Combined effect of Controlling Nutritional Status and Acute Kidney Injury on severe COVID-19 short-term outcomes

Salam, Bennouar; Abdelghani, Bachir Cherif; Amel, Kessira; Djamel-Eddine, Bennouar; Samia, Abdi

Introduction/ Objectives: Acute kidney injury (AKI) and malnutrition are two complications commonly reported in severe forms of COVID-19, their combined effect on short-term mortality is, however, not yet investigated. The objective of this study is to determine both their individual and combined effects on short-term prognosis. Materials and methods: This is a prospective, uni-centric study, including 247 severe COVID-19 patients, admitted between March 25th and May 20th, 2020, at the University Hospital of Blida. AKI was defined according to the KDIGO-2012 guidelines. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. The association with in-hospital mortality was assessed using the Kaplan-Meier method and proportional Cox regression. Results: Among the 247 severely affected COVID-19 patients included in this study, 34.4% developed AKI, 30.4 and 1.2%, respectively, had moderate and severe CONUT scores, 17.7% worsened and progressed to a critical state and 26.7% did not survive. Both AKI and CONUT score were significantly associated with mortality in a dose-response manner (pLog-Rank<0.0001). Their relative risks are respectively (HR=3.25 CI 95% [1.99-5.3] and HR=2.42 CI 95% [1.5-3.9], p<0.0001). In multivariate analysis, the highest risk was observed for the AKI-CONUT-high combination (HR=3.0, 95% CI [1.5-6.1], p=0.002). Conclusion: A possible synergistic interaction between AKI and CONUT score for COVID-19 short-term mortality has been highlighted. Monitoring of renal function associated with assessment of nutritional status should be performed routinely and systematically from the early stages of admission.