Mortality in Patients With Covid-19 and Acute Kidney Injury in the Intensive Care Unit

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Objective To identify risk factors for mortality among patients with COVID-19 and acute kidney injury. Methods This was a retrospective, analytical study focusing on acute kidney injury in patients with COVID-19 admitted to the intensive care unit (ICU) of the Infectious and Tropical Diseases Department. The study was conducted between March 2020 and December 2021. Results The study included 289 patients who tested positive for COVID-19. Among them, acute kidney injury was observed in 107 cases, representing a prevalence of 37%. The mean age of patients with AKI was 61.3 ± 13.6 years, and 45.7% were aged 65 years or older. Male predominance was noted, with a male-to-female ratio of 2.68. The primary reasons for ICU admission were acute respiratory distress (ARD) in 71% of cases and dyspnea in 12.1%. Comorbidities included hypertension (67.2%), diabetes mellitus (41.1%), and obesity (14.9%). According to KDIGO criteria, AKI was classified as stage 3 in 52.3% of patients, stage 2 in 16.8%, and stage 1 in 30.5%. AKI was identified prior to hospital admission in 40.1% of cases, between 24 and 72 hours after admission in 42.9%, and more than 72 hours after admission in 16.8%. Hemodialysis was performed in 36.4% of patients. The clinical course was marked by death in 68 patients (63.5%). Multivariate analysis identified the following factors as independently associated with increased risk of mortality in the context of COVID-19: acute respiratory distress (OR = 5.06; p = 0.006), KDIGO stage 3 AKI (OR = 5.15; p = 0.003), orotracheal intubation (OR = 4.37; p = 0.0001), and mechanical ventilation (OR = 4.01; p = 0.0001). Conclusion Acute kidney injury (AKI) is an adverse prognostic factor in the context of COVID-19. Mortality appears to be more closely related to the severity of SARS-CoV-2 infection than to respiratory support. Acute kidney injury COVID-19 acute respiratory distress respiratory support Figures Figure 1 Figure 2 INTRODUCTION The first case of COVID-19 was identified in December 2019 in Wuhan, China. The disease rapidly evolved into a global pandemic and was declared a “Public Health Emergency of International Concern” by the World Health Organization (WHO) on March 11, 2020. On that same date, the first case of COVID-19 was detected in the Republic of Côte d’Ivoire. The causative agent, SARS-CoV-2, typically manifests as respiratory involvement, ranging from paucisymptomatic forms to severe pneumonia with acute respiratory distress [ 1 ]. Beyond its respiratory tropism, accumulating evidence suggests multiorgan involvement in infected patients, attributed to viral binding to angiotensin-converting enzyme 2 (ACE2) receptors expressed on various human cell types [ 1 ]. Although acute respiratory failure remains the most frequent and severe organ dysfunction, acute kidney injury (AKI) is commonly reported in patients with SARS-CoV-2 infection. AKI is a frequent complication among critically ill patients admitted to intensive care units (ICUs) for acute respiratory distress syndrome (ARDS) secondary to COVID-19. Its reported incidence in ICU settings varies from 5% to 25% across studies [ 2 ]. A study conducted in Bordeaux, France, estimated the incidence of AKI at approximately 80% among critically ill patients requiring ICU admission [ 3 ]. In a large cohort of over 1,800 ICU patients with ARDS, 44.3% developed AKI, compared with 27.4% among ICU patients without ARDS [ 3 ]. The development of AKI is a negative prognostic indicator for survival in patients with COVID-19. In a study of patients aged 18 years and older hospitalized for COVID-19 across 13 hospitals in the New York metropolitan area between March 1 and April 27, 2020, and followed until hospital discharge, the incidence rates of in-hospital mortality were 10.8, 31.1, and 37.5 per 1,000 patient-days among patients without AKI, those with AKI not requiring dialysis (KDIGO stages 1–3), and those with AKI requiring dialysis (stage 3D), respectively [ 4 ]. Using patients without AKI as the reference group, the authors observed significantly increased risks of in-hospital death for patients with AKI stages 1–3 (HR 5.6; 95% CI, 5.0–6.3) and stage 3D (HR 11.3; 95% CI, 9.6–13.1). Another study conducted in Ireland among ICU-admitted patients reported an incidence of dialysis-requiring AKI of 22.2%, with mortality exceeding 75% [ 5 ]. Several factors associated with mortality in the context of COVID-19 and AKI have been reported in the literature. This study aims to identify risk factors for death among patients with COVID-19 and acute kidney injury admitted to the intensive care unit of the Department of Infectious and Tropical Diseases. MATERIALS AND METHODS Study Setting This study was conducted in the COVID-19 ICU of the Department of Infectious and Tropical Diseases (DITD) at Treichville Teaching Hospital. Study Design and Duration This was a retrospective, analytical study focusing on acute kidney injury in patients with confirmed COVID-19, conducted between March 2020 and December 2021. Study Population The study population consisted of all patients admitted to the DITD COVID-19 ICU during the study period. We included all patients with laboratory-confirmed SARS-CoV-2 infection (via RT-PCR), with or without acute kidney injury. Exclusion criteria were: negative RT-PCR test, incomplete medical records for key variables, death upon admission, and known pre-existing chronic kidney disease. The primary outcome was in-hospital mortality. Data Collection Data were extracted from medical records using a standardized case report form. The form included: Sociodemographic data age, gender Clinical data reason for admission, referring service/institution, known comorbidities (obesity, hypertension, diabetes, cardiovascular disease, chronic respiratory disease, liver disease, chronic kidney disease, HIV-related immunosuppression), regular medications (NSAIDs, ACE inhibitors, ARBs, diuretics, calcineurin inhibitors, beta-blockers, centrally acting antihypertensives, antidiabetics, lipid-lowering agents, antiretrovirals), hemodynamic and respiratory parameters (mean arterial pressure, urine output, oxygen saturation, FiO2, PEEP, temperature, heart rate, respiratory rate, peripheral oxygen saturation), lower limb edema, urinalysis, body mass index (BMI), qSOFA score [ 6 ], sepsis, septic shock [ 7 ], Glasgow Coma Scale (GCS), acute respiratory distress syndrome (ARDS), fluid balance (input/output). Laboratory data blood urea nitrogen, serum creatinine, sodium, potassium, calcium, chloride, phosphate, uric acid, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, platelet count, prothrombin time, activated partial thromboplastin time, blood glucose, C-reactive protein (CRP), transaminases, arterial blood gases (pH, HCO3-, PaO2, PaCO2), lactate, serum albumin, proteinuria, hematuria, urinary sodium, urinary potassium, renal ultrasound, thoracic computed tomography. Therapeutic data fluid and electrolyte management, oxygen therapy, sedation, neuromuscular blockade, orotracheal intubation, mechanical ventilation, vasopressor use, corticosteroids, antiplatelet agents, albumin, insulin, statins, diuretics, antihypertensives, antidiabetics, antivirals, low-molecular-weight heparin (LMWH), proton pump inhibitors (PPIs), antibiotics, and hemodialysis. In-hospital events: shock, AKI progression, death. Operational Definitions Acute Kidney Injury (AKI) Defined and staged according to KDIGO criteria [ 8 ]. Serum creatinine was measured daily during the first week, every other day during the second week, and twice weekly thereafter until discharge, using the standardized Jaffe method. Hypertension Defined per the Eighth Joint National Committee (JNC 8) guidelines [ 9 ] as blood pressure ≥ 140/90 mmHg. Hyperglycemia Defined as blood glucose > 1.26 g/L [ 10 ]. Sepsis Defined by the presence of at least two qSOFA criteria (systolic BP 22/min, GCS < 15) [ 11 ], or by the combination of systemic inflammatory response syndrome (SIRS) and suspected or confirmed infection [ 12 ]. A qSOFA score ≥ 2 warrants urgent intervention [ 13 ]. Septic Shock Defined as sepsis plus vasopressor requirement to maintain mean arterial pressure ≥ 65 mmHg and serum lactate > 4 mmol/L despite adequate fluid resuscitation [ 12 ]. Level of Consciousness : Assessed using the Glasgow Coma Scale (GCS): Stage I (vigil coma, GCS 13–14), Stage II (mild coma, GCS 10–12), Stage III (deep coma, GCS 7–9), Stage IV (brain death, GCS 3–6) [ 14 ]. Metabolic Acidosis Defined via the Henderson-Hasselbalch equation as plasma bicarbonate < 20 mmol/L, typically associated with compensatory reduction in PaCO2; pH may be markedly or mildly decreased. Acute Respiratory Distress Syndrome (ARDS) Defined per the Berlin 2012 criteria [ 15 ] as non-cardiogenic pulmonary edema causing hypoxemia, classified by PaO2/FiO2 ratio - Mild ARDS: PaO2/FiO2 201–300 mmHg with PEEP ≥ 5 cm H2O - Moderate ARDS: PaO2/FiO2 101–200 mmHg with PEEP ≥ 5 cm H2O - Severe ARDS: PaO2/FiO2 ≤ 100 mmHg with PEEP ≥ 5 cm H2O When PaO2 is unavailable, SpO2/FiO2 ≤ 315 suggests ARDS, even in non-intubated patients [ 16 ]. Statistical Analysis Statistical analyses were performed using IBM SPSS Statistics (version 25.0). Categorical variables are presented as percentages, and continuous variables as medians. Univariate analysis comparing groups based on the primary outcome (death) was conducted using Chi-square tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Multivariate analysis was performed using stepwise backward logistic regression. The final model included one variable per ten observed events. Only variables significant in univariate analysis were included. No imputation was performed for missing data. All tests were two-tailed, with statistical significance set at p < 0.05. Ethical Considerations The study received all required academic, administrative, and health authority approvals. As a retrospective chart review without direct patient contact, informed consent was waived. Patient confidentiality and anonymity were strictly maintained throughout data collection and analysis. RESULTS This study included 289 patients with confirmed COVID-19. Among them, acute kidney injury was observed in 107 cases (37% prevalence). The mean age of patients with AKI was 61.3 ± 13.6 