Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19: a multicentre, European, observational cohort study

Ben Carter, Euan Ramsay, Roxanna Short, Sarah Goodison, Jane Lumsden, Amarah Khan, Philip Braude, Arturo Vilches-Moraga, Terence J Quinn, Kathryn McCarthy, Jonathan Hewitt* (Corresponding Author), Phyo Kyaw Myint, COPE Study

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: The reduced renal function has prognostic significance in COVID and it has been linked to mortality in the general population. Reduced renal function is prevalent in older age and thus we set out to better understand its effect on mortality.

Methods: Patient clinical and demographic data was taken from the COVID-19 in
Older People (COPE) study during two periods (February-June 2020 and October
10 2020-March 2021, respectively). Kidney function on admission was measured using estimated glomerular filtration rate (eGFR). The primary outcomes were time to mortality and 28-day mortality. Secondary outcome was length of hospital stay. Data were analysed with multilevel Cox proportional hazards regression, and multilevel logistic regression and adjusted for individual patient clinical and demographic characteristics.

Results: 1,802 patients (55.0% male; median [IQR] 80 [73-86] years) were included in the study. 28-day mortality was 42.3% (n=742). 48% (n=801) had evidence of renal impairment on admission. Using a time-to-event analysis, reduced renal function was associated with increased in-hospital mortality (compared to eGFR ≥60 [Stage 1&2]): eGFR 45-59 [Stage 3a] aHR=1.26 (95%CI 1.02-1.55); eGFR 30-44 [Stage 3b] aHR=1.41 (95%CI 1.14-1.73); eGFR 1-29 [Stage 4&5] aHR=1.42 (95%CI 1.13-1.80). In the co-primary outcome of 28-day mortality, mortality was associated with: Stage 3a adjusted odds ratio (aOR)=1.18 (95%CI 0.88-1.58), Stage 3b aOR=1.40 (95%CI 1.03-1.89); and Stage 4&5 aOR=1.65 (95%CI 1.16-2.35).

Conclusion: eGFR on admission is a good independent predictor of mortality in
hospitalised older patients with COVID-19 population. We found evidence of a dose29 response between reduced renal function and increased mortality.
Original languageEnglish
Article number119
Number of pages8
JournalBMC Geriatrics
Volume22
Issue number1
Early online date12 Feb 2022
DOIs
Publication statusPublished - 12 Feb 2022

Keywords

  • COVID-19
  • chronic kidney failure
  • eGFR
  • mortality
  • dose-response

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