Risk factors for death and severity of the course of the new coronavirus infection (COVID-19)

BACKGROUND. Acute kidney injury (AKI) and comorbidities including cardiovascular disease, diabetes mellitus (DM), metabolic disorders, and other factors exacerbate the severity of the novel coronavirus infection (COVID-19). We studied 769 patients with COVID-19. In all cases, the novel coronavirus infection was severe and accompanied by organ dysfunction. We assessed the incidence of AKI, risk factors, and mortality in hospitalized patients with severe COVID-19.
THE AIM: to study the risk factors, incidence of AKI, need for renal replacement therapy (RRT), and mortality among patients with complicated COVID-19.
PATIENTS AND METHODS. The study included adult patients transferred to the Vladimirsky Regional Clinical Institute from hospitals in the Moscow Region with severe COVID-19 in 2020–2024. The COVID-19 diagnosis was confirmed using polymerase chain reaction (PCR) testing of nasopharyngeal samples. Patient characteristics and laboratory test results were assessed using an electronic database.
RESULTS. Analysis of the obtained results shows that mortality increased with the progression of lung disease (from 34 % with stage 2 lung disease to 76 % with stage 4) and the need for mechanical ventilation. AKI was observed in almost half of patients (46 %), but the incidence of AKI did not statistically significantly increase with lung disease progression. AKI was most often observed in stage 3 lung disease (52 % of patients). Gender did not statistically significantly affect mortality. Older patients were significantly more likely to die (mean age 56 years among survivors and 64.4 years among deaths). The need for mechanical ventilation was a significant risk factor for death. Thus, the mortality rate among patients without mechanical ventilation was 8.4 %, compared to 91.6 % among those receiving mechanical ventilation. The mortality rate was higher in patients with hypertension (87 %), chronic kidney disease (40.6 %), diabetes (36 %), and among patients receiving RRT (68 %).
CONCLUSION. In addition to the stage of lung disease, factors aggravating the course of COVID- 19 included comorbid cardiovascular diseases, chronic kidney disease and acute kidney injury, metabolic disorders, age, and the need for RRT.

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