years; 45.7% were aged ≥65 years. Male predominance was noted (male-to-female ratio: 2.68). The primary reasons for ICU admission were acute respiratory distress (ARD, 71%) and dyspnea (12.1%). Comorbidities included hypertension (67.2%), diabetes (41.1%), and obesity (14.9%). The most common clinical findings were coma (96.2%), hypoxia (SpO2 <92%, 77.6%), sepsis (79.4%), and oligo-anuria (62.6%). Among patients with ARDS (71%), severity was classified as severe in 50.4% and moderate in 15.8%. The qSOFA score was severe in 63.5% and critical in 25.2%. According to KDIGO criteria, AKI was stage 3 in 52.3%, stage 2 in 16.8%, and stage 1 in 30.5%. AKI was diagnosed prior to admission in 40.1%, between 24–72 hours post-admission in 42.9%, and >72 hours post-admission in 16.8% (Table 1). Table 1. General Characteristics of COVID-19-Positive Patients with Acute Kidney Injury (AKI)** Variables Total (n=107) Deceased (n=68) Survivors (n=39) P-value Unadjusted OR (95% CI) Age ( years ) Mean ± SD 61.33±13.6 61.78±13.74 60.54±13.5 0.95 <35 2.8% (3) 2.9%(2) 2.6%(1) 1 1.15 (0.1-13.12) [35-65[ 51.40%(55) 48.5%(33) 56.4%(22) 0.43 0.73 (0.33-1.61) ≥65 45.79% (49) 48.5%(33) 41%(16) 0.45 1.35 (0.61-3) Male 72.90 %(78) 73.5%(50) 71.8%(28) 0.84 1.09 (0.45-2.63) Reason for admission ARD 71.02 % (76) 82.4%(56) 51.3%(20) 0.001 4.43 (1.83-10.74) Dyspnea 12.15% (13) 1.5% (1) 30.8% (12) 0.000 0.03 (0.00-0.27) Acute pulmonary edema 5.61% (6) 4.4%(3) 7.7%(3) 0.47 0.55 (0.11-2.89) Loss of consciousness 11.21%(12) 11.8%(8) 10.3%(4) 0.81 1.17 (0.33-4.16) Comorbidities Hypertension 67.28%(72) 67.6%(46) 66.7%(26) 0.91 1.04 (0.45-2.42) Diabetes mellitus 41.12 %(44) 44.1%(30) 35.9%(14) 0.40 1.41 (0.63-3.17) Obesity 14.95%(16) 14.7%(10) 15.4%(6) 1 0.95 (0.32-2.84) HIV infection 6.54%(7) 7.4%(5) 5.1%(2) 1 1.47 (0.27-7.95) Clinical signs Hypertensive crisis 60.75% (65) 63.2%(43) 56.4%(22) 0.48 1.33 (0.66-2.96) Fever 48.60%(52) 51.5%(35) 43.6%(17) 0.43 1.37 (0.62-3.03) Coma 96.26% (103) 97.1%(66) 94.9%(37) 0.62 0.56 (0.08-4.15) Oxygen saturation <92% 77.60% (83) 80.5%(55) 71.8%(28) 0.4 1.66 (0.66-4.18) Oligo-anuria 62.61% (67) 63.2%(43) 61.6%(24) 0.86 1.07 (0.76-1.50) Obesity 29.90% (32) 29.4%(20) 30.8%(12) 0.88 0.94 (0.4-2.21) Sepsis 79.43% (85) 82.4%(56) 74.4%(29) 0.46 1.61 (0.62-4.17) qSOFA score Critical 25.23% (27) 30.9%(21) 15.4%(6) 0.12 2.46 (0.89-6.75) Severe 63.55 (68) 58.8%(40) 71.8%(28) 0.18 0.56 (0.24-1.31) Moderate 11.21% (12) 10.3%(7) 12.8%(5) 0.75 0.78 (0.23-2.65) ARDS severity Severe ARDS 50.46% (54) 60.3%(41) 33.3%(13) 0.007 3.04 (1.33-6.92) Moderate ARDS 15.88 (17) 20.6%(14) 7.7%(3) 0.13 3.11 (0.83-11.6) Mild ARDS 4.67% (5) 1.5%(1) 10.3%(4) 0.05 0.13 (0.01-1.21) AKI stage (KDIGO) Stage 1 30.8%(33) 26.5%(18) 38.5%(15) 0.196 0.58 (0.25-1.33) Stage 2 16.8%(18) 11.8%(8) 25.6%(10) 0.114 0.39 (0.14-1.08) Stage 3 52.3%(56) 61.8%(42) 35.9%(14) 0.01 2.88 (1.27-6.53) Hemoglobin (g/dL) ≥ 12 37.38% (40) 33.8%(23) 43.6%(17) 0.31 0.66 (0.29-1.48) [8-12[ 45.79% (49) 50%(34) 38.5%(15) 0.24 1.6 (0.72-3.57) <8 16.82 (18) 16.2% (11) 17.9% (11) 1 0.88 (0.31-2.5) Blood urea (g/L) [0.15-0.45[ 13%(14) 5.9%(4).1 25.6%(10) 0.009 0.18 (0.05-0.63) [0.45-2[ 70%(75) 70.6%(48) 69.2%(27) 0.88 1.07 (0.45-2.51) ≥ 2 16.8% (18) 23.5%(16) 5.1 %(2) 0.029 5.69 (1.23-26.27) Hypoalbuminemia 66.35% (71) 72.1%(49) 56.4%(22) 0.09 1.99 (0.87-4.55) Metabolic acidosis 23.36% (25) 27.9%(19) 15.4%(6) 0.215 2.13 (0.77-5.9) Antibiotic regimen Monotherapy 14.95% (16) 14.7% (10) 15.4% (6) 1 0.95 (0.32-2.84) Dual therapy 36.44% (39) 27.9% (19) 51.3% (20) 0.016 0.37 (0.16-0.84) Triple therapy 47.66% (51) 57.4% (39) 30.8% (12) 0.008 3.03 (1.32-6.95) Norepinephrine use 20.56% (22) 30.9%(21) 2.6%(1) 0.001 2.83 (0.78-4.88) Emergency interventions High-flow nasal oxygen (HFNO) 78.5%(84) 80.9%(55) 74.4%(29) 0.58 1.46 (0.57-3.73) Non-invasive ventilation (NIV) 52.33%(56) 38.3%(41) 38.5%(15) 0.98 0.99 (0.44-2.22) Neurosedation 37.38%(40) 57.4%(39) 2.6%(1) 0.000 3.93 (1.89-5.98) Neuromuscular blockade 19.62%(21) 29.4%(20) 2.6%(1) 0.002 2.76 (0.71-4.82) Orotracheal intubation (OTI) 38.31%(41) 58.8%(40) 2.6%(1) 0.000 3.99 (1.95-6.04) Mechanical ventilation (MV) 35.51%(38) 54.4%(37) 2.6%(1) 0.000 3.81 (1.77-5.86) Hemodialysis 36.4% (39) 79.5%(31) 20.5%(8) 0.009 3.25 (1.3-8.1) Abbreviations: ARD = Acute Respiratory Distress; ARDS = Acute Respiratory Distress Syndrome; AKI = Acute Kidney Injury; HFNO = High-Flow Nasal Oxygen; NIV = Non-Invasive Ventilation; OTI = Orotracheal Intubation; MV = Mechanical Ventilation; OR = Odds Ratio; CI = Confidence Interval Anemia was observed in 62.5% of patients, with hemoglobin <8 g/dL in 16.8%. Other laboratory abnormalities included hypoalbuminemia (66.3%) and metabolic acidosis (23.3%). All patients received antibiotic therapy: triple therapy in 47.6% and dual therapy in 36.4%. Additional interventions included norepinephrine infusion (20.5%), oxygen therapy (78.5%), non-invasive ventilation (52.3%), orotracheal intubation (38.3%), mechanical ventilation (35.5%), and hemodialysis (36.4%) (Table 1). Mortality occurred in 68 patients (63.5%). Survival was comparable between AKI and non-AKI patients during the first five days of ICU admission. However, from day 6 to day 30, survival was significantly better in the non-AKI group (p = 0.001) (Figure 1). Figure 1. Survival Curves of Patients With and Without Acute Kidney Injury (AKI) From day 1 to day 5, patients who developed AKI exhibited survival rates comparable to those without AKI, with no statistically significant difference (p = 0.073). Between day 5 and day 30, however, patients with AKI demonstrated significantly lower survival compared to those without AKI (p = 0.001). Furthermore, survival was significantly better when AKI developed >72 hours after ICU admission (p = 0.026). Beyond day 27, survival rates converged regardless of AKI onset timing (Figure 2). Figure 2. Survival curve according to the time of AKI onset From day 1 to day 25, patients who developed AKI prior to admission and those who developed AKI within 24–72 hours after admission had lower survival compared to patients who developed AKI ≥72 hours after admission, with a statistically significant difference (p = 0.026). From day 27 onward, survival was similar regardless of the timing of kidney injury onset. In univariate analysis, deceased patients were significantly more likely to have experienced ARD (p = 0.001), severe ARDS (p = 0.007), KDIGO stage 3 AKI (p = 0.01), blood urea >2 g/L (p = 0.02), triple antibiotic therapy (p = 0.008), norepinephrine use (p = 0.001), neurosedation (p < 0.001), neuromuscular blockade (p = 0.002), orotracheal intubation (p < 0.001), mechanical ventilation (p < 0.001), and hemodialysis (p = 0.009) (Table 1). In multivariate analysis, the following factors were independently associated with increased risk of death: acute respiratory distress (OR = 5.06; p = 0.006), KDIGO stage 3 AKI (OR = 5.15; p = 0.003), orotracheal intubation (OR = 4.37; p < 0.001), and mechanical ventilation (OR = 4.01; p < 0.001) (Table 2). Table 2. Factors Associated with Risk of Death — Multivariate Logistic Regression Analysis Variables P-value Adjusted 95% CI Lower Upper ARD 0.006 5.06 1.6 15.99 Blood urea ≥2 g/L 0.1 5.07 0.73 35.22 Severe ARDS 0.842 0.84 0.16 4.45 KDIGO Stage 3 AKI 0.003 5.15 1.73 15.34 Triple antibiotic therapy 0.13 2.57 0.75 8.76 Norepinephrine use 0.1 8.35 0.67 45.93 Neurosedation 0.9 0.002 0.000 5.97 Neuromuscular blockade 0.66 0.09 2 45.7 Orotracheal intubation 0.0001 4.36 2.19 6.53 Mechanical ventilation 0.0001 4.01 1.87 6.15 Hemodialysis 0.07 0.41 0.31 2.31 DISCUSSION Although COVID-19 primarily manifests with respiratory symptoms, systemic complications involving the coagulation system, gastrointestinal tract, heart, and kidneys have been widely reported. Renal manifestations most commonly present as acute kidney injury (AKI), which is recognized as an independent predictor of poor prognosis in patients with SARS-CoV-2 infection. Our study demonstrated that, starting from the sixth day of hospitalization, the presence of AKI significantly and negatively impacts patient prognosis. A retrospective study conducted between April 2020 and October 2021 in a private hospital in Kenya, involving 1,366 hospitalized COVID-19 patients, similarly found that AKI was associated with a higher risk of mortality, with risk increasing proportionally with AKI stage [17]. In our cohort, more than six out of ten patients with COVID-19 and AKI died. Alfano et al. reported a mortality rate of 56.5% in a study conducted in Italy [18]. Another study from Pakistan documented a mortality rate of 62.1% among COVID-19 patients with AKI, compared to 31.4% in those without AKI [19]. Furthermore, a systematic review encompassing 142 studies and 49,048 COVID-19 patients—including 5,152 cases of AKI—confirmed that AKI is independently associated with increased mortality risk [20]. Identifying risk factors for death may facilitate the development of targeted strategies to prevent renal injury, as AKI has been shown to increase in-hospital mortality risk by approximately five-fold [21]. Early identification of high-risk patients, implementation of preventive measures, and timely supportive interventions in predisposed individuals could improve outcomes and mitigate long-term sequelae. In our study, seven out of ten patients were admitted due to acute respiratory distress (ARD), and multivariate analysis confirmed ARD as an independent predictor of mortality. A multicenter study in Saudi Arabia involving 340 ICU-admitted patients reported an ARD incidence of 81.2% [22]. Similarly, Alfano et al. identified ARD as the leading cause of death among COVID-19 patients with AKI [18]. More than half of our patients presented with KDIGO stage 3 AKI, and this advanced stage was independently associated with increased mortality (Tables 1 and 2). Ng et al. reported similarly elevated mortality rates in patients with AKI, whether requiring dialysis (adjusted HR 6.4; 95% CI, 5.5–7.6) or not (adjusted HR 3.4; 95% CI, 3.0–3.9), compared to those without AKI [4]. Interestingly, our data showed improved survival when AKI was diagnosed more than 72 hours after ICU admission (Figure 2). This may reflect more timely and aggressive clinical interventions initiated once AKI is recognized, potentially mitigating further organ damage. In our cohort, 36.4% of patients received hemodialysis. Cheruiyot et al. reported a lower rate