Kenan Turgutalp1, Savas Ozturk2, Mustafa Arici3, Necmi Eren4, Numan Gorgulu5, Mahmut Islam6, Sami Uzun2, Tamer Sakaci7, Zeki Aydin8, Erkan Sengul9, Bulent Demirelli10, Yavuz Ayar11, Mehmet Riza Altiparmak12, Savas Sipahi13, Ilay Berke Mentes14, Tuba Elif Ozler15, Ebru Gok Oguz16, Bulent Huddam17, Ender Hur18, Rumeyza Kazancioglu19, Ozkan Gungor20, Bulent Tokgoz21, Halil Zeki Tonbul22, Alaattin Yildiz23, Siren Sezer24, Ali Riza Odabas25, Kenan Ates26. 1. Department of Nephrology, Mersin University Faculty of Medicine, Mersin, Turkey. 2. Department of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey. 3. Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey. marici@hacettepe.edu.tr. 4. Department of Nephrology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey. 5. Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey. 6. Department of Nephrology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey. 7. Health Sciences University, Sisli Hamidiye Etfal Education and Research Hospital, Nephrology Department, Istanbul, Turkey. 8. Department of Nephrology, Darica Farabi Training and Research Hospital, Kocaeli, Turkey. 9. Health Science University, Kocaeli Derince Education and Research Hospital, Division of Nephrology, Kocaeli, Turkey. 10. Department of Nephrology, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. 11. Department of Nephrology, Bursa City Hospital, Bursa, Turkey. 12. Department of Internal Medicine, Division of Nephrology, Istanbul University- Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey. 13. Department of Internal Medicine, Division of Nephrology, Sakarya University Faculty of Medicine, Education and Research Hospital, Sakarya, Turkey. 14. Department of Internal Medicine, Division of Nephrology, Marmara University School of Medicine. Marmara University Pendik Education and Research Hospital, Istanbul, Turkey. 15. Department of Internal Medicine, Division of Nephrology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey. 16. Department of Nephrology, University of Health Sciences, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey. 17. Departmant of Internal Medicine, Division of Nefrology, Mugla Sitki Kocman University Faculty of Medicine, Education and Research Hospital, Mugla, Turkey. 18. Department of Nephrology, Manisa Merkezefendi State Hospital, Manisa, Turkey. 19. Department of Internal Medicine, Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey. 20. Department of Nephrology, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey. 21. Erciyes University School of Medicine Department of Nephrology, Kayseri, Turkey. 22. Department of Internal Medicine, Division of Nephrology, Necmettin Erbakan University, Konya, Turkey. 23. Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey. 24. Department of Internal Medicine and Nephrology, Atılım University Faculty of Medicine, Ankara, Turkey. 25. Department of Nephrology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey. 26. Ankara University Faculty of Medicine Department of Nephrology, Ankara, Turkey.
Abstract
BACKGROUND: Maintenance hemodialysis (MHD) patients are at increased risk for coronavirus disease 2019 (COVID-19). The aim of this study was to describe clinical, laboratory, and radiologic characteristics and determinants of mortality in a large group of MHD patients hospitalized for COVID-19. METHODS: This multicenter, retrospective, observational study collected data from 47 nephrology clinics in Turkey. Baseline clinical, laboratory and radiological characteristics, and COVID-19 treatments during hospitalization, need for intensive care and mechanical ventilation were recorded. The main study outcome was in-hospital mortality and the determinants were analyzed by Cox regression survival analysis. RESULTS: Of 567 MHD patients, 93 (16.3%) patients died, 134 (23.6%) patients admitted to intensive care unit (ICU) and 91 of the ones in ICU (67.9%) needed mechanical ventilation. Patients who died were older (median age, 66 [57-74] vs. 63 [52-71] years, p = 0.019), had more congestive heart failure (34.9% versus 20.7%, p = 0.004) and chronic obstructive pulmonary disease (23.6% versus 12.7%, p = 0.008) compared to the discharged patients. Most patients (89.6%) had radiological manifestations compatible with COVID-19 pulmonary involvement. Median platelet (166 × 103 per mm3 versus 192 × 103 per mm3, p = 0.011) and lymphocyte (800 per mm3 versus 1000 per mm3, p < 0.001) counts and albumin levels (median, 3.2 g/dl versus 3.5 g/dl, p = 0.001) on admission were lower in patients who died. Age (HR: 1.022 [95% CI, 1.003-1.041], p = 0.025), severe-critical disease clinical presentation at the time of diagnosis (HR: 6.223 [95% CI, 2.168-17.863], p < 0.001), presence of congestive heart failure (HR: 2.247 [95% CI, 1.228-4.111], p = 0.009), ferritin levels on admission (HR; 1.057 [95% CI, 1.006-1.111], p = 0.028), elevation of aspartate aminotransferase (AST) (HR; 3.909 [95% CI, 2.143-7.132], p < 0.001) and low platelet count (< 150 × 103 per mm3) during hospitalization (HR; 1.864 [95% CI, 1.025-3.390], p = 0.041) were risk factors for mortality. CONCLUSION: Hospitalized MHD patients with COVID-19 had a high mortality rate. Older age, presence of heart failure, clinical severity of the disease at presentation, ferritin level on admission, decrease in platelet count and increase in AST level during hospitalization may be used to predict the mortality risk of these patients.
