COVID-19 patients’ lung involvement severity as a predictor of kidney dysfunction and coagulopathy disorders

Introduction: Kidney dysfunction, coagulopathy disorders, and lung involvement are the most common disorders caused by the COVID-19 virus. Objectives: This study aimed to investigate the correlation of lung involvement severity with kidney dysfunction and coagulopathy disorders in COVID-19 patients. Patients and Methods: This descriptive-analytical study was conducted on 97 patients with COVID-19 referred to Imam Reza hospital in Kermanshah from December 2020 to June 2021. Lung involvement severity, kidney function tests, and coagulation laboratory data were collected. Logistic regression test was conducted to explore the correlation between lung involvement with kidney dysfunction and coagulopathy disorders. Results: Out of 97 patients, 53 (54.6%) were male, with a mean age of 59.31 ± 16.44 years. The correlation between lung involvement severity with kidney function tests, including, blood urea nitrogen, serum creatinine, and coagulation factors, including prothrombin time (PT), partial thromboplastin time (PTT), and D-dimer, were significant ( P > 0.05). Lung involvement severity significantly predicted kidney dysfunction and coagulopathy disorders. Conclusion: Lung involvement severity would be


Implication for health policy/practice/research/ medical education
In a descriptive-analytical study on 97 patients with COVID-19, we found that the correlation between lung involvement with kidney function and coagulation disorder was significant, and lung involvement severity significantly predicted kidney dysfunction and coagulopathy disorders.. correlation between pulmonary involvement severity with renal and coagulation disorders in patients with COVID-19.

Study design and participants
This descriptive-analytical study was conducted on 97 patients with COVID-19 referred to Imam Reza hospital in Kermanshah from December 2020 to June 2021. Inclusion criteria included the definite diagnosis of COVID-19 based on RT-PCR and radiologic findings. At the admission, the chest CT-scan was captured, and the lung involvement severity was determined by an emergency medicine specialist. The laboratory data, including renal function tests and coagulation factors were checked and allocated into two groups of normal and abnormal. Data were recorded in a checklist, and the correlation between lung involvement with kidney dysfunction and coagulopathy disorders were investigated.

Data collection
Demographic characteristics were collected from patients' clinical documents or patients' interviews. Laboratory data were obtained through the health information system (HIS). To calculate lung involvement, a chest CT-scan was captured and analyzed by the researchers (emergency medicine specialists). Radiologic findings were evaluated by the percentage of lung involvement, and based on these results; we classified the cases into three stages severe, moderate, and mild. Lung involvement for each lobe was calculated with a score of one for patients with <5% lung involvement, a score of two for 5-25%, a score of three for 25-50%, a score of four for 50-75%, and a score of five for 75-100% lung involvement. For the total score lung involvement calculation, the scores of all five lobes were added together. Patients without lung involvement were considered normal. To classify lung involvement severity, a score of 1-8 was considered mild, 9-15 moderate, and >15 to 25 was severe (13).

Statistical analysis
Data were analyzed with SPSS version 26. The results for quantitative data were reported as "mean ± standard deviation (SD)" and for qualitative data as "frequency (percentage)". Quantitative variables were used to represent the mean of the data centers and standard deviation was performed to represent the distribution of the data. Analytical tests such as chi-square, Fisher's exact test, and logistic regression were performed to explore the association between lung involvement severity with kidney dysfunction and coagulopathy dysfunction. A P value less than 0.05 was considered significant.

Results
Demographic and clinical characteristics of studded patients were summarized in Table 1. Results demonstrated that most patients were male and without underlying disease. Most of them have severe lung involvement and in the final outcomes got recovery (Table 1).
Results showed that the correlation between the lung involvement severity with kidney function tests such as blood urea nitrogen (BUN) and serum creatinine (Cr) was statistically significant; also, its correlation with coagulation factors such as prothrombin time (PT), partial thromboplastin time (PTT), and D-dimer was significant (Table 2).
Results demonstrated that the correlation of lung involvement severity with kidney dysfunction and coagulopathy disorders was significant. Lung involvement severity could significantly predict BUN, serum creatinine, PT, PTT, and D-dimer abnormalities (Table 3).

Discussion
Our results demonstrated that lung involvement severity and as a result COVID-19 disease severity significantly could predict kidney dysfunction and coagulopathy disorders in COVID-19 patients, and patients with severe pulmonary involvement experienced more renal and coagulation disorders. This finding is similar to a study by Saurabh et al, which reported that SARS-CoV-2 patients' disease severity and lung involvement are significantly   also proved that COVID-19 disease severity is associated with higher D-dimer levels and other coagulopathy disorders (16)(17)(18)(19). It seems that increasing the level of D-dimer value and other coagulation factors in patients with COVID-19 would be able to activate the coagulation cascades and causes the blood vessels' microthrombi that causing disseminated intravascular coagulation (16).
The other finding in this study is to investigate the correlation of lung involvement severity with kidney dysfunction; Results showed that lung involvement severity is associated with BUN and serum creatinine abnormality and significantly predicted kidney dysfunction. This result is consistent with the study by Cheng et al, which reported that kidney dysfunction is a predictor of COVID-19 disease severity and mortality (20). A meta-analysis study by Singh et al showed that renal dysfunction is significantly associated with SARS-CoV-2 disease severity (21). Additionally, Henry et al in a meta-analysis study, reported that kidney disorder and COVID-19 disease severity are correlated (22). It seems that kidney dysfunction in patients with COVID-19 is caused by dehydration and decreased urinary output, which causes diffused complications and other organ failures.

Conclusion
Results in this study, in line with previous studies, demonstrated that the correlation between lung involvement severity with kidney function tests and coagulation factors was significant; therefore, we conclude that lung involvement severity would be able to predict kidney dysfunction and coagulopathy disorders in patients with COVID-19.

Limitations of the study
These data belong to a single center. Therefore, our data should be compared with the data of the other countries.