of 15.6% (10 out of 64 patients) [17]. Access to renal replacement therapy in this context is heavily influenced by local resource availability and clinical decision-making. In our setting, two dialysis machines were available in the dedicated COVID-19 ICU, and nephrologists often adopted a “watchful waiting” approach before initiating dialysis. However, given the profound impact of factors such as baseline estimated glomerular filtration rate (eGFR) reduction and oliguria, it is clinically reasonable to assess individual probabilities of renal recovery and overall survival when discussing goals of care. The Renal Physicians Association recommends shared decision-making to evaluate whether to initiate dialysis, conduct a time-limited trial of dialysis, or transition to palliative or end-of-life care [23]. Critically ill COVID-19 patients receiving hemodialysis frequently develop hypoxemia, respiratory failure, and other extrapulmonary complications—including increased risks of shock, worsening AKI, and thromboembolic events. As the disease progresses, these patients often require mechanical ventilation and intensive monitoring in the ICU [24]. Contrary to our findings, some authors have suggested that ICU admission and respiratory support are not independent predictors of mortality or poor outcomes [24]. However, in our cohort, orotracheal intubation and mechanical ventilation were strongly associated with mortality (Table 2). This discrepancy may be explained by the fact that most critically ill dialysis-dependent patients also require intubation and mechanical ventilation. Intubation itself has been associated with increased risks of nosocomial infection and mortality [24]. Therefore, a critical question remains: Is mortality driven by the act of intubation itself—or by the underlying severity of illness that necessitates such invasive respiratory support? Conclusion Acute kidney injury (AKI) is a significant negative prognostic factor in patients with COVID-19. Mortality appears to be primarily associated with the severity of SARS-CoV-2 infection itself, rather than with the use of respiratory support interventions. Declarations AUTHORS' CONTRIBUTION KONAN SERGE DIDIER wrote this article, conducted the study and entered the data. He carried out the statistical analysis of the data. OUATTARA KOLO CLAUDE directed this work from the protocol to the final draft. YAO Hubert coordinated the study and publication of this article. OUATTARA KOLO CLAUDE submitted the article online and adapted it to the journal's recommendations. 2. MANAGEMENT OF INTERVIEW AND OBSERVATION DATA All recorded data will remain strictly confidential and can only be consulted by the medical team in charge of the research. These data will be subject to computer processing. They can be consulted on request addressed to YAO KOUAME HUBERT. 3. COMPENSATION Participation in the study was not subject to financial compensation for the participants. 4. PROJECT DURATION AND FUNDING This study was funded by the authors with their own funds. 5. RIGHTS OF THE PARTICIPANT The participants were submitted to a confidential questionnaire, and in order to preserve their anonymity a unique number was assigned to them. Participation in this study was entirely free and voluntary. Participants were free to accept or refuse to participate in our study. Those who accepted were also free, at any time, to end their participation, and, on simple verbal notice without giving an explanation 5. DISSEMINATION OF RESULTS The results of this study had been submitted only to BMC journal. The manuscript is not under consideration by another journal and has not been previously published. 7. CONFLICTS OF INTEREST This project does not represent any risk of conflicts of interest on the part of the researchers, the sponsor or any other person involved in the study. C LINICAL TRIAL NUMBER : not applicable. ETHICS The study was conducted in accordance with good clinical practice and national research guidelines. The full study protocol was approved by the Ethics and Scientific Committee of the Treichville University Hospital, in accordance with the Declaration of Helsinki. Informed consent from patients was obtained for their inclusion in the study. To respect the confidentiality of patient records, names were not mentioned, and data collection was carried out during our daily practice. CONSENT TO PUBLISH Consent to Publish declarations: not applicable References -Bonny V, Maillard A, Mousseaux C, Plaçais L, Richier Q. COVID-19: Pathogenesis of a multi-faceted disease. Rev Med Interne. 2020;41(6):375–89. -Martinez-Rojas MA, Vega-Vega O, Bobadilla NA. Is the kidney a target of SRAS-CoV-2? AmJ Physiol Ren Physiol. 2020;318(6):F1454–62. -Rubin S, Orieux A, Prevel R, Garric A, Bats ML, Dabernat S. Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019. Clin Kidney J. 2020;13(3):354–61. -Jia H, Ng JS Hirsch,* Azzour Hazzan, Wanchoo R, Shah HH, Deepa A, Malieckal DW, Ross P, Sharma V, Sakhiya S, Fishbane, Kenar D, Jhaveri, on behalf of the Northwell Nephrology COVID-19 Research Consortium. Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury. Am J Kidney Dis. 77(2):204–215. Published online September 19, 2020. 10.1053/ j.ajkd.2020.09.002 -Intensive Care National Audit & Research Centre: ICNARC report on COVID-19 in critical care. 2020. Available at: https://www.icnarc.org/DataServices/Attachments/Download/c31dd38d-d77b-ea11-9124 00505601089b. Accessed April 21, 2020]. -Morelle J, Devresse A, Demoulin N, GillioMOn V, et al. COVID-19, kidney and kidney diseases. Louvain Med. 2020;139(6):308–11. -Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829–38. -Hirsch JS, Ng JH, Ross DW, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209–18. -James PA, Oparil S, Cartel BL, et al. Evidence-based guideline for management of high blood pressure in adults: report from the panel members appointed the Eighth Joint National Committee. JAMA. 2014;311(5):507–20. Imran -SA, et al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Targets for Glycemic Control. Can J Diabetes. 2018;42(1):S2–6. -Malone B, Urakova N, Snijder EJ, et al. Structures and functions of coronavirus replication–transcription complexes and their relevance for SARS-CoV-2 drug design. Nat Rev Mol Cell Biol. 2022;23(1):21–39. -Gupta S, Parker J, Smits S, Underwood J, Dolwani S. Persistent viral shedding of SARS-CoV-2 in faeces - a rapid review. Colorectal Dis. 2020;22(6):611–20. -Okada P, Buathong R, Phuygun S, Thanadachakul T, Parnmen S, Wongboot W, et al. Early transmission patterns of coronavirus disease 2019 (COVID-19) in travellers from Wuhan to Thailand. Eurosurveillance. 2020;25(8):2000097. -Eurosurveillancepatterns of early transmission of coronavirus disease 2019 (COVID-19) among travelers from Wuhan, Thailand. January 2020 n.d. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.8.2000097?crawler=true (accessed April 13,2021). -Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382:1177–9. -Coronavirus Disease. (COVID-19) situation reports n.d. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports (accessed April 13,2021). Cheruiyot -Susan, Shabani J, Shah J, Gathu C, Sokwala A. Associated Factors and Outcomes of Acute Kidney Injury in COVID-19 Patients in Kenya. Can J Kidney Health Disease. 2024;11:1–10. -GaetanoAlfano;Annachiara Ferrari · Francesco Fontana · Giacomo Mori. · Riccardo Magistroni ·Marianna Meschiari· Erica Franceschini · Marianna Menozzi· Gianluca Cuomo · Gabriella Orlando · Antonella Santoro · Margherita Digaetano · Cinzia Puzzolante · Federica Carli · Andrea Bedini · Jovana Milic · Irene Coloretti · Paolo Raggi · Cristina Mussini · Massimo Girardis · Gianni Cappelli· Giovanni Guaraldi· for the Modena Covid-19 Working Group (MoCo19). Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19 Clinical and Experimental Nephrology (2021) 25:1203–14. Ahmed -Raheel, Maula KF, Ali Z, Ismail M. Inayat Ur Rehman, Sedra Fazle Maula, Samina Masood Ali6, Tahir Mehmood Khan. Acute Kidney Injury and Mortality among Patients with Coronavirus Disease-2019 in Pakistan. Saudi J Kidney Dis Transpl. 2021;32(6):1764–74. -Edouard L, Fu HW, vander Endt J, Milders, Esmee M, van der Willik, Esther NM, de Rooij OM, Dekkers. Joris I. Rotmans and Merel van Diepen. Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis. Clinical Kidney Journal, 2020,13, 4, 550–563. -Nugent J, Aklilu A, Yamamoto Y, et al. Assessment of acute kidney injury and longitudinal kidney function after hospital discharge among patients with and without COVID-19. JAMA Netw Open. 2021;4(3):e211095–211095. -Safwat AM, Eldaboosy SO. Nour,Ahmed Kabil,Ahmad Taha,Sameh Makled,Ahmed Lotfi,Usama Nabway,Hatem Kanany. Acute kidney injury in Coronavirus disease-19 related pneumonia in the intensive care unit: a retrospective multicenter study. Multidisciplinary Respiratory Medicine 2023; volume 18:895. ; 2010. https://cdn.ymaws.com/www.renalmd . org/resource/resmgr/Store/Shared_Decision_Making_Recom. pdf. -Renal Physicians Association. Shared Decision-Making in the Appropriate Initiation of and Withdrawal From Dial ysis: Clinical Practice Guideline. 2nd ed. Renal Physicians Association, Scherer JS, Holley JL. The role of time-limited trials in dialysis decision making in critically ill patients. Clin J Am Soc Nephrol. 2016;11(2):344–353. 10.2215/CJN.03550315 He -Zhangxiu, Peng Z, Gao N, Zhong S, Yu F, Tang Z, Liao Z, Zhao S. Gloria Umwiza, Ming Chen and Wei Long. Risk factors for the mortality of hemodialysis patients with COVID-19 in northern Hunan province, China. BMC Nephrol. 2025;26:26. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":78472,"visible":true,"origin":"","legend":"\u003cp\u003eSurvival Curves of Patients With and Without Acute Kidney Injury (AKI)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7577412/v1/3556b280414e8831e432a54b.jpeg"},{"id":94222993,"identity":"bae7a42f-7f04-40ce-bf0e-90b31a42cf9a","added_by":"auto","created_at":"2025-10-23 19:05:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35694,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSurvival curve according to the time of AKI onset\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7577412/v1/938acd96f31700d04c65e038.png"},{"id":96651408,"identity":"25bf39f1-2d40-41ae-8896-1aa4547fa14c","added_by":"auto","created_at":"2025-11-24 16:14:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1124645,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7577412/v1/e6c59a32-38c8-4aa8-bd8b-f35974c68778.