KASMEJ
Kastamonu Medical Journal

Kastamonu Medical Journal regularly publishes internationally qualified issues in the field of Medicine in the light of up-to-date information.

eISSN: 2757-9336
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
The effects of acute kidney injury in the first 48 hours on clinical outcomes and mortality in COVID-19 patients admitted to the intensive care unit from the emergency department
Abstract
Aims: The aim of this study was to evaluate the impact of acute kidney injury (AKI) in the first 48 hours on clinical outcomes and mortality in COVID-19 patients admitted from the emergency department (ED) to the intensive care unit (ICU).
Methods: This retrospective observational cohort study, conducted at Pamukkale University Faculty of Medicine, analyzed 243 COVID-19 patients admitted to the ICU between March 2020 and 2023. Patients were divided into two groups according to the development of AKI based on serum creatinine (Scr) values assessed within the first 48 hours after ICU admission: group 1 (AKI-) without AKI (n=186) and group 2 (AKI+) with AKI (n=57). The two groups were compared in terms of clinical outcomes and mortality rates.
Results: AKI+ patients were generally older and had higher mortality rates. AKI- patients were more likely to be discharged. AKI+ patients stayed in the ICU longer and required more treatment, including hemodynamic support, respiratory support, and renal replacement therapy (RRT). Scr levels were significantly different between groups at 24 and 48 hours. AKI+ patients had higher blood urea nitrogen (BUN), albumin, and BUN/albumin ratio (BAR) levels, indicating renal dysfunction and metabolic imbalances. In addition, procalcitonin levels were also significantly higher in AKI+ patients, suggesting an increased inflammatory or septic response. Other elevated markers included C-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide (pro-BNP), D-dimer, and troponin T, indicating worsening cardiac and inflammatory conditions. Finally, AKI+ patients had lower APACHE II scores.
Conclusion: In COVID-19 patients admitted from the ED to the ICU, developing AKI+ within the first 48 hours was associated with an increased risk of mortality and worse clinical outcomes. In contrast, AKI- patients showed more favorable clinical outcomes, including a higher chance of survival and less need for intensive interventions.

Keywords : COVID-19, acute kidney injury, intensive care unit, emergency department, mortality

