Acute kidney injury and elevated transaminases in hospitalized patients with COVID-19

The aim: to study the relationship of elevated alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) at admission with the prevalence, risk of development, and the course of acute kidney injury (AKI) in patients with a novel coronavirus infection (COVID-19). Materials and methods. A retrospective analysis of the register of patients with COVID-19 was performed. We included patients with the laboratory-confirmed infection, the presence of the typical computer tomography (CT) picture, and assessment of the AST, ALT levels within 48 hours. Definition of AKI was based on KDIGO criteria. Results. 828 patients were included, 51% were male, the mean age was 65±16 years, arterial hypertension (HTN) was diagnosed in 70%, diabetes mellitus - in 26%, chronic kidney disease (CKD) - in 8%. In-hospital mortality was 21%. The AKI incidence was 27%, the most episodes were related to community-acquired AKI (CA-AKI) (16% and 11%). 16% of patients had hematuria at admission, 33% - proteinuria. At admission, 41% of patients had abnormal level of aminotransferases. These patients had higher levels of inflammatory markers, d-dimer, the higher frequency of proteinuria at admission (41% vs 27%, p<0.001), AKI (33% vs 23%, p=0.003) and in-hospital mortality (24.6% vs 18.2%, p=0.03). Clinical outcomes were poorer in the group with a predominant elevated AST, such as intensive care unit hospitalization (35% vs 29%), the need for mechanical ventilation (21% vs 16%), vasopressor support (12% vs 10%), progression of lung lesion by CT (25% vs 20%), in-hospital mortality (26% vs 18%) and the AKI incidence (35% vs 25%). Multinomial logistic regression found that HTN, CKD, elevated AST and hematuria were shown to be associated with CA-AKI, and age over 65 years HTN, oncology, elevated AST and hematuria were predictors of hospital-acquired AKI (HA-AKI). Conclusions. AKI incidence was statistically higher in patients with elevated aminotransferases at admission. Patients with predominant elevated AST were more likely to have adverse outcomes, AKI, than patients with elevated ALT. Elevated AST at admission was associated with CA-AKI and was a predictor of HA-AKI in hospitalized patients with COVID-19.

острое повреждение почек, COVID-19, повышение трансаминаз, acute kidney injury, COVID-19, elevated transaminases

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