(1339) Impact of Chikungunya Virus Infection on Renal Outcomes: A Case Series From Level 1 Outbreak Country

Introduction: Chikungunya (Chik) virus is an arbovirus transmitted by the Aedes Aegypti mosquito. Classic symptoms are self-limited and involve fever, myalgias, arthralgias, joint edema, arthritis and cutaneous rash. However, in rare circumstances Chik is associated with systemic inflammation, hepatitis, encephalitis and progression to shock. Paraguay is currently undergoing an outbreak of Chik infection with a significant proportion of patients requiring hospital admission.

Methods: The aim of the study was to describe the clinical/laboratory characteristics of patients with Chik infection and evaluate the risks factors for ICU admission, development of AKI, requirement of RRT and hospital mortality. It was a retrospective cohort (Jan-Mar 2023) that included patients (n=31) with Chik infection confirmed by serum RT-PCR. Variables analyzed included Hgb, WBC count, platelets, CRP, creat, BUN and ABG. AKI was diagnosed using KDIGO. Data was analyzed using t-test, odd-ratio and multivariate analysis.

Results: Mean age was 69 years (SD 11) and male gender was 65% (20/31). Comorbid conditions were hypertension 80% (25/31), chronic heart disease 58% (18/31) and type 2 DM 55% (17/31). Mean lab results on admission: Hb 11.8 g/dl (SD 2), WBC count 10,069 cells/uL (SD 7500), platelet count 159,400 cells/uL (SD 77,600), CRP 100 mg/dl (SD 86), BUN 59, 7 mg/dl (SD 33.1), creat 3.6 mg/dl (SD 2.95). AKI stage 1 was found in 10 patients (32%), AKI stage 2 (32%) and AKI stage 3 in 11 patients (35%). Need for ICU admission occurred in 35% (11/31) and progression to RRT occurred in 16% (5/31). Overall mortality was 25.8% (8/31). Variables that predicted mortality were WBC count > 16,200 (p < 0.005) and Ph < 7.24 (p < 0.007). Clinical outcomes that predicted higher mortality were ICU admission (OR 33.2, IC 95% 3.2 - 350) and progression to RRT (OR 6.3, IC 95% 0.8 - 48). In a multivariate analysis, the predictors for AKI and need for ICU admission were leukocytosis, high CRP and metabolic acidosis.

Conclusions: Our study shows that AKI is a strong predictor for poor outcomes (ICU admission and high mortality) during Chik infection. Our mortality rate correlates with previous larger reports (30%). The prognostic markers for development of AKI and need for ICU were leukocytosis, elevated CRP and metabolic acidosis on admission.