Risk assessment for acute kidney injury and death among new COVID-19 positive adult patients without chronic kidney disease: retrospective cohort study among three US hospitals

Objective To develop simple but clinically informative risk stratification tools using a few top demographic factors and biomarkers at COVID-19 diagnosis to predict acute kidney injury (AKI) and death. Design Retrospective cohort analysis, follow-up from 1 February through 28 May 2020. Setting 3 teaching hospitals, 2 urban and 1 community-based in the Boston area. Participants Eligible patients were at least 18 years old, tested COVID-19 positive from 1 February through 28 May 2020, and had at least two serum creatinine measurements within 30 days of a new COVID-19 diagnosis. Exclusion criteria were having chronic kidney disease or having a previous AKI within 3 months of a new COVID-19 diagnosis. Main outcomes and measures Time from new COVID-19 diagnosis until AKI event, time until death event. Results Among 3716 patients, there were 1855 (49.9%) males and the average age was 58.6 years (SD 19.2 years). Age, sex, white blood cell, haemoglobin, platelet, C reactive protein (CRP) and D-dimer levels were most strongly associated with AKI and/or death. We created risk scores using these variables predicting AKI within 3 days and death within 30 days of a new COVID-19 diagnosis. Area under the curve (AUC) for predicting AKI within 3 days was 0.785 (95% CI 0.758 to 0.813) and AUC for death within 30 days was 0.861 (95% CI 0.843 to 0.878). Haemoglobin was the most predictive component for AKI, and age the most predictive for death. Predictive accuracies using all study variables were similar to using the simplified scores. Conclusion Simple risk scores using age, sex, a complete blood cell count, CRP and D-dimer were highly predictive of AKI and death and can help simplify and better inform clinical decision making.