Ozgur Akin Oto1, Savas Ozturk2, Kenan Turgutalp3, Mustafa Arici4, Nadir Alpay5, Ozgur Merhametsiz6, Savas Sipahi7, Melike Betul Ogutmen8, Berna Yelken9, Mehmet Riza Altiparmak10, Numan Gorgulu11, Erhan Tatar12, Oktay Ozkan2, Yavuz Ayar13, Zeki Aydin14, Hamad Dheir15, Abdullah Ozkok16, Seda Safak17, Mehmet Emin Demir6, Ali Riza Odabas18, Bulent Tokgoz19, Halil Zeki Tonbul20, Siren Sezer21, Kenan Ates22, Alaattin Yildiz17. 1. Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey. maviozgurluk@gmail.com. 2. Department of Nephrology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey. 3. Division of Nephrology, Department of Internal Medicine, Mersin University Faculty of Medicine, Training and Research Hospital, Mersin, Turkey. 4. Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey. 5. Division of Nephrology, Memorial Hizmet Hospital Department of Internal Medicine, İstanbul, Turkey. 6. Division of Nephrology, Department of Internal Medicine, Yeni Yuzyil University Faculty of Medicine, Istanbul, Turkey. 7. Division of Nephrology, Department of Internal Medicine, Sakarya University Faculty of Medicine, Training and Research Hospital, Sakarya, Turkey. 8. Department of Nephrology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey. 9. Department of Transplantation, Koc University Hospital, Istanbul, Turkey. 10. Division of Nephrology, Department of Internal Medicine, Istanbul University - Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey. 11. Division of Nephrology, Department of Internal Medicine, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey. 12. Department of Nephrology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey. 13. Department of Nephrology, Bursa City Hospital, Bursa, Turkey. 14. Department of Nephrology, Darica Farabi Training and Research Hospital, Kocaeli, Turkey. 15. Division of Nephrology, Department of Internal Medicine, Sakarya University Training and Research Hospital, Sakarya, Turkey. 16. Şişli Memorial Hospital Department of Internal Medicine, Division of Nephrology, İstanbul, Turkey. 17. Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey. 18. Department of Nephrology, University of Health Sciences, Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkey. 19. Department of Nephrology, Erciyes University Faculty of Medicine, Kayseri, Turkey. 20. Department of Nephrology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey. 21. Division of Nephrology, Department of Internal Medicine, Atilim University Faculty of Medicine, Istanbul, Turkey. 22. Division of Nephrology, Department of Internal Medicine, Ankara University Faculty of Medicine, Ankara, Turkey.
Abstract
BACKGROUND: We aimed to present the demographic characteristics, clinical presentation, and outcomes of our multicenter cohort of adult KTx recipients with COVID-19. METHODS: We conducted a multicenter, retrospective study using data of patients hospitalized for COVID-19 collected from 34 centers in Turkey. Demographic characteristics, clinical findings, laboratory parameters (hemogram, CRP, AST, ALT, LDH, and ferritin) at admission and follow-up, and treatment strategies were reviewed. Predictors of poor clinical outcomes were analyzed. The primary outcomes were in-hospital mortality and the need for ICU admission. The secondary outcome was composite in-hospital mortality and/or ICU admission. RESULTS: One hundred nine patients (male/female: 63/46, mean age: 48.4 ± 12.4 years) were included in the study. Acute kidney injury (AKI) developed in 46 (42.2%) patients, and 4 (3.7%) of the patients required renal replacement therapy (RRT). A total of 22 (20.2%) patients were admitted in the ICU, and 19 (17.4%) patients required invasive mechanical ventilation. 14 (12.8%) of the patients died. Patients who were admitted in the ICU were significantly older (age over 60 years) (38.1% vs 14.9%, p = 0.016). 23 (21.1%) patients reached to composite outcome and these patients were significantly older (age over 60 years) (39.1% vs. 13.9%; p = 0.004), and had lower serum albumin (3.4 g/dl [2.9-3.8] vs. 3.8 g/dl [3.5-4.1], p = 0.002), higher serum ferritin (679 μg/L [184-2260] vs. 331 μg/L [128-839], p = 0.048), and lower lymphocyte counts (700/μl [460-950] vs. 860 /μl [545-1385], p = 0.018). Multivariable analysis identified presence of ischemic heart disease and initial serum creatinine levels as independent risk factors for mortality, whereas age over 60 years and initial serum creatinine levels were independently associated with ICU admission. On analysis for predicting secondary outcome, age above 60 and initial lymphocyte count were found to be independent variables in multivariable analysis. CONCLUSION: Over the age of 60, ischemic heart disease, lymphopenia, poor graft function were independent risk factors for severe COVID-19 in this patient group. Whereas presence of ischemic heart disease and poor graft function were independently associated with mortality.
BACKGROUND: We aimed to present the demographic characteristics, clinical presentation, and outcomes of our multicenter cohort of adult KTx recipients with COVID-19. METHODS: We conducted a multicenter, retrospective study using data of patients hospitalized for COVID-19 collected from 34 centers in Turkey. Demographic characteristics, clinical findings, laboratory parameters (hemogram, CRP, AST, ALT, LDH, and ferritin) at admission and follow-up, and treatment strategies were reviewed. Predictors of poor clinical outcomes were analyzed. The primary outcomes were in-hospital mortality and the need for ICU admission. The secondary outcome was composite in-hospital mortality and/or ICU admission. RESULTS: One hundred nine patients (male/female: 63/46, mean age: 48.4 ± 12.4 years) were included in the study. Acute kidney injury (AKI) developed in 46 (42.2%) patients, and 4 (3.7%) of the patients required renal replacement therapy (RRT). A total of 22 (20.2%) patients were admitted in the ICU, and 19 (17.4%) patients required invasive mechanical ventilation. 14 (12.8%) of the patientsdied. Patients who were admitted in the ICU were significantly older (age over 60 years) (38.1% vs 14.9%, p = 0.016). 23 (21.1%) patients reached to composite outcome and these patients were significantly older (age over 60 years) (39.1% vs. 13.9%; p = 0.004), and had lower serum albumin (3.4 g/dl [2.9-3.8] vs. 3.8 g/dl [3.5-4.1], p = 0.002), higher serum ferritin (679 μg/L [184-2260] vs. 331 μg/L [128-839], p = 0.048), and lower lymphocyte counts (700/μl [460-950] vs. 860 /μl [545-1385], p = 0.018). Multivariable analysis identified presence of ischemic heart disease and initial serum creatinine levels as independent risk factors for mortality, whereas age over 60 years and initial serum creatinine levels were independently associated with ICU admission. On analysis for predicting secondary outcome, age above 60 and initial lymphocyte count were found to be independent variables in multivariable analysis. CONCLUSION: Over the age of 60, ischemic heart disease, lymphopenia, poor graft function were independent risk factors for severe COVID-19 in this patient group. Whereas presence of ischemic heart disease and poor graft function were independently associated with mortality.
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