151. Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients
- Author
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Antonio Greco, Andrea Fontana, Massimiliano Copetti, Lucia Florio, Michele Prencipe, Maurizio Leone, Salvatore De Cosmo, Valentina Massa, Antonio Mirijello, Angela de Matthaeis, Michele Inglese, Filippo Aucella, Maria Maddalena D’Errico, and Pamela Piscitelli
- Subjects
medicine.medical_specialty ,Univariate analysis ,Creatinine ,glomerular filtration rate ,business.industry ,Hazard ratio ,Acute kidney injury ,respiratory failure ,Renal function ,General Medicine ,medicine.disease ,Article ,chemistry.chemical_compound ,cardiovascular comorbidities ,Respiratory failure ,chemistry ,Internal medicine ,medicine ,Medicine ,Risk factor ,business ,chronic kidney disease ,Kidney disease - Abstract
Background: The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. Methods: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or <, 60 mL/min/1.73 m2. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. Results: Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (p <, 0.0001). Age (p <, 0.001), SpO2 (p <, 0.001), previous anti-platelet treatment (p = 0.006), Charlson’s Comorbidities Index (p <, 0.001), serum creatinine (p <, 0.001), eGFR (p = 0.003), low eGFR (p <, 0.001), blood glucose levels (p <, 0.001), and LDH (p = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95%CI 1.02-2.63, p = 0.040) and age (HR per 5 years 1.22, 95%CI 1.10-1.36, p <, 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (p = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (p <, 0.001). Conclusions: Patients with reduced eGFR at admission should be considered at high risk for clinical deterioration and death, requiring the best supportive treatment in order to prevent the worst outcome.
- Published
- 2021