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMortality in Patients With Covid-19 and Acute Kidney Injury in the Intensive Care Unit\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe first case of COVID-19 was identified in December 2019 in Wuhan, China. The disease rapidly evolved into a global pandemic and was declared a \u0026ldquo;Public Health Emergency of International Concern\u0026rdquo; by the World Health Organization (WHO) on March 11, 2020. On that same date, the first case of COVID-19 was detected in the Republic of C\u0026ocirc;te d\u0026rsquo;Ivoire. The causative agent, SARS-CoV-2, typically manifests as respiratory involvement, ranging from paucisymptomatic forms to severe pneumonia with acute respiratory distress [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Beyond its respiratory tropism, accumulating evidence suggests multiorgan involvement in infected patients, attributed to viral binding to angiotensin-converting enzyme 2 (ACE2) receptors expressed on various human cell types [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough acute respiratory failure remains the most frequent and severe organ dysfunction, acute kidney injury (AKI) is commonly reported in patients with SARS-CoV-2 infection. AKI is a frequent complication among critically ill patients admitted to intensive care units (ICUs) for acute respiratory distress syndrome (ARDS) secondary to COVID-19. Its reported incidence in ICU settings varies from 5% to 25% across studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A study conducted in Bordeaux, France, estimated the incidence of AKI at approximately 80% among critically ill patients requiring ICU admission [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In a large cohort of over 1,800 ICU patients with ARDS, 44.3% developed AKI, compared with 27.4% among ICU patients without ARDS [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe development of AKI is a negative prognostic indicator for survival in patients with COVID-19. In a study of patients aged 18 years and older hospitalized for COVID-19 across 13 hospitals in the New York metropolitan area between March 1 and April 27, 2020, and followed until hospital discharge, the incidence rates of in-hospital mortality were 10.8, 31.1, and 37.5 per 1,000 patient-days among patients without AKI, those with AKI not requiring dialysis (KDIGO stages 1\u0026ndash;3), and those with AKI requiring dialysis (stage 3D), respectively [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Using patients without AKI as the reference group, the authors observed significantly increased risks of in-hospital death for patients with AKI stages 1\u0026ndash;3 (HR 5.6; 95% CI, 5.0\u0026ndash;6.3) and stage 3D (HR 11.3; 95% CI, 9.6\u0026ndash;13.1). Another study conducted in Ireland among ICU-admitted patients reported an incidence of dialysis-requiring AKI of 22.2%, with mortality exceeding 75% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral factors associated with mortality in the context of COVID-19 and AKI have been reported in the literature. This study aims to identify risk factors for death among patients with COVID-19 and acute kidney injury admitted to the intensive care unit of the Department of Infectious and Tropical Diseases.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Setting\u003c/h2\u003e\u003cp\u003eThis study was conducted in the COVID-19 ICU of the Department of Infectious and Tropical Diseases (DITD) at Treichville Teaching Hospital.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Design and Duration\u003c/h3\u003e\n\u003cp\u003eThis was a retrospective, analytical study focusing on acute kidney injury in patients with confirmed COVID-19, conducted between March 2020 and December 2021.\u003c/p\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of all patients admitted to the DITD COVID-19 ICU during the study period. We included all patients with laboratory-confirmed SARS-CoV-2 infection (via RT-PCR), with or without acute kidney injury. Exclusion criteria were: negative RT-PCR test, incomplete medical records for key variables, death upon admission, and known pre-existing chronic kidney disease.\u003c/p\u003e\u003cp\u003eThe primary outcome was in-hospital mortality.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData were extracted from medical records using a standardized case report form. The form included:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSociodemographic data\u003c/strong\u003e\u003cp\u003eage, gender\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eClinical data\u003c/strong\u003e\u003cp\u003ereason for admission, referring service/institution, known comorbidities (obesity, hypertension, diabetes, cardiovascular disease, chronic respiratory disease, liver disease, chronic kidney disease, HIV-related immunosuppression), regular medications (NSAIDs, ACE inhibitors, ARBs, diuretics, calcineurin inhibitors, beta-blockers, centrally acting antihypertensives, antidiabetics, lipid-lowering agents, antiretrovirals), hemodynamic and respiratory parameters (mean arterial pressure, urine output, oxygen saturation, FiO2, PEEP, temperature, heart rate, respiratory rate, peripheral oxygen saturation), lower limb edema, urinalysis, body mass index (BMI), qSOFA score [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], sepsis, septic shock [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], Glasgow Coma Scale (GCS), acute respiratory distress syndrome (ARDS), fluid balance (input/output).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eLaboratory data\u003c/strong\u003e\u003cp\u003eblood urea nitrogen, serum creatinine, sodium, potassium, calcium, chloride, phosphate, uric acid, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, platelet count, prothrombin time, activated partial thromboplastin time, blood glucose, C-reactive protein (CRP), transaminases, arterial blood gases (pH, HCO3-, PaO2, PaCO2), lactate, serum albumin, proteinuria, hematuria, urinary sodium, urinary potassium, renal ultrasound, thoracic computed tomography.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTherapeutic data\u003c/strong\u003e\u003cp\u003efluid and electrolyte management, oxygen therapy, sedation, neuromuscular blockade, orotracheal intubation, mechanical ventilation, vasopressor use, corticosteroids, antiplatelet agents, albumin, insulin, statins, diuretics, antihypertensives, antidiabetics, antivirals, low-molecular-weight heparin (LMWH), proton pump inhibitors (PPIs), antibiotics, and hemodialysis.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eIn-hospital events: shock, AKI progression, death.\u003c/p\u003e\n\u003ch3\u003eOperational Definitions\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eAcute Kidney Injury (AKI)\u003c/strong\u003e\u003cp\u003eDefined and staged according to KDIGO criteria [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Serum creatinine was measured daily during the first week, every other day during the second week, and twice weekly thereafter until discharge, using the standardized Jaffe method.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003cp\u003eDefined per the Eighth Joint National Committee (JNC 8) guidelines [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] as blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;140/90 mmHg.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHyperglycemia\u003c/strong\u003e\u003cp\u003eDefined as blood glucose\u0026thinsp;\u0026gt;\u0026thinsp;1.26 g/L [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSepsis\u003c/strong\u003e\u003cp\u003eDefined by the presence of at least two qSOFA criteria (systolic BP\u0026thinsp;\u0026lt;\u0026thinsp;100 mmHg, respiratory rate\u0026thinsp;\u0026gt;\u0026thinsp;22/min, GCS\u0026thinsp;\u0026lt;\u0026thinsp;15) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], or by the combination of systemic inflammatory response syndrome (SIRS) and suspected or confirmed infection [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A qSOFA score\u0026thinsp;\u0026ge;\u0026thinsp;2 warrants urgent intervention [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSeptic Shock\u003c/strong\u003e\u003cp\u003eDefined as sepsis plus vasopressor requirement to maintain mean arterial pressure\u0026thinsp;\u0026ge;\u0026thinsp;65 mmHg and serum lactate\u0026thinsp;\u0026gt;\u0026thinsp;4 mmol/L despite adequate fluid resuscitation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eLevel of Consciousness\u003c/b\u003e: Assessed using the Glasgow Coma Scale (GCS): Stage I (vigil coma, GCS 13\u0026ndash;14), Stage II (mild coma, GCS 10\u0026ndash;12), Stage III (deep coma, GCS 7\u0026ndash;9), Stage IV (brain death, GCS 3\u0026ndash;6) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMetabolic Acidosis\u003c/strong\u003e\u003cp\u003eDefined via the Henderson-Hasselbalch equation as plasma bicarbonate\u0026thinsp;\u0026lt;\u0026thinsp;20 mmol/L, typically associated with compensatory reduction in PaCO2; pH may be markedly or mildly decreased.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcute Respiratory Distress Syndrome (ARDS)\u003c/strong\u003e\u003cp\u003eDefined per the Berlin 2012 criteria [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] as non-cardiogenic pulmonary edema causing hypoxemia, classified by PaO2/FiO2 ratio\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e- Mild ARDS: PaO2/FiO2 201\u0026ndash;300 mmHg with PEEP\u0026thinsp;\u0026ge;\u0026thinsp;5 cm H2O\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- Moderate ARDS: PaO2/FiO2 101\u0026ndash;200 mmHg with PEEP\u0026thinsp;\u0026ge;\u0026thinsp;5 cm H2O\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- Severe ARDS: PaO2/FiO2\u0026thinsp;\u0026le;\u0026thinsp;100 mmHg with PEEP\u0026thinsp;\u0026ge;\u0026thinsp;5 cm H2O\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eWhen PaO2 is unavailable, SpO2/FiO2\u0026thinsp;\u0026le;\u0026thinsp;315 suggests ARDS, even in non-intubated patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics (version 25.0). Categorical variables are presented as percentages, and continuous variables as medians. Univariate analysis comparing groups based on the primary outcome (death) was conducted using Chi-square tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Multivariate analysis was performed using stepwise backward logistic regression. The final model included one variable per ten observed events. Only variables significant in univariate analysis were included. No imputation was performed for missing data. All tests were two-tailed, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eThe study received all required academic, administrative, and health authority approvals. As a retrospective chart review without direct patient contact, informed consent was waived. Patient confidentiality and anonymity were strictly maintained throughout data collection and analysis.