POS-081 Cytokine storm and secondary bacterial infections in COVID-19 patients with AKI: A multi-center retrospective study

Abstract

Introduction Acute kidney injury (AKI) may develop in patients with coronavirus disease 2019 (COVID-19) and is associated with in-hospital death. Methods We investigated the incidence of AKI in 223 hospitalized patients with COVID-19 and analyzed the influence factors of AKI. The incidence of cytokine storm syndrome and its correlation with other clinicopathologic variables were also investigated. We retrospectively enrolled adult patients (≥18 years) with virologically-confirmed COVID-19 who were hospitalized at three hospitals in Wuhan and Guizhou, China between February 13, 2020 and April 8, 2020. One hundred twenty-four patients with moderate COVID-19 and 99 with severe COVID-19 were included. Results AKI was present in 35 (15.7%) patients. The incidence of AKI was 30.3% for severe COVID-19 and 4.0% for moderate COVID-19 (P<0.001). Furthermore, cytokine storm was present in 30 (13.5%) patients and only in severe group. Kidney injury at admission (OR 3.132, 95%CI 1.150-8.527; P=0.025), cytokine storm (OR 4.234, 95%CI 1.361-13.171; P=0.013) and acute respiratory distress syndrome (OR 7.684, 95%CI 2.622-22.523; P<0.001) were influence factors of AKI. Seventeen (48.6%) patients who received invasive mechanical ventilation developed AKI, of whom 64.7% (11/17) died. Of the AKI patients, 57.1% were susceptible to bacterial infection characterized by elevated leukocyte counts. Up to 86.7% AKI patients with cytokine storm may develop secondary bacterial infection. The leukocyte counts were significantly higher in AKI patients with cytokine storm than those without (13.0×10⁹/L, IQR11.3 vs. 8.3×10⁹/L, IQR7.5, P=0.005). Conclusions Approximately one in six patients with COVID-19 eventually develop AKI. Kidney injury at admission, cytokine storm and ARDS during the course are influence factors of AKI. Cytokine storm and secondary bacterial infections may be responsible for AKI development in COVID-19 patients. No conflict of interest