COVID-19: Higher Mortality with B.1.1.7 Variant / Acute Kidney Injury / Bamlanivimab + Etesevimab

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Here are some of the recent developments on COVID-19:

Higher mortality with B.1.1.7: The B.1.1.7 variant of SARS-CoV-2 is associated with an increased mortality rate, compared with previously circulating strains, according to a study in The BMJ. Researchers matched nearly 55,000 people in the U.K. who tested positive for the B.1.1.7 variant with a similar number who were positive for other strains. The 28-day mortality rate was higher among those infected with the B.1.1.7 variant (0.41% vs. 0.26%). The authors note: "Other analyses have indicated that the new variant is also associated with increased transmissibility, which would lead to a potentially exponential increase in the resulting number of deaths."

Acute kidney injury: Acute kidney injury (AKI) tied to COVID-19 is associated with a greater decline in kidney function than AKI not linked to COVID-19, according to a study in JAMA Network Open. Researchers studied roughly 1600 patients who developed AKI during their hospital stay between March and August 2020. COVID-19 patients were compared with patients without COVID-19. After discharge, patients with COVID-19-associated AKI had their mean estimated glomerular filtration rates (eGFR) decline 14.0/mL/min/1.73 m²/y faster than did other patients. In addition, among patients without full AKI recovery at discharge, patients with COVID-19 were less likely than other AKI patients to recover during follow-up. The authors conclude: "This eGFR trajectory may reinforce the importance of monitoring kidney function after AKI and studying interventions to limit kidney disease after COVID-19–associated AKI."

Bamlanivimab + etesevimab: The monoclonal antibody combination of bamlanivimab plus etesevimab is associated with an 87% reduced risk for COVID-19 hospitalization or death, the manufacturer reported on Wednesday. Nearly 800 high-risk outpatients aged 12 years and older with mild-to-moderate COVID-19 were randomized to receive either the antibody combination or placebo. The composite of hospitalization or death occurred in 4 patients in the antibody group versus 15 in the placebo group. Four deaths occurred — all in the placebo group. The National Institutes of Health recommends bamlanivimab plus etesevimab for the treatment of outpatients with mild-to-moderate COVID-19 who are at high risk for clinical progression.