Journal Article

Association of SARS-CoV-2 viral load at admission with in-hospital acute kidney injury: A retrospective cohort study

Johnson, Kipp W., Levin, Matthew A., Houldsworth, Jane, Cordon-Cardo, Carlos, Charney, Alexander W., Nadkarni, Girish N., Jaladanki, Suraj K., De Freitas, Jessica K., Chaudhary, Kumardeep, Chaudhry, Fayzan, Fayad, Zahi A., Zhao, Shan, Paranjpe, Ishan, Bottinger, Erwin P., Pujdas, Elisabet, Glicksberg, Benjamin S.

2021

Overview

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated Coronavirus Disease 2019 (COVID-19) is a public health emergency. Acute kidney injury (AKI) is a common complication in hospitalized patients with COVID-19 although mechanisms underlying AKI are yet unclear. There may be a direct effect of SARS-CoV-2 virus on the kidney; however, there is currently no data linking SARS-CoV-2 viral load (VL) to AKI. We explored the association of SARS-CoV-2 VL at admission to AKI in a large diverse cohort of hospitalized patients with COVID-19. We included patients hospitalized between March 13th and May 19th, 2020 with SARS-CoV-2 in a large academic healthcare system in New York City (N = 1,049) with available VL at admission quantified by real-time RT-PCR. We extracted clinical and outcome data from our institutional electronic health records (EHRs). AKI was defined by KDIGO guidelines. We fit a Fine-Gray competing risks model (with death as a competing risk) using demographics, comorbidities, admission severity scores, and log10 transformed VL as covariates and generated adjusted hazard ratios (aHR) and 95% Confidence Intervals (CIs). VL was associated with an increased risk of AKI (aHR = 1.04, 95% CI: 1.01-1.08, p = 0.02) with a 4% increased hazard for each log10 VL change. Patients with a viral load in the top 50th percentile had an increased adjusted hazard of 1.27 (95% CI: 1.02-1.58, p = 0.03) for AKI as compared to those in the bottom 50th percentile. VL is weakly but significantly associated with in-hospital AKI after adjusting for confounders. This may indicate the role of VL in COVID-19 associated AKI. This data may inform future studies to discover the mechanistic basis of COVID-19 associated AKI.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acute Kidney Injury - metabolism / Acute Kidney Injury - virology / Acute renal failure / Adult / Aged / Aged, 80 and over / Anesthesiology / Biology and Life Sciences / Biomedical engineering / Cohort analysis / Cohort Studies / Comorbidity / Computer and Information Sciences / Coronaviruses / COVID-19 / COVID-19 - metabolism / COVID-19 - mortality / COVID-19 - virology / Creatinine / Customization / Data analysis / Diagnosis / Editing / Electronic health records / Female / Funding / Genetics / Health risks / Hospital Mortality / Hospitalization / Hospitalization - statistics & numerical data / Humans / Intelligence / Kidneys / Male / Measurement / Medicine / Medicine and Health Sciences / Methodology / Middle Aged / Mortality / New York City - epidemiology / Pain / Pathology / Patients / Polymerase chain reaction / Precision medicine / Proportional Hazards Models / Radiology / Research and Analysis Methods / Retrospective Studies / Risk Factors / RNA-directed DNA polymerase / SARS-CoV-2 - isolation & purification / Severe acute respiratory syndrome / Severe acute respiratory syndrome coronavirus 2 / Viral diseases / Viral Load / Viremia / Visualization