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThis study included 289 patients with confirmed COVID-19. Among them, acute kidney injury was observed in 107 cases (37% prevalence).\u003c/p\u003e\n\u003cp\u003eThe mean age of patients with AKI was 61.3 \u0026plusmn; 13.6 years; 45.7% were aged \u0026ge;65 years. Male predominance was noted (male-to-female ratio: 2.68). The primary reasons for ICU admission were acute respiratory distress (ARD, 71%) and dyspnea (12.1%). Comorbidities included hypertension (67.2%), diabetes (41.1%), and obesity (14.9%). The most common clinical findings were coma (96.2%), hypoxia (SpO2 \u0026lt;92%, 77.6%), sepsis (79.4%), and oligo-anuria (62.6%). Among patients with ARDS (71%), severity was classified as severe in 50.4% and moderate in 15.8%. The qSOFA score was severe in 63.5% and critical in 25.2%.\u003c/p\u003e\n\u003cp\u003eAccording to KDIGO criteria, AKI was stage 3 in 52.3%, stage 2 in 16.8%, and stage 1 in 30.5%. AKI was diagnosed prior to admission in 40.1%, between 24\u0026ndash;72 hours post-admission in 42.9%, and \u0026gt;72 hours post-admission in 16.8% (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1. General Characteristics of COVID-19-Positive Patients with Acute Kidney Injury (AKI)**\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"737\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n=107)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeceased (n=68)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvivors (n=39)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnadjusted OR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (\u003c/strong\u003e\u003cstrong\u003eyears\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e61.33\u0026plusmn;13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e61.78\u0026plusmn;13.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e60.54\u0026plusmn;13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u0026lt;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e2.8% (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e2.9%(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e2.6%(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.15 (0.1-13.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e[35-65[\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e51.40%(55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e48.5%(33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e56.4%(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.73 (0.33-1.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u0026ge;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e45.79% (49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e48.5%(33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e41%(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.35 (0.61-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e72.90 %(78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e73.5%(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e71.8%(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.09 (0.45-2.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReason for admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eARD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e71.02 % (76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e82.4%(56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e51.3%(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e4.43 (1.83-10.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eDyspnea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e12.15% (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e1.5% (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e30.8% (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.03 (0.00-0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eAcute pulmonary edema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e5.61% (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e4.4%(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e7.7%(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.55 (0.11-2.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eLoss of consciousness \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e11.21%(12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e11.8%(8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e10.3%(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.17 (0.33-4.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eHypertension \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e67.28%(72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e67.6%(46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e66.7%(26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.04 (0.45-2.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eDiabetes mellitus \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e41.12 %(44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e44.1%(30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e35.9%(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.41 (0.63-3.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e14.95%(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e14.7%(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e15.4%(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.95 (0.32-2.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eHIV infection \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e6.54%(7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e7.4%(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e5.1%(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.47 (0.27-7.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical signs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eHypertensive crisis \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 60.75% (65)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e63.2%(43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e56.4%(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.33 (0.66-2.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;48.60%(52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e51.5%(35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e43.6%(17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.37 (0.62-3.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eComa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e96.26% (103)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e97.1%(66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e94.9%(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.56 (0.08-4.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eOxygen saturation\u0026nbsp;\u0026lt;92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e77.60% (83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e80.5%(55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e71.8%(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.66 (0.66-4.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eOligo-anuria \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u0026nbsp; 62.61% (67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e63.2%(43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e61.6%(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u0026nbsp;0.86 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.07 (0.76-1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e29.90% (32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e29.4%(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e30.8%(12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u0026nbsp;0.94 (0.4-2.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eSepsis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e79.43% (85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e82.4%(56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e74.4%(29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.61 (0.62-4.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eqSOFA score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eCritical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e25.23% (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e30.9%(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e15.4%(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e2.46 (0.89-6.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e63.55 (68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e58.8%(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e71.8%(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.56 (0.24-1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e11.21% (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e10.3%(7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e12.8%(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.78 (0.23-2.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eARDS severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eSevere ARDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e50.46% (54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e60.3%(41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e33.3%(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e3.04 (1.33-6.