BACKGROUND: Maintenance hemodialysis (MHD) patients are at increased risk for coronavirus disease 2019 (COVID-19). The aim of this study was to describe clinical, laboratory, and radiologic characteristics and determinants of mortality in a large group of MHD patients hospitalized for COVID-19. METHODS: This multicenter, retrospective, observational study collected data from 47 nephrology clinics in Turkey. Baseline clinical, laboratory and radiological characteristics, and COVID-19 treatments during hospitalization, need for intensive care and mechanical ventilation were recorded. The main study outcome was in-hospital mortality and the determinants were analyzed by Cox regression survival analysis. RESULTS: Of 567 MHD patients, 93 (16.3%) patientsdied, 134 (23.6%) patients admitted to intensive care unit (ICU) and 91 of the ones in ICU (67.9%) needed mechanical ventilation. Patients who died were older (median age, 66 [57-74] vs. 63 [52-71] years, p = 0.019), had more congestive heart failure (34.9% versus 20.7%, p = 0.004) and chronic obstructive pulmonary disease (23.6% versus 12.7%, p = 0.008) compared to the discharged patients. Most patients (89.6%) had radiological manifestations compatible with COVID-19 pulmonary involvement. Median platelet (166 × 103 per mm3 versus 192 × 103 per mm3, p = 0.011) and lymphocyte (800 per mm3 versus 1000 per mm3, p < 0.001) counts and albumin levels (median, 3.2 g/dl versus 3.5 g/dl, p = 0.001) on admission were lower in patients who died. Age (HR: 1.022 [95% CI, 1.003-1.041], p = 0.025), severe-critical disease clinical presentation at the time of diagnosis (HR: 6.223 [95% CI, 2.168-17.863], p < 0.001), presence of congestive heart failure (HR: 2.247 [95% CI, 1.228-4.111], p = 0.009), ferritin levels on admission (HR; 1.057 [95% CI, 1.006-1.111], p = 0.028), elevation of aspartate aminotransferase (AST) (HR; 3.909 [95% CI, 2.143-7.132], p < 0.001) and low platelet count (< 150 × 103 per mm3) during hospitalization (HR; 1.864 [95% CI, 1.025-3.390], p = 0.041) were risk factors for mortality. CONCLUSION: Hospitalized MHD patients with COVID-19 had a high mortality rate. Older age, presence of heart failure, clinical severity of the disease at presentation, ferritin level on admission, decrease in platelet count and increase in AST level during hospitalization may be used to predict the mortality risk of these patients.
Authors: Anthony M Valeri; Shelief Y Robbins-Juarez; Jacob S Stevens; Wooin Ahn; Maya K Rao; Jai Radhakrishnan; Ali G Gharavi; Sumit Mohan; S Ali Husain Journal: J Am Soc Nephrol Date: 2020-05-28 Impact factor: 10.121
Authors: Hernando Trujillo; Fernando Caravaca-Fontán; Ángel Sevillano; Eduardo Gutiérrez; Jara Caro; Elena Gutiérrez; Claudia Yuste; Amado Andrés; Manuel Praga Journal: Kidney Int Rep Date: 2020-05-01
Authors: Jia H Ng; Jamie S Hirsch; Rimda Wanchoo; Mala Sachdeva; Vipulbhai Sakhiya; Susana Hong; Kenar D Jhaveri; Steven Fishbane Journal: Kidney Int Date: 2020-08-15 Impact factor: 10.612
Authors: Leszek Tylicki; Ewelina Puchalska-Reglińska; Piotr Tylicki; Aleksander Och; Karolina Polewska; Bogdan Biedunkiewicz; Aleksandra Parczewska; Krzysztof Szabat; Jacek Wolf; Alicja Dębska-Ślizień Journal: J Clin Med Date: 2022-01-06 Impact factor: 4.241