Hadith Rastad1, Hanieh-Sadat Ejtahed2,3, Gita Shafiee4, Anis Safari5, Ehsan Shahrestanaki6, Zeinab Khodaparast7, Neda Shafiabadi Hassani8, Mohammad Rezaei5, Morteza Nazari6, Akram Zakani9, Mohammad Mahdi Niksima5, Mehdi Azimzadeh5,10, Fatemeh Karimi9, Ramin Tajbakhsh11, Mostafa Qorbani12,13. 1. Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran. 2. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 3. Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 4. Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 5. Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran. 6. Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran. 7. Clinical Research Development Center of Kamali hospital, Alborz University of Medical Sciences, Karaj, Iran. 8. Cardiovascular Research Center of Rajaei, Alborz University of Medical Sciences, Karaj, Iran. 9. Clinical Research Development Center of Rajaei, Alborz University of Medical Sciences, Karaj, Iran. 10. Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran. 11. Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran. ramintajbakkhsh@gmail.com. 12. Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. mqorbani1379@yahoo.com. 13. Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran. mqorbani1379@yahoo.com.
Abstract
BACKGROUND: The extent to which patients with End-stage renal disease (ESRD) are at a higher risk of COVID-19-related death is still unclear. Therefore, the aim of this study was to identify the ESRD patients at increased risk of COVID-19 -related death and its associated factors. METHODS: This retrospective cohort study was conducted on 74 patients with ESRD and 446 patients without ESRD hospitalized for COVID-19 in Alborz province, Iran, from Feb 20 2020 to Apr 26 2020. Data on demographic factors, medical history, Covid-19- related symptoms, and blood tests were obtained from the medical records of patients with confirmed COVID-19. We fitted univariable and multivariable Cox regression models to assess the association of underlying condition ESRD with the COVID-19 in-hospital mortality. Results were presented as crude and adjusted Hazard Ratios (HRs) and 95% confidence intervals (CIs). In the ESRD subgroup, demographic factors, medical history, symptoms, and blood parameters on the admission of survivors were compared with non-survivors to identify factors that might predict a high risk of mortality. RESULTS: COVID-19 patients with ESRD had in-hospital mortality of 37.8% compared to 11.9% for those without ESRD (P value < 0.001). After adjusting for confounding factors, age, sex, and comorbidities, ESRD patients were more likely to experience in-hospital mortality compared to non-ESRD patients (Adjusted HR (95% CI): 2.59 (1.55-4.32)). The Log-rank test revealed that there was a significant difference between the ESRD and non-ESRD groups in terms of the survival distribution (χ2 (1) = 21.18, P-value < 0.001). In the ESRD subgroup, compared to survivors, non-survivors were older, and more likely to present with lack of consciousness or O2 saturation less than 93%; they also had lower lymphocyte but higher neutrophil counts and AST concentration at the presentation (all p -values < 0.05). CONCLUSIONS: Our findings suggested that the presence of ESRD would be regarded as an important risk factor for mortality in COVID-19 patients, especially in those who are older than age 65 years and presented with a lack of consciousness or O2 saturation less than 93%.
BACKGROUND: The extent to which patients with End-stage renal disease (ESRD) are at a higher risk of COVID-19-related death is still unclear. Therefore, the aim of this study was to identify the ESRDpatients at increased risk of COVID-19 -related death and its associated factors. METHODS: This retrospective cohort study was conducted on 74 patients with ESRD and 446 patients without ESRD hospitalized for COVID-19 in Alborz province, Iran, from Feb 20 2020 to Apr 26 2020. Data on demographic factors, medical history, Covid-19- related symptoms, and blood tests were obtained from the medical records of patients with confirmed COVID-19. We fitted univariable and multivariable Cox regression models to assess the association of underlying condition ESRD with the COVID-19 in-hospital mortality. Results were presented as crude and adjusted Hazard Ratios (HRs) and 95% confidence intervals (CIs). In the ESRD subgroup, demographic factors, medical history, symptoms, and blood parameters on the admission of survivors were compared with non-survivors to identify factors that might predict a high risk of mortality. RESULTS:COVID-19patients with ESRD had in-hospital mortality of 37.8% compared to 11.9% for those without ESRD (P value < 0.001). After adjusting for confounding factors, age, sex, and comorbidities, ESRDpatients were more likely to experience in-hospital mortality compared to non-ESRDpatients (Adjusted HR (95% CI): 2.59 (1.55-4.32)). The Log-rank test revealed that there was a significant difference between the ESRD and non-ESRD groups in terms of the survival distribution (χ2 (1) = 21.18, P-value < 0.001). In the ESRD subgroup, compared to survivors, non-survivors were older, and more likely to present with lack of consciousness or O2 saturation less than 93%; they also had lower lymphocyte but higher neutrophil counts and AST concentration at the presentation (all p -values < 0.05). CONCLUSIONS: Our findings suggested that the presence of ESRD would be regarded as an important risk factor for mortality in COVID-19patients, especially in those who are older than age 65 years and presented with a lack of consciousness or O2 saturation less than 93%.
Authors: Carina E Imburgia; Joseph E Rower; Danielle J Green; Autumn M Mcknite; Walter E Kelley; Christopher A Reilly; Kevin M Watt Journal: ASAIO J Date: 2021-11-17 Impact factor: 3.826