Markers of inflammation and risk for AKI and need for dialysis in patients with COVID-19

Background: Acute kidney injury (AKI) is a reported manifestation of COVID-19 (CoV-AKI) Release of inflammatory cytokines has been recognized as a characteristic feature of COVID-19 and is linked to severity of illness However, it has not been clearly determined if levels of serum markers of inflammation are associated with risk for development of AKI or its severity Methods: We conducted an observational study in patients hospitalized at Ochsner Medical Center over 1-month period with COVID-19 and diagnosis of AKI We examined the relationship between the blood level of ferritin, C-reactive protein (CRP), procalcitonin (proCal), D-dimer and lactate dehydrogenase (LDH) and the incidence of AKI, as well as AKI requiring renal replacement therapy (AKI-RRT), by assessing comparison of means and proportions and by logistic regression analysis Results: Among 644 patients with COVID-19, we compared 161 (26%) with AKI vs 414 (64%) without AKI Median serum creatinine on admission was higher in the AKI group (1 8 vs 1 1 mg/dL, p<0 0001) Preexisting chronic kidney disease rates were comparable (35% vs 28%, for AKI and no AKI groups) The median value of inflammatory markers on admission were higher in the AKI group [ferritin 1016 (516-2534) vs 680 (315-1416) ng/mL, p<0 0001;CRP 163 (93-243) vs 93 (46-165) mg/L, p<0 0001;proCal 0 37 (0 2-1 6) vs 0 12 (0 06-0 32) ng/mL, p<0 0001;D-dimer 1 57 (0 96-5 14) vs 1 13(0 68-2 57) mcg/mL, p=0 0004;and LDH 532 (365-804) vs 428 (309-548), p=0 0004] On multivariate logistic regression analysis, CRP (p=0 003) and ferritin (p<0 035) were associated with greater risk for AKI In addition, ferritin ≥ 1200 ng/mL and CRP ≥ 300 mg/L were independently associated with AKI [adjusted odds ratio: 2 3 (1 3-4), p=0 003, and 2 5 (1 0-6 3), p=0 05;respectively] Furthermore, ferritin, CRP, proCal and LDH levels were significantly higher in those with AKI-RRT compared to those not requiring RRT (p=0 022 to p=0 009) Conclusions: Higher level of inflammatory markers were associated with CoV-AKI, and levels were even higher for those with CoV-AKI-RRT In patients with COVID-19, magnitude of ferritin and CRP on admission could be used for AKI risk stratification