Associated factors for critical illness and mortality in chronic kidney disease patients admitted with COVID-19 at Nakornping Hospital

Abstract

Introduction: Chronic kidney disease (CKD) is an important risk factor for severe coronavirus disease 2019 (COVID-19). Patients with CKD have a higher risk of hospitalization, critical illness, and death compared with the general population. However, data on factors that predict severe disease and mortality specifically in patients with moderate-to-advanced CKD are still limited, especially in real-world clinical settings.

Objective: This study aims to identify clinical and laboratory factors associated with progression to critical illness or in-hospital mortality among patients with stage 3–4 CKD hospitalized for COVID-19 at Nakornping Hospital.

Methods: This retrospective cohort study was conducted at Nakornping Hospital. We reviewed electronic medical records of adult patients with stage 3-4 CKD who were admitted with confirmed COVID-19 between March 2020 and 2022. Baseline demographic data, comorbidities, and laboratory results at hospital admission were collected. The primary outcome was a composite of critical illness or in-hospital death. Multivariate logistic regression analysis was used to identify independent factors associated with the primary outcome.

Results: A total of 128 in-patients with stage 3–4 CKD and COVID-19 were included; 48 patients (37.5%) had mild-to-moderate disease, while 80 patients (62.5%) developed critical illness or died during hospitalization. Advanced age (> 80 years) was significantly associated with a higher risk of critical illness or death (OR 3.13, 95% CI 1.14-8.61, p = 0.027) and also patients with stage IV CKD (OR 2.56, 95% CI 1.20-5.42, p = 0.014), elevated white blood cell count (> 10,000/μL) (OR 2.75, 95% CI 1.23-6.16, p = 0.014), elevated sodium levels (OR 8.71, 95% CI 1.09-19.93, p=0.042), increased C-reactive protein (OR 1.00 95% CI 1.00-1.01, p < 0.001), lower serum albumin levels (OR 1.37, 95% CI 1.06-1.77, p=0.015), and elevated serum lactate levels (OR 5.93 95% CI 1.65-21.32, p = 0.013). Sex, diabetes mellitus, hypertension, and prior COVID-19 vaccination were not significantly associated with the primary outcome. After adjusted for laboratory variables, only WBC > 10,000/μL and lactate > 3 mmol/L had been significantly associated with higher risk of critical illness or death (AOR 4.70, 95% CI 1.51-14.61, p= 0.008 and AOR 9.36, 95% CI 2.13-41.06, p= 0.003).

Conclusion: PIMs used among older adults in this setting was high. Universal coverage health insurance, polypharmacy (≥ 5 medications), and musculoskeletal disease were significantly associated with PIMs use.