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; Phyo Kyaw Myint; COPE Study

doi:10.1186/s12877-022-02782-5

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 journal › Article › peer-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 language	English
Article number	119
Number of pages	8
Journal	BMC Geriatrics
Volume	22
Issue number	1
Early online date	12 Feb 2022
DOIs	https://doi.org/10.1186/s12877-022-02782-5
Publication status	Published - 12 Feb 2022

Keywords

COVID-19
chronic kidney failure
eGFR
mortality
dose-response

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Carter, B., Ramsay, E., Short, R., Goodison, S., Lumsden, J., Khan, A., Braude, P., Vilches-Moraga, A., Quinn, T. J., McCarthy, K., Hewitt, J., Myint, P. K., & COPE Study (2022). Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19: a multicentre, European, observational cohort study. BMC Geriatrics, 22(1), [119]. https://doi.org/10.1186/s12877-022-02782-5

Carter, B, Ramsay, E, Short, R, Goodison, S, Lumsden, J, Khan, A, Braude, P, Vilches-Moraga, A, Quinn, TJ, McCarthy, K, Hewitt, J, Myint, PK & COPE Study 2022, 'Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19: a multicentre, European, observational cohort study', BMC Geriatrics, vol. 22, no. 1, 119. https://doi.org/10.1186/s12877-022-02782-5

@article{48a43d16f91848f1ab64b08f3a3a7464,

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

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 inOlder People (COPE) study during two periods (February-June 2020 and October10 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 inhospitalised older patients with COVID-19 population. We found evidence of a dose29 response between reduced renal function and increased mortality.",

keywords = "COVID-19, chronic kidney failure, eGFR, mortality, dose-response",

author = "Ben Carter and Euan Ramsay and Roxanna Short and Sarah Goodison and Jane Lumsden and Amarah Khan and Philip Braude and Arturo Vilches-Moraga and Quinn, {Terence J} and Kathryn McCarthy and Jonathan Hewitt and Myint, {Phyo Kyaw} and {COPE Study}",

note = "Acknowledgements: COPE Team Members (collaborators). Funding: No funding declared for this study. The Study was sponsored by Cardiff University who had no role on the study design, analysis or interpretation of the findings. BC is partially supported by the NIHR Maudsley Biomedical Research Centre at South London Maudsley NHS Foundation Trust, and King's College London. EAR received the Gwyn Seymour Scholarship from the Department of Medicine for the Elderly, NHS Grampian, as part of the Aberdeen Summer Research Scholarship Scheme, Aberdeen Clinical Academic Training Programme, University of Aberdeen.",

year = "2022",

month = feb,

day = "12",

doi = "10.1186/s12877-022-02782-5",

language = "English",

volume = "22",

journal = "BMC Geriatrics",

issn = "1471-2318",

publisher = "BioMed Central",

number = "1",

}

TY - JOUR

T1 - Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19

T2 - a multicentre, European, observational cohort study

AU - Carter, Ben

AU - Ramsay, Euan

AU - Short, Roxanna

AU - Goodison, Sarah

AU - Lumsden, Jane

AU - Khan, Amarah

AU - Braude, Philip

AU - Vilches-Moraga, Arturo

AU - Quinn, Terence J

AU - McCarthy, Kathryn

AU - Hewitt, Jonathan

AU - Myint, Phyo Kyaw

AU - COPE Study

N1 - Acknowledgements: COPE Team Members (collaborators). Funding: No funding declared for this study. The Study was sponsored by Cardiff University who had no role on the study design, analysis or interpretation of the findings. BC is partially supported by the NIHR Maudsley Biomedical Research Centre at South London Maudsley NHS Foundation Trust, and King's College London. EAR received the Gwyn Seymour Scholarship from the Department of Medicine for the Elderly, NHS Grampian, as part of the Aberdeen Summer Research Scholarship Scheme, Aberdeen Clinical Academic Training Programme, University of Aberdeen.

PY - 2022/2/12

Y1 - 2022/2/12

N2 - 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 inOlder People (COPE) study during two periods (February-June 2020 and October10 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 inhospitalised older patients with COVID-19 population. We found evidence of a dose29 response between reduced renal function and increased mortality.

AB - 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 inOlder People (COPE) study during two periods (February-June 2020 and October10 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 inhospitalised older patients with COVID-19 population. We found evidence of a dose29 response between reduced renal function and increased mortality.

KW - COVID-19

KW - chronic kidney failure

KW - eGFR

KW - mortality

KW - dose-response

U2 - 10.1186/s12877-022-02782-5

DO - 10.1186/s12877-022-02782-5

M3 - Article

C2 - 35151257

VL - 22

JO - BMC Geriatrics

JF - BMC Geriatrics

SN - 1471-2318

IS - 1

M1 - 119

ER -

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

Abstract

Keywords

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