1. Association of SARS-CoV-2 viral load at admission with in-hospital acute kidney injury: A retrospective cohort study
- Author
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Kumardeep Chaudhary, Benjamin S. Glicksberg, Erwin P. Bottinger, Zahi A. Fayad, Jane Houldsworth, Carlos Cordon-Cardo, Elisabet Pujdas, Kipp W. Johnson, Matthew A. Levin, Alexander W. Charney, Shan Zhao, Suraj K. Jaladanki, Jessica K De Freitas, Fayzan Chaudhry, Ishan Paranjpe, and Girish N. Nadkarni
- Subjects
RNA viruses ,Male ,Viral Diseases ,Epidemiology ,Coronaviruses ,Electronic Medical Records ,Artificial Gene Amplification and Extension ,Comorbidity ,030204 cardiovascular system & hematology ,Polymerase Chain Reaction ,Cohort Studies ,Medical Conditions ,0302 clinical medicine ,Risk Factors ,Chronic Kidney Disease ,Medicine and Health Sciences ,Medicine ,Hospital Mortality ,030212 general & internal medicine ,Pathology and laboratory medicine ,Aged, 80 and over ,Multidisciplinary ,Hazard ratio ,Acute kidney injury ,Viral Load ,Medical microbiology ,Acute Kidney Injury ,Middle Aged ,Hospitalization ,Infectious Diseases ,Nephrology ,Viruses ,Cohort ,Female ,SARS CoV 2 ,Pathogens ,Anatomy ,Information Technology ,Viral load ,Research Article ,Cohort study ,Adult ,Computer and Information Sciences ,medicine.medical_specialty ,SARS coronavirus ,Science ,Research and Analysis Methods ,Microbiology ,03 medical and health sciences ,Virology ,Internal medicine ,Renal Diseases ,Humans ,Molecular Biology Techniques ,Molecular Biology ,Aged ,Proportional Hazards Models ,Retrospective Studies ,SARS-CoV-2 ,business.industry ,Proportional hazards model ,Organisms ,Viral pathogens ,Biology and Life Sciences ,COVID-19 ,Covid 19 ,Health Information Technology ,Kidneys ,Retrospective cohort study ,Renal System ,Reverse Transcriptase-Polymerase Chain Reaction ,medicine.disease ,Microbial pathogens ,Health Care ,Medical Risk Factors ,New York City ,business ,Viral Transmission and Infection - Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated Coronavirus Disease 2019 (COVID-19) is a public health emergency. Acute kidney injury (AKI) is a common complication in hospitalized patients with COVID-19 although mechanisms underlying AKI are yet unclear. There may be a direct effect of SARS-CoV-2 virus on the kidney; however, there is currently no data linking SARS-CoV-2 viral load (VL) to AKI. We explored the association of SARS-CoV-2 VL at admission to AKI in a large diverse cohort of hospitalized patients with COVID-19. Methods and findings We included patients hospitalized between March 13th and May 19th, 2020 with SARS-CoV-2 in a large academic healthcare system in New York City (N = 1,049) with available VL at admission quantified by real-time RT-PCR. We extracted clinical and outcome data from our institutional electronic health records (EHRs). AKI was defined by KDIGO guidelines. We fit a Fine-Gray competing risks model (with death as a competing risk) using demographics, comorbidities, admission severity scores, and log10 transformed VL as covariates and generated adjusted hazard ratios (aHR) and 95% Confidence Intervals (CIs). VL was associated with an increased risk of AKI (aHR = 1.04, 95% CI: 1.01–1.08, p = 0.02) with a 4% increased hazard for each log10 VL change. Patients with a viral load in the top 50th percentile had an increased adjusted hazard of 1.27 (95% CI: 1.02–1.58, p = 0.03) for AKI as compared to those in the bottom 50th percentile. Conclusions VL is weakly but significantly associated with in-hospital AKI after adjusting for confounders. This may indicate the role of VL in COVID-19 associated AKI. This data may inform future studies to discover the mechanistic basis of COVID-19 associated AKI.
- Published
- 2021
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