outbreak of coronavirus disease 2019 (COVID-19) began in December 2019 in China, over 1 million people have been infected and over 55,000 have died worldwide, and these numbers continue to rise. Combating this pandemic requires a multidisciplinary approach from the medical research community, including translational studies to understand the pathogenesis of disease, randomized controlled trials of novel and re-purposed pharmacotherapies, and rigorously conducted epidemiologic studies that include granular patient-level data. Current knowledge of the clinical features and outcomes of COVID-19 is mostly limited to studies from China and Italy. In one of the larger such studies, which consisted of 1099 patients hospitalized in mainland China, only 173 (16%) were classified as having severe disease, and only 15 (1.4%) died. The study was therefore inadequately powered to determine independent risk factors for death. A larger study consisting of 72,314 patients was recently published by the Chinese Center for Disease Control and Prevention. This nationwide registry study identified several important findings, including the striking monotonic relationship between older age and greater risk of death. Important limitations of the study, however, were lack of granular patient-level data and relatively few patients (<5% of the cohort) who were critically ill. Among critically ill patients with COVID-19, acute mortality rates have been reported to be as high as 49-62%, underscoring the importance of studying this patient population. Data from the United Kingdom (UK) suggest that >50% of critically ill patients have a degree of acute kidney injury (AKI) and >20% need renal replacement therapy (RRT). Mortality is particularly high in those who are mechanically ventilated and need RRT (>75%). Detailed information about the risk of AKI, contributing factors and reasons for high mortality in critically ill COVID-19 patients is lacking. To meet this urgent need, the investigators plan to collect clinical data from >250 critically ill patients with COVID-19 admitted to the intensive care unit (ICU) at Guy's & St Thomas' Hospital. The investigators will collaborate with Dr Gupta and Prof Leaf from Harvard Medical School, Boston (US) who are leading a similar study across >50 sites in the United States. The aim is to describe the epidemiology and determine the independent risk factors for mortality and acute organ injury in AKI and to assess the impact of different treatment strategies on survival. This will allow the development of prevention strategies and design of appropriately powered intervention studies.

Official Title
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Study of the Treatment and Outcomes in Critically Ill Patients With COVID-19 and High Risk of Acute Kidney Injury

Conditions
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COVID, Acute Kidney Injury, Critical Illness

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults (aged ≥18 years) Confirmed diagnosis of COVID-19 Hospitalized in the ICU for illness related to COVID-19 Any of the following: Current in-patient in ICU Previous in-patient in ICU and died in ICU or hospital Previous in-patient in ICU and discharged from ICU alive Exclusion Criteria: Younger than 18 years old On chronic dialysis within the last year or on dialysis at ICU admission Functioning kidney transplant No creatinine within 48 hours of ICU admission

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Critically Ill Patients with COVID-19<br>We plan to recruit patients who are admitted to intensive care units with COVID-19 diagnosis. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of any stage of acute kidney injury | As defined by Kidney Diseases: Improving Global Outcomes (KDIGO) criteria | 14 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality | Mortality | 14-day, hospital, and intensive care unit (ICU) mortality | 
| Renal recovery | Defined by return of creatinine to < 1.5 times of baseline | 14 days | 
| Percentage of patients who receive renal replacement therapy | Percentage | 14 days | 
| Percentage of participants who are dialysis dependent | Percentage of participants who are dialysis dependent | Through study completion, an average of 90 days | 
| Free-days of vasoactive medications and mechanical ventilation | Days without vasoactive medications and mechanical ventilation | Day 30 | 
| Length of intensive care unit and hospital stay | Length of intensive care unit and hospital stay | Through study completion, an average of 90 days | 
| Number of participants with consequences following AKI | Congestive heart failure, Arrhythmia, Acute respiratory distress syndrome, Septic shock, Acute cardiac injury, pneumonia | Through study completion, an average of 90 days | 
| Time from illness onset to need for mechanical ventilator support | Time from illness onset to need for mechanical ventilator support | Through study completion, an average of 30 days |