IMR Press / RCM / Volume 22 / Issue 4 / DOI: 10.31083/j.rcm2204174
Open Access Original Research
Racial differences in cardiopulmonary outcomes of hospitalized COVID-19 patients with acute kidney injury
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1 Division of Cardiovascular Medicine, Ohio State University, Columbus, OH 43210, USA
2 Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA
3 Department of Internal Medicine, Medical College of Georgia, Augusta, GA 30912, USA
4 Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort-Worth, TX 76107, USA
5 Division of Nuclear Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
6 Department of Hospital Medicine, Covenant Health System, Knoxville, TN 37902, USA
7 Division of Cardiovascular Disease, Emory University School of Medicine, Atlanta, GA 30322, USA
8 Division of Cardiovascular Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA
*Correspondence: (Obiora Egbuche)
Academic Editors: Lee Stoner, Jun Zhang, Ferdinando Carlo Sasso and Davide Bolignano
Rev. Cardiovasc. Med. 2021, 22(4), 1667–1675;
Submitted: 8 August 2021 | Revised: 12 October 2021 | Accepted: 1 November 2021 | Published: 22 December 2021
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

In-hospital acute kidney injury (IH-AKI) has been reported in a significant proportion of patients with COVID-19 and is associated with increased disease burden and poor outcomes. However, the mechanisms of injury are not fully understood. We sought to determine the significance of race on cardiopulmonary outcomes and in-hospital mortality of hospitalized COVID-19 patients with AKI. We conducted a retrospective cohort study of consecutive patients hospitalized in Grady Health System in Atlanta, Georgia between February and July 2020, who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on qualitative polymerase-chain-reaction assay. We evaluated the primary composite outcome of in-hospital cardiac events, and mortality in blacks with AKI versus non-blacks with AKI. In a subgroup analysis, we evaluated the impact of AKI in all blacks and in all non-blacks. Of 293 patients, effective sample size was 267 after all exclusion criteria were applied. The mean age was 61.4 ± 16.7, 39% were female, and 75 (28.1%) had IH-AKI. In multivariable analyses, blacks with IH-AKI were not more likely to have in-hospital cardiac events (aOR 0.3, 95% Confidence interval (CI) 0.04–1.86, p = 0.18), require ICU stay (aOR 0.80, 95% CI 0.20–3.25, p = 0.75), acute respiratory distress syndrome (aOR 0.77, 95% CI 0.16–3.65, p = 0.74), require mechanical ventilation (aOR 0.51, 95% CI 0.12–2.10, p = 0.35), and in-hospital mortality (aOR 1.40, 95% CI 0.26–7.50, p = 0.70) when compared to non-blacks with IH-AKI. Regardless of race, the presence of AKI was associated with worse outcomes. Black race is not associated with higher risk of in-hospital cardiac events and mortality in hospitalized COVID-19 patients who develop AKI. However, blacks with IH-AKI are more likely to have ARDS or die from any cause when compared to blacks without IH-AKI.

Black race
Cardiac events
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