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eModerate ARDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e15.88 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e20.6%(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e7.7%(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e3.11 (0.83-11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eMild ARDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e4.67% (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e1.5%(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e10.3%(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.13 (0.01-1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u003cstrong\u003eAKI stage (KDIGO)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eStage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e30.8%(33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e26.5%(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e38.5%(15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.58 (0.25-1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eStage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e16.8%(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e11.8%(8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e25.6%(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.39 (0.14-1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eStage 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e52.3%(56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e61.8%(42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e35.9%(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e2.88 (1.27-6.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemoglobin (g/dL) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u0026ge; 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e37.38% (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e33.8%(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e43.6%(17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.66 (0.29-1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e[8-12[\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e45.79% (49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e50%(34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e38.5%(15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.6 (0.72-3.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u0026lt;8 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e16.82 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e16.2% (11) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e17.9% (11) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.88 (0.31-2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood urea (g/L) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e[0.15-0.45[\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e13%(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e5.9%(4).1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e25.6%(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.18 (0.05-0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e[0.45-2[\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e70%(75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e70.6%(48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e69.2%(27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.07 (0.45-2.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u0026ge; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e16.8% (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e23.5%(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e5.1 %(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e5.69 (1.23-26.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eHypoalbuminemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e66.35% (71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e72.1%(49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e56.4%(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.99 (0.87-4.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eMetabolic acidosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e23.36% (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e27.9%(19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e15.4%(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e2.13 (0.77-5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotic regimen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eMonotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e14.95% (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e14.7% (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e15.4% (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.95 (0.32-2.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eDual therapy \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e36.44% (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e27.9% (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e51.3% (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.37 (0.16-0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eTriple therapy \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e47.66% (51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e57.4% (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e30.8% (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e3.03 (1.32-6.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eNorepinephrine use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e20.56% (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u0026nbsp;30.9%(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e2.6%(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e2.83 (0.78-4.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmergency\u003c/strong\u003e interventions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eHigh-flow nasal oxygen (HFNO)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e78.5%(84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e80.9%(55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e74.4%(29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e1.46 (0.57-3.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eNon-invasive ventilation (NIV) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e52.33%(56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e38.3%(41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e38.5%(15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e0.99 (0.44-2.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eNeurosedation \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e37.38%(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e57.4%(39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e2.6%(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e3.93 (1.89-5.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eNeuromuscular blockade \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e19.62%(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e29.4%(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e2.6%(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e2.76 (0.71-4.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eOrotracheal intubation (OTI) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e38.31%(41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e58.8%(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e2.6%(1)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e3.99 (1.95-6.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003eMechanical ventilation (MV) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e35.51%(38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e54.4%(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e2.6%(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e3.81 (1.77-5.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9239%;\"\u003e\n \u003cp\u003e\u0026nbsp; Hemodialysis \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3533%;\"\u003e\n \u003cp\u003e36.4% (39) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3043%;\"\u003e\n \u003cp\u003e79.5%(31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5163%;\"\u003e\n \u003cp\u003e20.5%(8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.96739%;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9348%;\"\u003e\n \u003cp\u003e3.25 (1.3-8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: ARD = Acute Respiratory Distress; ARDS = Acute Respiratory Distress Syndrome; AKI = Acute Kidney Injury; HFNO = High-Flow Nasal Oxygen; NIV = Non-Invasive Ventilation; OTI = Orotracheal Intubation; MV = Mechanical Ventilation; OR = Odds Ratio; CI = Confidence Interval\u003c/p\u003e\n\u003cp\u003eAnemia was observed in 62.5% of patients, with hemoglobin \u0026lt;8 g/dL in 16.8%. Other laboratory abnormalities included hypoalbuminemia (66.3%) and metabolic acidosis (23.3%).\u003c/p\u003e\n\u003cp\u003eAll patients received antibiotic therapy: triple therapy in 47.6% and dual therapy in 36.4%. Additional interventions included norepinephrine infusion (20.5%), oxygen therapy (78.5%), non-invasive ventilation (52.3%), orotracheal intubation (38.3%), mechanical ventilation (35.5%), and hemodialysis (36.4%) (Table 1).\u003c/p\u003e\n\u003cp\u003eMortality occurred in 68 patients (63.5%). Survival was comparable between AKI and non-AKI patients during the first five days of ICU admission. However, from day 6 to day 30, survival was significantly better in the non-AKI group (p = 0.001) (Figure 1).\u003c/p\u003e\n\u003cp\u003eFigure 1. Survival Curves of Patients With and Without Acute Kidney Injury (AKI)\u003c/p\u003e\n\u003cp\u003eFrom day 1 to day 5, patients who developed AKI exhibited survival rates comparable to those without AKI, with no statistically significant difference (p = 0.073). Between day 5 and day 30, however, patients with AKI demonstrated significantly lower survival compared to those without AKI (p = 0.001).\u003c/p\u003e\n\u003cp\u003eFurthermore, survival was significantly better when AKI developed \u0026gt;72 hours after ICU admission (p = 0.026). Beyond day 27, survival rates converged regardless of AKI onset timing (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2. Survival curve according to the time of AKI onset\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom day 1 to day 25, patients who developed AKI prior to admission and those who developed AKI within 24\u0026ndash;72 hours after admission had lower survival compared to patients who developed AKI \u0026ge;72 hours after admission, with a statistically significant difference (p = 0.026). From day 27 onward, survival was similar regardless of the timing of kidney injury onset.\u003c/p\u003e\n\u003cp\u003eIn univariate analysis, deceased patients were significantly more likely to have experienced ARD (p = 0.001), severe ARDS (p = 0.007), KDIGO stage 3 AKI (p = 0.01), blood urea \u0026gt;2 g/L (p = 0.02), triple antibiotic therapy (p = 0.008), norepinephrine use (p = 0.001), neurosedation (p \u0026lt; 0.001), neuromuscular blockade (p = 0.002), orotracheal intubation (p \u0026lt; 0.001), mechanical ventilation (p \u0026lt; 0.001), and hemodialysis (p = 0.009) (Table 1).