{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T01:31:13Z","timestamp":1783474273509,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T00:00:00Z","timestamp":1647561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Acute kidney injury (AKI), electrolyte, and acid\u2013base disorders complicate the clinical course of critically ill patients with coronavirus-associated disease (COVID-19) and are associated with poor outcomes. It is not known whether the severity of clinical conditions at admission in the intensive care unit (ICU) changes the clinical significance of AKI and\/or electrolyte or acid\u2013base disorders developing during ICU stay. We conducted a retrospective study in critically ill patients with COVID-19 to evaluate whether the severity of clinical conditions at admission in the ICU affects the impact of AKI and of serum electrolytes or acid\u2013base status on mortality. We carried out a 28-day retrospective follow-up study on 115 critically ill patients consecutively admitted to ICU for severe COVID-19 at a tertiary care university hospital and surviving longer than 24 h. We collected baseline demographic and clinical characteristics, and longitudinal data on kidney function, kidney replacement therapy, serum electrolytes, and acid\u2013base status. We used Cox proportional hazards multiple regression models to test the interaction between the time-varying variates new-onset AKI or electrolyte or acid\u2013base disorders and Sequential Organ Failure Assessment (SOFA) or Acute Physiology and Chronic Health Evaluation II (APACHE II) score at admission. After adjusting for age, sex, Charlson\u2019s comorbidity index, and AKI present at ICU admission, new-onset AKI was significantly associated with 28-day mortality only in the patients in the lowest and middle SOFA score tertiles [lowest SOFA tertile, hazard ratio (HR) 4.27 (95% CI: 1.27\u201314.44; <jats:italic>P<\/jats:italic> = 0.019), middle SOFA tertile, HR 3.17 (95% CI: 1.11\u20139.04, <jats:italic>P<\/jats:italic> = 0.031), highest SOFA tertile, HR 0.77 (95% CI: 0.24\u20132.50; <jats:italic>P<\/jats:italic> = 0.66); <jats:italic>P<\/jats:italic> = 0.026 for interaction with SOFA as a continuous variable]. After stratifying for APACHE II tertile, results were similar [adjusted HR (aHR) in the lowest tertile 6.24 (95% CI: 1.85\u201321.03, <jats:italic>P<\/jats:italic> = 0.003)]. SOFA or APACHE II at admission did not affect the relationship of serum electrolytes and acid\u2013base status with mortality, except for new-onset acidosis which was associated with increased mortality, with the HR of death increasing with SOFA or APACHE II score (<jats:italic>P<\/jats:italic> &amp;lt; 0.001 and <jats:italic>P<\/jats:italic> = 0.013, respectively). Thus, unlike in the most severe critically ill patients admitted to the ICU for COVID-19, in patients with the less severe conditions at admission the development of AKI during the stay is a strong indicator of increased hazard of death.<\/jats:p>","DOI":"10.3389\/fmed.2022.799298","type":"journal-article","created":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T04:57:06Z","timestamp":1647579426000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["The Association of New-Onset Acute Kidney Injury and Mortality in Critically Ill Patients With COVID-19 With Less Severe Clinical Conditions at Admission: A Moderation Analysis"],"prefix":"10.3389","volume":"9","author":[{"given":"Giuseppe","family":"Regolisti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Maggiore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Di Mario","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micaela","family":"Gentile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe Daniele","family":"Benigno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Gandolfini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Pistolesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santo","family":"Morabito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Barbagallo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Picetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Fiaccadori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10050900","article-title":"COVID-19 and the kidney: a worrisome scenario of acute and chronic consequences.","volume":"10","author":"Sanchez-Russo","year":"2021","journal-title":"J Clin Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.xkme.2020.11.008","article-title":"The prevalence of acute kidney injury in patients hospitalized with COVID-19 infection: a systematic review and meta-analysis.","volume":"3","author":"Silver","year":"2021","journal-title":"Kidney Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/j.kint.2020.05.006","article-title":"Acute kidney injury in patients hospitalized with COVID-19.","volume":"98","author":"Hirsch","year":"2020","journal-title":"Kidney Int."},{"key":"B4","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.1681\/ASN.2020040426","article-title":"Clinicopathological features and outcomes of acute kidney injury in critically ill COVID-19 with prolonged disease course: a retrospective cohort.","volume":"31","author":"Xia","year":"2020","journal-title":"J Am Soc Nephrol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1681\/ASN.2020060897","article-title":"AKI treated with renal replacement therapy in critically ill patients with COVID-19.","volume":"32","author":"Gupta","year":"2021","journal-title":"J Am Soc Nephrol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.1001\/jamainternmed.2020.3596","article-title":"Factors associated with death in critically ill patients with Coronavirus disease 2019 in the US.","volume":"180","author":"Gupta","year":"2020","journal-title":"JAMA Intern Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1093\/ckj\/sfaa112","article-title":"Kidney disease and electrolytes in COVID-19: more than meets the eye.","volume":"13","author":"Carriazo","year":"2020","journal-title":"Clin Kidney J."},{"key":"B9","doi-asserted-by":"publisher","first-page":"23","DOI":"10.5049\/EBP.2020.18.2.23","article-title":"Hypertension and electrolyte disorders in patients with COVID-19.","volume":"18","author":"Lim","year":"2020","journal-title":"Electrolyte Blood Press."