Predictors of Acute Kidney Injury and In-Hospital Mortality in Patients With RT-PCR Confirmed Lassa Fever in Southwest Nigeria

Abstract

Abstract Background Data on the epidemiology of acute kidney injury (AKI) in adults hospitalized with Lassa fever is limited. We investigated the rates and predictors of AKI and in-hospital mortality at a National Treatment Centre in Southwest Nigeria. Methods This retrospective study included 482 adults with RT-PCR-confirmed Lassa fever admitted to the Federal Medical Centre, Owo, Ondo State, Nigeria, from January 2019 to December 2024. Predictors of AKI and in-hospital mortality were identified by multivariable logistic regression and Cox proportional hazards regression analyses. Results Acute kidney injury prevalence was 21% (95% CI, 17.4%–24.9%). Overall, 48 patients (10.1%) died: 33 (32.7%) with AKI and 15 (4.0%) without AKI (OR 11.647; 95% CI, 6.001–22.604; P < .001). Independent predictors of AKI included male sex (P < .001), bleeding abnormalities (P = .044), diabetes (P = .029), elevated white blood cell count (P = .005), increased neutrophil count (P = .003), and elevated aspartate transaminase (P = .017). Predictors of in-hospital mortality were AKI (P = .033), oliguria (P = .045), mean arterial blood pressure (P = .001), hematuria (P = .015), and elevated monocyte count (P = .022). Kaplan–Meier analysis demonstrated significantly poorer survival in patients with AKI versus those without (mean survival 19.0 vs 29.7 days; P ≤ .001). Conclusions Acute kidney injury complicates approximately one-fifth of RT-PCR-confirmed Lassa fever hospitalizations and is associated with an 11-fold increase in mortality. Male sex, bleeding, diabetes, leukocytosis, and elevated aspartate transaminase independently predict AKI, while oliguria, hematuria, blood pressure, and monocyte count predict death.