Download Article


1. Hilton J, Boyer N, Nadim MK, Forni LG, Kellum JA. COVID-19 and acute kidney injury. Crit Care Clin. 2022;38(3):473-489. doi:10.1016/j.ccc.2022.01.002
2. Al-Dorzi HM, Alsolamy S, Arabi YM. Critically ill patients with middle east respiratory syndrome Coronavirus infection. Crit Care. 2016;20:65. doi:10.1186/s13054-016-1234-4
3. Taylor EH, Marson EJ, Elhadi M, et al. Factors associated with mortality in patients with COVID-19 admitted to intensive care: a systematic review and meta-analysis. Anaesthesia. 2021;76(9):1224-1232. doi:10. 1111/anae.15532
4. Zhao WJ, Tan RZ, Gao J, Su H, Wang L, Liu J. Research on the global trends of COVID-19 associated acute kidney injury: a bibliometric analysis. Ren Fail. 2024;46(1):2338484. doi:10.1080/0886022X.2024. 2338484
5. Bell JS, James BD, Al-Chalabi S, Sykes L, Kalra PA, Green D. Community-versus hospital-acquired acute kidney injury in hospitalized COVID-19 patients. BMC Nephrol. 2021;22(1):269. doi:10.1186/s12882-021-02471-2
6. Pelayo J, Lo KB, Bhargav R, et al. Clinical characteristics and outcomes of community- and hospital-acquired acute kidney injury with COVID-19 in a US inner city hospital system. Cardiorenal Med. 2020;10(4):223-231. doi:10.1159/000509182
7. Chen YT, Shao SC, Hsu CK, Wu IW, Hung MJ, Chen YC. Incidence of acute kidney injury in COVID-19 infection: a systematic review and meta-analysis. Crit Care. 2020;24(1):346. doi:10.1186/s13054-020-03009-y
8. Arikan H, Ozturk S, Tokgoz B, et al. Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: a multicenter study by the Turkish society of nephrology. PLoS One. 2021;16(8): e0256023. doi:10.1371/journal.pone.0256023
9. Kolhe NV, Fluck RJ, Selby NM, Taal MW. Acute kidney injury associated with COVID-19: a retrospective cohort study. PLoS Med. 2020;17(10):e1003406. doi:10.1371/journal.pmed.1003406
10. Wang C, Li G, Liang X, et al. Predictive value of fibrinogen-to-albumin ratio for post-contrast acute kidney injury in patients undergoing elective percutaneous coronary intervention. Med Sci Monit. 2020;26:e924498. doi:10.12659/MSM.924498
11. Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with COVID-19 using the ISARIC WHO clinical characterisation protocol: prospective observational cohort study. BMJ. 2020;369:m1985. doi:10.1136/bmj.m1985
12. Del Valle DM, Kim-Schulze S, Huang HH, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nat Med. 2020;26(10):1636-1643. doi:10.1038/s41591-020-1051-9
13. Peng S, Wang HY, Sun X, et al. Early versus late acute kidney injury among patients with COVID-19-a multicenter study from Wuhan, China. Nephrol Dial Transplant. 2020;35(12):2095-2102. doi:10.1093/ndt/gfaa288
14. Han X, Ye Q. Kidney involvement in COVID-19 and its treatments. J Med Virol. 2021;93(3):1387-1395. doi:10.1002/jmv.26653
15. Schaubroeck H, Vandenberghe W, Boer W, et al. Acute kidney injury in critical COVID-19: a multicenter cohort analysis in seven large hospitals in Belgium. Crit Care. 2022;26(1):225. doi:10.1186/s13054-022-04086-x
16. Dereli N, Babayigit M, Menteş O, et al. Are we aware of COVID-19-related acute kidney injury in intensive care units? Eur Rev Med Pharmacol Sci. 2022;26(5):1753-1760. doi:10.26355/eurrev_202203_28245
17. Cui X, Yu X, Wu X, et al. Acute kidney injury in patients with the Coronavirus disease 2019: a multicenter study. Kidney Blood Press Res. 2020;45(4):612-622. doi:10.1159/000509517
18. Imam Z, Odish F, Gill I, et al. Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID-19 patients in Michigan, United States. J Intern Med. 2020;288(4):469-476. doi:10.1111/joim.13119
19. Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395(10239):1763-1770. doi:10.1016/S0140-6736(20)31189-2
20. Stony Brook COVID-19 Research Consortium. Geospatial distribution and predictors of mortality in hospitalized patients with COVID-19: a cohort study. Open Forum Infect Dis. 2020;7(10):ofaa436. doi:10.1093/ofid/ofaa436
21. Hung KC, Li YY, Huang YT, et al. Efficacy of blood urea nitrogen-to-albumin ratio for predicting prognostic outcomes of inpatients with COVID-19: a meta-analysis. Medicine (Baltimore). 2023;102(7):e33007. doi:10.1097/MD.0000000000033007
22. Küçükceran K, Ayrancı MK, Girişgin AS, Koçak S, Dündar ZD. The role of the BUN/albumin ratio in predicting mortality in COVID-19 patients in the emergency department. Am J Emerg Med. 2021;48:33-37. doi:10. 1016/j.ajem.2021.03.090
23. Kaeley N, Singh S, Mahala P, Choudhary S, Singh U. Predictive value of blood urea nitrogen/albumin ratio in mortality in moderate to severe COVID-19 patients: a retrospective observational analysis. Cureus. 2023; 15(11):e48416. doi:10.7759/cureus.48416
24. Ertekin B, Acar T. The relationship between albumin and its proportion to other markers in predicting mortality in severe COVID-19 patients. Eur Rev Med Pharmacol Sci. 2023;27(13):6429-6436. doi:10.26355/eurrev_202307_33003
25. Sipahioglu H, Onuk S. Lactate dehydrogenase/albumin ratio as a prognostic factor in severe acute respiratory distress syndrome cases associated with COVID-19. Medicine (Baltimore). 2022;101(38):e30759. doi:10.1097/MD.0000000000030759
26. Singh S, Singh K. Blood urea nitrogen/albumin ratio and mortality risk in patients with COVID-19. Indian J Crit Care Med. 2022;26(5):626-631. doi:10.5005/jp-journals-10071-24150
27. Zahid U, Ramachandran P, Spitalewitz S, et al. Acute kidney injury in COVID-19 patients: an Inner city hospital experience and policy implications. Am J Nephrol. 2020;51(10):786-796. doi:10.1159/000511160
28. Bansal A, Kumar A, Patel D, et al. Meta-analysis comparing outcomes in patients with and without cardiac injury and Coronavirus disease 2019 (COVID-19). Am J Cardiol. 2021;141:140-146. doi:10.1016/j.amjcard. 2020.11.009
29. Randhawa G, Syed KA, Singh K, et al. The relationship between obesity, hemoglobin A1c and the severity of COVID-19 at an urban tertiary care center in New York City: a retrospective cohort study. BMJ Open. 2021; 11(1):e044526. doi:10.1136/bmjopen-2020-044526
30. Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-810. doi:10.1001/jamacardio.2020.0950
Article available in :
Volume 5, Issue 1, 2025
Page : 19-24
https://doi.org/10.51271/KMJ-0177
Article Information
Received : 15 Eki 2024
Accepted : 27 Kas 2024
Published : 04 Mar 2025
Corresponding Author :

Turan Evran: Department of Anesthesia and Reanimation, Faculty of Medicine, Pamukkale University, Denizli, Turkiye

[email protected]
Citation : Evran T, Çopur İ, Mete A, et al. The effects of acute kidney injury in the first 48 hours on clinical outcomes and mortality in COVID-19 patients admitted to the intensive care unit from the emergency department. Kastamonu Med J. 2025;5(1):19-24.

Read: 76
Cited: 0
Download : 65
_Footer