Association between acute kidney injury and in-hospital mortality in patients with myocardial infarction and COVID-19

Objective. The aim of the paper is to evaluate the incidence and clinical phenotypes of acute kidney injury (AKI) in patients with myocardial infarction (MI) and COVID-19 following percutaneous coronary intervention (PCI), and to assess the association of AKI and its phenotypes with in-hospital mortality. Materials and Methods. We evaluated 132 patients (82 (62 %) men, 50 (38 %) women; median age 68 (62; 74) years) with MI and confirmed COVID-19 who underwent PCI. Results. AKI was diagnosed in 58 (44 %) patients. The distribution by severity stages was as follows: Stage 1 in 45 (77 %) patients, Stage 2 in 8 (14 %), and Stage 3 in 5 (9 %). The community-acquired phenotype predominated (40 (69 %) patients), while hospital-acquired AKI was observed in 31 % of cases (18 patients). In 21 (36 %) patients, AKI superimposed on pre-existing chronic kidney disease (CKD), whereas the remaining 37 (64 %) patients had no prior history of CKD. AKI was present in the majority of patients who died in the hospital (19 (76 %)), and its presence was associated with a significantly increased risk of in-hospital mortality (OR 5.52; 95 % CI 2.01–15.13; p=0.0008). In-hospital mortality was highest in patients with community-acquired new-onset AKI and those with hospital-acquired AKI superimposed on CKD (10 (38 %) and 5 (56 %) patients, respectively). Conclusion. Patients with MI and COVID-19 undergoing PCI exhibited a high incidence of AKI, predominantly characterized by Stage 1 severity and the community-acquired new-onset phenotype. AKI was associated with a significantly increased risk of in-hospital mortality. The most unfavorable phenotypes regarding in-hospital death were community-acquired new-onset AKI and hospital-acquired AKI superimposed on CKD.