Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients
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...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/22/5224 |
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| author | Antonio Mirijello Pamela Piscitelli Angela de Matthaeis Michele Inglese Maria Maddalena D’Errico Valentina Massa Antonio Greco Andrea Fontana Massimiliano Copetti Lucia Florio Maurizio Angelo Leone Michele Antonio Prencipe Filippo Aucella Salvatore De Cosmo |
| author_facet | Antonio Mirijello Pamela Piscitelli Angela de Matthaeis Michele Inglese Maria Maddalena D’Errico Valentina Massa Antonio Greco Andrea Fontana Massimiliano Copetti Lucia Florio Maurizio Angelo Leone Michele Antonio Prencipe Filippo Aucella Salvatore De Cosmo |
| author_sort | Antonio Mirijello |
| collection | DOAJ |
| description | 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 m<sup>2</sup>. 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 (<i>p</i> < 0.0001). Age (<i>p</i> < 0.001), SpO2 (<i>p</i> < 0.001), previous anti-platelet treatment (<i>p</i> = 0.006), Charlson’s Comorbidities Index (<i>p</i> < 0.001), serum creatinine (<i>p</i> < 0.001), eGFR (<i>p</i> = 0.003), low eGFR (<i>p</i> < 0.001), blood glucose levels (<i>p</i> < 0.001), and LDH (<i>p</i> = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02–2.63, <i>p</i> = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10–1.36, <i>p</i> < 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 (<i>p</i> = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (<i>p</i> < 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. |
| first_indexed | 2024-03-10T05:24:20Z |
| format | Article |
| id | doaj.art-15c9b394005c4fcdb8003b924bd4ed41 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T05:24:20Z |
| publishDate | 2021-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-15c9b394005c4fcdb8003b924bd4ed412023-11-22T23:48:14ZengMDPI AGJournal of Clinical Medicine2077-03832021-11-011022522410.3390/jcm10225224Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 PatientsAntonio Mirijello0Pamela Piscitelli1Angela de Matthaeis2Michele Inglese3Maria Maddalena D’Errico4Valentina Massa5Antonio Greco6Andrea Fontana7Massimiliano Copetti8Lucia Florio9Maurizio Angelo Leone10Michele Antonio Prencipe11Filippo Aucella12Salvatore De Cosmo13Unit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Geriatrics, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Geriatrics, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Geriatrics, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Neurology, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Neurology, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Nephrology, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Nephrology, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyUnit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyBackground: 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 m<sup>2</sup>. 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 (<i>p</i> < 0.0001). Age (<i>p</i> < 0.001), SpO2 (<i>p</i> < 0.001), previous anti-platelet treatment (<i>p</i> = 0.006), Charlson’s Comorbidities Index (<i>p</i> < 0.001), serum creatinine (<i>p</i> < 0.001), eGFR (<i>p</i> = 0.003), low eGFR (<i>p</i> < 0.001), blood glucose levels (<i>p</i> < 0.001), and LDH (<i>p</i> = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02–2.63, <i>p</i> = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10–1.36, <i>p</i> < 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 (<i>p</i> = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (<i>p</i> < 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.https://www.mdpi.com/2077-0383/10/22/5224chronic kidney diseaseglomerular filtration raterespiratory failurecardiovascular comorbidities |
| spellingShingle | Antonio Mirijello Pamela Piscitelli Angela de Matthaeis Michele Inglese Maria Maddalena D’Errico Valentina Massa Antonio Greco Andrea Fontana Massimiliano Copetti Lucia Florio Maurizio Angelo Leone Michele Antonio Prencipe Filippo Aucella Salvatore De Cosmo Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients Journal of Clinical Medicine chronic kidney disease glomerular filtration rate respiratory failure cardiovascular comorbidities |
| title | Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients |
| title_full | Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients |
| title_fullStr | Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients |
| title_full_unstemmed | Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients |
| title_short | Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients |
| title_sort | low egfr is a strong predictor of worse outcome in hospitalized covid 19 patients |
| topic | chronic kidney disease glomerular filtration rate respiratory failure cardiovascular comorbidities |
| url | https://www.mdpi.com/2077-0383/10/22/5224 |
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