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/6667047","article-title":"Fluid and electrolyte disturbances in COVID-19 and their complications.","volume":"2021","author":"Pourfridoni","year":"2021","journal-title":"Biomed Res Int."},{"key":"B11","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1007\/s10157-020-01996-4","article-title":"Hypokalemia in patients with COVID 19.","volume":"25","author":"Alfano","year":"2021","journal-title":"Clin Exp Nephrol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1007\/s11739-021-02632-z","article-title":"Electrolyte imbalance in COVID 19 patients admitted to the emergency department: a case\u2013control study.","volume":"16","author":"De Carvalho","year":"2021","journal-title":"Intern Emerg Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1177\/0004563220972539","article-title":"Correlating arterial blood gas, acid\u2013base and blood pressure abnormalities with outcomes in COVID-19 intensive care patients.","volume":"58","author":"Bezuidenhout","year":"2021","journal-title":"Ann Clin Biochem."},{"key":"B14","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1016\/j.chest.2021.04.062","article-title":"Identification of distinct clinical subphenotypes in critically ill patients with COVID-19.","volume":"160","author":"Vasquez","year":"2021","journal-title":"Chest."},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmni.2020.100753","article-title":"Baseline electrolyte abnormalities would be related to poor prognosis in hospitalized coronavirus disease 2019 patients.","volume":"37","author":"Tezcan","year":"2020","journal-title":"New Microbes New Infect."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1007\/s40618-020-01301-w","article-title":". Hyponatremia, IL-6, and SARS-CoV-2 (COVID-19) infection: may all fit together?","volume":"43","author":"Berni","year":"2020","journal-title":"J Endocrinol Invest."},{"key":"B17","first-page":"1","article-title":"KDIGO clinical practice guideline for acute kidney injury.","volume":"2","year":"2012","journal-title":"Kidney Int Suppl."},{"key":"B18","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International consensus definitions for sepsis and septic shock (Sepsis-3).","volume":"31","author":"Singer","year":"2016","journal-title":"JAMA."},{"key":"B19","first-page":"1","article-title":"KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.","volume":"3","year":"2013","journal-title":"Kidney Int Suppl."},{"key":"B20","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.jcrc.2021.01.013","article-title":"Sustained low-efficiency dialysis with regional citrate anticoagulation in critically ill patients with COVID-19 associated AKI: a pilot study.","volume":"63","author":"Di Mario","year":"2021","journal-title":"J Crit Care."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1482","DOI":"10.2215\/CJN.00710113","article-title":"World incidence of AKI: a meta-analysis.","volume":"8","author":"Susantitaphong","year":"2013","journal-title":"Clin J Am Soc Nephrol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1016\/j.ekir.2020.06.013","article-title":"Outcomes for patients with COVID-19 and acute kidney injury: a systematic review and meta-analysis.","volume":"5","author":"Robbins-Juarez","year":"2020","journal-title":"Kidney Int Rep."},{"key":"B23","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/j.mayocpiqo.2020.07.00","article-title":"Incidence and risk factors for acute kidney injury and its effect on mortality in patients hospitalized from COVID-19.","volume":"4","author":"Nimkar","year":"2020","journal-title":"Mayo Clin Proc Innov Qual Outcomes."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1863","DOI":"10.1007\/s00134-020-06211-2","article-title":"Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study.","volume":"46","author":"Xie","year":"2020","journal-title":"Intensive Care Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1177\/088506662097085","article-title":"Clinical characteristics and outcomes of patients with severe COVID-19 induced acute kidney injury.","volume":"36","author":"Xu","year":"2021","journal-title":"J Intensive Care Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/s40620-020-00918-7","article-title":"Severe acute kidney injury in critically ill COVID-19 patients.","volume":"34","author":"Pi\u00f1eiro","year":"2021","journal-title":"J Nephrol."},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.11122","article-title":"Assessment of hypokalemia and clinical characteristics in patients with coronavirus disease 2019 in Wenzhou, China.","volume":"3","author":"Chen","year":"2020","journal-title":"JAMA Netw Open."},{"key":"B28","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China.","volume":"382","author":"Guan","year":"2020","journal-title":"N Engl J Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1002\/jmv.25783","article-title":"Clinical features and treatment of COVID-19 patients in northeast Chongqing.","volume":"92","author":"Wan","year":"2020","journal-title":"J Med Virol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1093\/qjmed\/hcaa089","article-title":"Epidemiologic and clinical characteristics of 91 hospitalized patients with COVID-19 in Zhejiang, China: a retrospective, multi-centre case series.","volume":"113","author":"Qian","year":"2020","journal-title":"QJM."},{"key":"B32","doi-asserted-by":"publisher","first-page":"893","DOI":"10.3967\/bes2020.123","article-title":"Association of overlapped and un-overlapped comorbidities with COVID-19 severity and treatment outcomes: a retrospective cohort study from nine provinces in China.","volume":"33","author":"Yan","year":"2020","journal-title":"Biomed Environ Sci."},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22094503","article-title":"Dysregulation of the renin-angiotensin-aldosterone system (RAA) in patients infected with SARS-CoV-2-possible clinical consequences.","volume":"22","author":"Dettlaff-Pokora","year":"2021","journal-title":"Int J Mol Sci."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.799298\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T04:57:13Z","timestamp":1647579433000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.799298\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,18]]},"references-count":33,"alternative-id":["10.3389\/fmed.2022.799298"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.799298","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,18]]},"article-number":"799298"}}