\u003c/p\u003e\n\u003cp\u003eIn multivariate analysis, the following factors were independently associated with increased risk of death: acute respiratory distress (OR = 5.06; p = 0.006), KDIGO stage 3 AKI (OR = 5.15; p = 0.003), orotracheal intubation (OR = 4.37; p \u0026lt; 0.001), and mechanical ventilation (OR = 4.01; p \u0026lt; 0.001) (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2. Factors Associated with Risk of Death \u0026mdash; Multivariate Logistic Regression Analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"638\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eARD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e5.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e15.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eBlood urea \u0026ge;2 g/L \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e5.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e35.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eSevere ARDS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e4.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eKDIGO Stage 3 AKI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e5.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e15.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eTriple antibiotic therapy \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eNorepinephrine use \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e8.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e45.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eNeurosedation \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e5.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eNeuromuscular blockade \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e45.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026nbsp;Orotracheal intubation \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e4.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eMechanical ventilation \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e4.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eHemodialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAlthough COVID-19 primarily manifests with respiratory symptoms, systemic complications involving the coagulation system, gastrointestinal tract, heart, and kidneys have been widely reported. Renal manifestations most commonly present as acute kidney injury (AKI), which is recognized as an independent predictor of poor prognosis in patients with SARS-CoV-2 infection.\u003c/p\u003e\n\u003cp\u003eOur study demonstrated that, starting from the sixth day of hospitalization, the presence of AKI significantly and negatively impacts patient prognosis. A retrospective study conducted between April 2020 and October 2021 in a private hospital in Kenya, involving 1,366 hospitalized COVID-19 patients, similarly found that AKI was associated with a higher risk of mortality, with risk increasing proportionally with AKI stage [17].\u003c/p\u003e\n\u003cp\u003eIn our cohort, more than six out of ten patients with COVID-19 and AKI died. Alfano et al. reported a mortality rate of 56.5% in a study conducted in Italy [18]. Another study from Pakistan documented a mortality rate of 62.1% among COVID-19 patients with AKI, compared to 31.4% in those without AKI [19]. Furthermore, a systematic review encompassing 142 studies and 49,048 COVID-19 patients—including 5,152 cases of AKI—confirmed that AKI is independently associated with increased mortality risk [20]. Identifying risk factors for death may facilitate the development of targeted strategies to prevent renal injury, as AKI has been shown to increase in-hospital mortality risk by approximately five-fold [21]. Early identification of high-risk patients, implementation of preventive measures, and timely supportive interventions in predisposed individuals could improve outcomes and mitigate long-term sequelae.\u003c/p\u003e\n\u003cp\u003eIn our study, seven out of ten patients were admitted due to acute respiratory distress (ARD), and multivariate analysis confirmed ARD as an independent predictor of mortality. A multicenter study in Saudi Arabia involving 340 ICU-admitted patients reported an ARD incidence of 81.2% [22]. Similarly, Alfano et al. identified ARD as the leading cause of death among COVID-19 patients with AKI [18].\u003c/p\u003e\n\u003cp\u003eMore than half of our patients presented with KDIGO stage 3 AKI, and this advanced stage was independently associated with increased mortality (Tables 1 and 2). Ng et al. reported similarly elevated mortality rates in patients with AKI, whether requiring dialysis (adjusted HR 6.4; 95% CI, 5.5–7.6) or not (adjusted HR 3.4; 95% CI, 3.0–3.9), compared to those without AKI [4].\u003c/p\u003e\n\u003cp\u003eInterestingly, our data showed improved survival when AKI was diagnosed more than 72 hours after ICU admission (Figure 2). This may reflect more timely and aggressive clinical interventions initiated once AKI is recognized, potentially mitigating further organ damage.\u003c/p\u003e\n\u003cp\u003eIn our cohort, 36.4% of patients received hemodialysis. Cheruiyot et al. reported a lower rate of 15.6% (10 out of 64 patients) [17]. Access to renal replacement therapy in this context is heavily influenced by local resource availability and clinical decision-making. In our setting, two dialysis machines were available in the dedicated COVID-19 ICU, and nephrologists often adopted a “watchful waiting” approach before initiating dialysis. However, given the profound impact of factors such as baseline estimated glomerular filtration rate (eGFR) reduction and oliguria, it is clinically reasonable to assess individual probabilities of renal recovery and overall survival when discussing goals of care. The Renal Physicians Association recommends shared decision-making to evaluate whether to initiate dialysis, conduct a time-limited trial of dialysis, or transition to palliative or end-of-life care [23].\u003c/p\u003e\n\u003cp\u003eCritically ill COVID-19 patients receiving hemodialysis frequently develop hypoxemia, respiratory failure, and other extrapulmonary complications—including increased risks of shock, worsening AKI, and thromboembolic events. As the disease progresses, these patients often require mechanical ventilation and intensive monitoring in the ICU [24]. Contrary to our findings, some authors have suggested that ICU admission and respiratory support are not independent predictors of mortality or poor outcomes [24]. However, in our cohort, orotracheal intubation and mechanical ventilation were strongly associated with mortality (Table 2). This discrepancy may be explained by the fact that most critically ill dialysis-dependent patients also require intubation and mechanical ventilation. Intubation itself has been associated with increased risks of nosocomial infection and mortality [24]. Therefore, a critical question remains: Is mortality driven by the act of intubation itself—or by the underlying severity of illness that necessitates such invasive respiratory support?\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAcute kidney injury (AKI) is a significant negative prognostic factor in patients with COVID-19. Mortality appears to be primarily associated with the severity of SARS-CoV-2 infection itself, rather than with the use of respiratory support interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAUTHORS\u0026apos; CONTRIBUTION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKONAN SERGE DIDIER wrote this article, conducted the study and entered the data. He carried out the statistical analysis of the data. OUATTARA KOLO CLAUDE directed this work from the protocol to the final draft. YAO Hubert coordinated the study and publication of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOUATTARA KOLO CLAUDE submitted the article online and adapted it to the journal\u0026apos;s recommendations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. MANAGEMENT OF INTERVIEW AND OBSERVATION DATA\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll recorded data will remain strictly confidential and can only be consulted by the medical team in charge of the research. These data will be subject to computer processing. They can be consulted on request addressed to YAO KOUAME HUBERT.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. COMPENSATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipation in the study was not subject to financial compensation for the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. PROJECT DURATION AND FUNDING\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the authors with their own funds.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. RIGHTS OF THE PARTICIPANT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants were submitted to a confidential questionnaire, and in order to preserve their anonymity a unique number was assigned to them.\u003c/p\u003e\n\u003cp\u003eParticipation in this study was entirely free and voluntary. Participants were free to accept or refuse to participate in our study. Those who accepted were also free, at any time, to end their participation, and, on simple verbal notice without giving an explanation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. DISSEMINATION OF RESULTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study had been submitted only to BMC journal. The manuscript is not under consideration by another journal and has not been previously published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7. CONFLICTS OF INTEREST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project does not represent any risk of conflicts of interest on the part of the researchers, the sponsor or any other person involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003cstrong\u003eLINICAL TRIAL NUMBER\u003c/strong\u003e: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with good clinical practice and national research guidelines. The full study protocol was approved by the Ethics and Scientific Committee of the Treichville University Hospital, in accordance with the Declaration of Helsinki. Informed consent from patients was obtained for their inclusion in the study. To respect the confidentiality of patient records, names were not mentioned, and data collection was carried out during our daily practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;CONSENT TO PUBLISH\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent to Publish declarations: not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e-Bonny V, Maillard A, Mousseaux C, Pla\u0026ccedil;ais L, Richier Q. COVID-19: Pathogenesis of a multi-faceted disease. Rev Med Interne. 