Study of the Treatment and Outcomes in Critically Ill Patients With COVID-19 and High Risk of Acute Kidney Injury

Since the outbreak of coronavirus disease 2019 (COVID-19) began in December 2019 in China,
over 1 million people have been infected and over 55,000 have died worldwide, and these
numbers continue to rise. Combating this pandemic requires a multidisciplinary approach from
the medical research community, including translational studies to understand the
pathogenesis of disease, randomized controlled trials of novel and re-purposed
pharmacotherapies, and rigorously conducted epidemiologic studies that include granular
patient-level data.

Current knowledge of the clinical features and outcomes of COVID-19 is mostly limited to
studies from China and Italy. In one of the larger such studies, which consisted of 1099
patients hospitalized in mainland China, only 173 (16%) were classified as having severe
disease, and only 15 (1.4%) died. The study was therefore inadequately powered to determine
independent risk factors for death. A larger study consisting of 72,314 patients was recently
published by the Chinese Center for Disease Control and Prevention. This nationwide registry
study identified several important findings, including the striking monotonic relationship
between older age and greater risk of death. Important limitations of the study, however,
were lack of granular patient-level data and relatively few patients (<5% of the cohort) who
were critically ill. Among critically ill patients with COVID-19, acute mortality rates have
been reported to be as high as 49-62%, underscoring the importance of studying this patient
population. Data from the United Kingdom (UK) suggest that >50% of critically ill patients
have a degree of acute kidney injury (AKI) and >20% need renal replacement therapy (RRT).
Mortality is particularly high in those who are mechanically ventilated and need RRT (>75%).

Detailed information about the risk of AKI, contributing factors and reasons for high
mortality in critically ill COVID-19 patients is lacking. To meet this urgent need, the
investigators plan to collect clinical data from >250 critically ill patients with COVID-19
admitted to the intensive care unit (ICU) at Guy's & St Thomas' Hospital. The investigators
will collaborate with Dr Gupta and Prof Leaf from Harvard Medical School, Boston (US) who are
leading a similar study across >50 sites in the United States.

The aim is to describe the epidemiology and determine the independent risk factors for
mortality and acute organ injury in AKI and to assess the impact of different treatment
strategies on survival. This will allow the development of prevention strategies and design
of appropriately powered intervention studies.