Hemorrhagic and Thromboembolic Complications in Critically Ill Patients with COVID 19 and Acute Kidney Injury: A Single Center Experience

Abstract

Rationale: Patients with COVID-19 critical illness are at high risk for multiorgan dysfunction, most commonly acute kidney injury (AKI). We sought to characterize the rates of thrombotic and hemorrhagic complications in patients with COVID-19 ARDS as a function of coexisting AKI. Methods: We performed a single-center retrospective analysis of all patients with severe COVID-19 infection, admitted to ICU level of care between 3/1/2020 and 6/1/2020, and we obtained patient data through the Research Patient Data Registry. We excluded patients who did not develop AKI, those who were admitted with a primary medical problem unrelated to coexisting COVID-19 infection, and those with end stage renal disease. We stratified patients into two cohorts: Those with AKI not requiring renal replacement therapy (RRT) and AKI requiring RRT. All data collection was approved by the IRB at Mass General Brigham (IRB #2020P001674). All data was analyzed using Excel and R version 4.0.1 (2020-06-06) when comparing groups-medians and interquartile ranges are reported. Pearson's Chi-squared test was used during statistical analysis. Results: 272 patients were identified, of which 136 patients were excluded from further study due to reasons as above. Of the remaining 136 patients analyzed, all developed AKI as per AKIN criteria, and we identified those who did not require RRT (100), and those who were initiated on RRT (36). Median age was 66 ± 9.75, and 57 ± 7.12, respectively. 38% (38/100) and 27.7% (10/36) were female, respectively. Complications investigated included non-cerebrovascular hemorrhage (17% vs. 38.88%, p 0.014), cerebrovascular hemorrhage (4% vs. 16.66%, p 0.033), thromboembolic phenomena (24% vs 38.8%, p 0.136) and overall ICU Mortality (48% vs 38.8%, p 0.45). Conclusions: Patients with COVID-19 ARDS and associated AKI had a high number of hemorrhagic and thromboembolic complications. There is a higher incidence of hemorrhagic and thromboembolic complications in the AKI-RRT group, with CVA-and non-CVAhemorrhagic complications being statistically significant. Overall ICU mortality was apparently lower in the AKIRRT group, without reaching statistical significance. Our data highlight a clinically most relevant topic, defining COVID-19 patients with AKI as a high-risk population for thromboembolic and hemorrhagic complications, and underlining the importance of careful decisions regarding prophylactic anticoagulant strategies.