2020;41(6):375\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Martinez-Rojas MA, Vega-Vega O, Bobadilla NA. Is the kidney a target of SRAS-CoV-2? AmJ Physiol Ren Physiol. 2020;318(6):F1454\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Rubin S, Orieux A, Prevel R, Garric A, Bats ML, Dabernat S. Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019. Clin Kidney J. 2020;13(3):354\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Jia H, Ng JS Hirsch,* Azzour Hazzan, Wanchoo R, Shah HH, Deepa A, Malieckal DW, Ross P, Sharma V, Sakhiya S, Fishbane, Kenar D, Jhaveri, on behalf of the Northwell Nephrology COVID-19 Research Consortium. Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury. Am J Kidney Dis. 77(2):204\u0026ndash;215. Published online September 19, 2020. 10.1053/ j.ajkd.2020.09.002\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Intensive Care National Audit \u0026amp; Research Centre: ICNARC report on COVID-19 in critical care. 2020. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.icnarc.org/DataServices/Attachments/Download/c31dd38d-d77b-ea11-9124\u003c/span\u003e\u003cspan address=\"https://www.icnarc.org/DataServices/Attachments/Download/c31dd38d-d77b-ea11-9124\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e 00505601089b. Accessed April 21, 2020].\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Morelle J, Devresse A, Demoulin N, GillioMOn V, et al. COVID-19, kidney and kidney diseases. Louvain Med. 2020;139(6):308\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Hirsch JS, Ng JH, Ross DW, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-James PA, Oparil S, Cartel BL, et al. Evidence-based guideline for management of high blood pressure in adults: report from the panel members appointed the Eighth Joint National Committee. JAMA. 2014;311(5):507\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eImran -SA, et al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Targets for Glycemic Control. Can J Diabetes. 2018;42(1):S2\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Malone B, Urakova N, Snijder EJ, et al. Structures and functions of coronavirus replication\u0026ndash;transcription complexes and their relevance for SARS-CoV-2 drug design. Nat Rev Mol Cell Biol. 2022;23(1):21\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Gupta S, Parker J, Smits S, Underwood J, Dolwani S. Persistent viral shedding of SARS-CoV-2 in faeces - a rapid review. Colorectal Dis. 2020;22(6):611\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Okada P, Buathong R, Phuygun S, Thanadachakul T, Parnmen S, Wongboot W, et al. Early transmission patterns of coronavirus disease 2019 (COVID-19) in travellers from Wuhan to Thailand. Eurosurveillance. 2020;25(8):2000097.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Eurosurveillancepatterns of early transmission of coronavirus disease 2019 (COVID-19) among travelers from Wuhan, Thailand. January 2020 n.d. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.8.2000097?crawler=true\u003c/span\u003e\u003cspan address=\"https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.8.2000097?crawler=true\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (accessed April 13,2021).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382:1177\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Coronavirus Disease. (COVID-19) situation reports n.d. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports\u003c/span\u003e\u003cspan address=\"https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (accessed April 13,2021).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCheruiyot -Susan, Shabani J, Shah J, Gathu C, Sokwala A. Associated Factors and Outcomes of Acute Kidney Injury in COVID-19 Patients in Kenya. Can J Kidney Health Disease. 2024;11:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-GaetanoAlfano;Annachiara Ferrari \u0026middot; Francesco Fontana \u0026middot; Giacomo Mori. \u0026middot; Riccardo Magistroni \u0026middot;Marianna Meschiari\u0026middot; Erica Franceschini \u0026middot; Marianna Menozzi\u0026middot; Gianluca Cuomo \u0026middot; Gabriella Orlando \u0026middot; Antonella Santoro \u0026middot; Margherita Digaetano \u0026middot; Cinzia Puzzolante \u0026middot; Federica Carli \u0026middot; Andrea Bedini \u0026middot; Jovana Milic \u0026middot; Irene Coloretti \u0026middot; Paolo Raggi \u0026middot; Cristina Mussini \u0026middot; Massimo Girardis \u0026middot; Gianni Cappelli\u0026middot; Giovanni Guaraldi\u0026middot; for the Modena Covid-19 Working Group (MoCo19). Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19 Clinical and Experimental Nephrology (2021) 25:1203\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmed -Raheel, Maula KF, Ali Z, Ismail M. Inayat Ur Rehman, Sedra Fazle Maula, Samina Masood Ali6, Tahir Mehmood Khan. Acute Kidney Injury and Mortality among Patients with Coronavirus Disease-2019 in Pakistan. Saudi J Kidney Dis Transpl. 2021;32(6):1764\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Edouard L, Fu HW, vander Endt J, Milders, Esmee M, van der Willik, Esther NM, de Rooij OM, Dekkers. Joris I. Rotmans and Merel van Diepen. Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis. Clinical Kidney Journal, 2020,13, 4, 550\u0026ndash;563.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Nugent J, Aklilu A, Yamamoto Y, et al. Assessment of acute kidney injury and longitudinal kidney function after hospital discharge among patients with and without COVID-19. JAMA Netw Open. 2021;4(3):e211095\u0026ndash;211095.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Safwat AM, Eldaboosy SO. Nour,Ahmed Kabil,Ahmad Taha,Sameh Makled,Ahmed Lotfi,Usama Nabway,Hatem Kanany. Acute kidney injury in Coronavirus disease-19 related pneumonia in the intensive care unit: a retrospective multicenter study. Multidisciplinary Respiratory Medicine 2023; volume 18:895.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e; 2010.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://cdn.ymaws.com/www.renalmd\u003c/span\u003e\u003cspan address=\"https://cdn.ymaws.com/www.renalmd\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. org/resource/resmgr/Store/Shared_Decision_Making_Recom. pdf. -Renal Physicians Association. Shared Decision-Making in the Appropriate Initiation of and Withdrawal From Dial ysis: Clinical Practice Guideline. 2nd ed. Renal Physicians Association, Scherer JS, Holley JL. The role of time-limited trials in dialysis decision making in critically ill patients. Clin J Am Soc Nephrol. 2016;11(2):344\u0026ndash;353. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2215/CJN.03550315\u003c/span\u003e\u003cspan address=\"10.2215/CJN.03550315\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHe -Zhangxiu, Peng Z, Gao N, Zhong S, Yu F, Tang Z, Liao Z, Zhao S. Gloria Umwiza, Ming Chen and Wei Long. Risk factors for the mortality of hemodialysis patients with COVID-19 in northern Hunan province, China. BMC Nephrol. 2025;26:26.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acute kidney injury, COVID-19, acute respiratory distress, respiratory support","lastPublishedDoi":"10.21203/rs.3.rs-7577412/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7577412/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe development of acute kidney injury (AKI) is a negative prognostic indicator for survival in patients with COVID-19 infection.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo identify risk factors for mortality among patients with COVID-19 and acute kidney injury.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis was a retrospective, analytical study focusing on acute kidney injury in patients with COVID-19 admitted to the intensive care unit (ICU) of the Infectious and Tropical Diseases Department. The study was conducted between March 2020 and December 2021.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe study included 289 patients who tested positive for COVID-19. Among them, acute kidney injury was observed in 107 cases, representing a prevalence of 37%. The mean age of patients with AKI was 61.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6 years, and 45.7% were aged 65 years or older. Male predominance was noted, with a male-to-female ratio of 2.68. The primary reasons for ICU admission were acute respiratory distress (ARD) in 71% of cases and dyspnea in 12.1%. Comorbidities included hypertension (67.2%), diabetes mellitus (41.1%), and obesity (14.9%). According to KDIGO criteria, AKI was classified as stage 3 in 52.3% of patients, stage 2 in 16.8%, and stage 1 in 30.5%. AKI was identified prior to hospital admission in 40.1% of cases, between 24 and 72 hours after admission in 42.9%, and more than 72 hours after admission in 16.8%. Hemodialysis was performed in 36.4% of patients. The clinical course was marked by death in 68 patients (63.5%). Multivariate analysis identified the following factors as independently associated with increased risk of mortality in the context of COVID-19: acute respiratory distress (OR\u0026thinsp;=\u0026thinsp;5.06; p\u0026thinsp;=\u0026thinsp;0.006), KDIGO stage 3 AKI (OR\u0026thinsp;=\u0026thinsp;5.15; p\u0026thinsp;=\u0026thinsp;0.003), orotracheal intubation (OR\u0026thinsp;=\u0026thinsp;4.37; p\u0026thinsp;=\u0026thinsp;0.0001), and mechanical ventilation (OR\u0026thinsp;=\u0026thinsp;4.01; p\u0026thinsp;=\u0026thinsp;0.0001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eAcute kidney injury (AKI) is an adverse prognostic factor in the context of COVID-19. Mortality appears to be more closely related to the severity of SARS-CoV-2 infection than to respiratory support.\u003c/p\u003e","manuscriptTitle":"Mortality in Patients With Covid-19 and Acute Kidney Injury in the Intensive Care Unit","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 19:05:41","doi":"10.21203/rs.3.rs-7577412/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33205e82-47ba-4c4a-a98d-1504080e2a39","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T16:14:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 19:05:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7577412","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7577412","identity":"rs-7577412","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}