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Sertbas Y, Solak EE, Dagci S, Kizilay V, Yazici Z, Elarslan S, Ozdil K. Clinical outcomes of COVID-19 in patients with chronic diseases. North Clin Istanb 2023; 10:401-410. [PMID: 37719255 PMCID: PMC10500237 DOI: 10.14744/nci.2022.64436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/31/2022] [Accepted: 10/10/2022] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVE This study was carried out to evaluate the clinical outcomes of patients having chronic diseases (CD) and COVID-19 infection. METHODS The study was carried out retrospectively by including 1.516 patients with CDs who applied to two education and research hospitals between June 01, 2021, and August 01, 2021, and were diagnosed with COVID-19. As CDs; cardiovascular diseases, diabetes mellitus (DM), hyperlipidemia, asthma, chronic obstructive pulmonary diseases, rheumatological diseases, malignancy, cerebrovascular disease, and chronic kidney diseases (CKD) were screened and evaluated statistically. RESULTS A total of 1.516 patients with a mean age of 58.05±18.51 years were included in the study. It has been observed that 68.9% of COVID-19 patients have at least one CD. Women were more tend to have CDs than men (73.8% vs. 64.8%). Patients with a history of CD were significantly older and had a longer hospital stay than those without. Patients with CDs were 5.49 times more likely to be hospitalized in the intensive care unit (ICU) and their death rate was 2.52 times higher than the other patients. After the regression analysis, while hypertension (HT) (Odds Ratio [OR]: 2.39), DM (OR: 3.64), and any type of cancer (OR: 2.75) were seen as independent risk factors in hospitalizations in the ICU, cardiovascular diseases (OR: 2.27), CKD (OR: 3.69) and psychiatric disorders (OR: 2.18) were seen as independent risk factors associated with mortality. CONCLUSION The follow-up of COVID-19 patients with CDs should be done more cautiously than others. It should be kept in mind that patients with HT, DM, and cancer may need intensive care at any time of hospitalization, while those with cerebrovascular disease, CKD, and psychiatric problems may have a higher mortality rate than other patients.
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Affiliation(s)
- Yasar Sertbas
- Department of Internal Medicine, Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkiye
| | - Ebru Elci Solak
- Department of Cardiology, Health Sciences University, Siyami Ersek Training and Research Hospital, Istanbul, Turkiye
| | - Selma Dagci
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkiye
| | - Volkan Kizilay
- Department of Statistics, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkiye
| | - Zeynep Yazici
- Department of Cardiology, Health Sciences University, Siyami Ersek Training and Research Hospital, Istanbul, Turkiye
| | - Serkan Elarslan
- Department of Internal Medicine, Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkiye
| | - Kamil Ozdil
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkiye
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Cugnata F, Scarale MG, De Lorenzo R, Simonini M, Citterio L, Querini PR, Castagna A, Di Serio C, Lanzani C. Profiling Covid-19 patients with respect to level of severity: an integrated statistical approach. Sci Rep 2023; 13:5498. [PMID: 37015962 PMCID: PMC10071456 DOI: 10.1038/s41598-023-32089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
A full understanding of the characteristics of Covid-19 patients with a better chance of experiencing poor vital outcomes is critical for implementing accurate and precise treatments. In this paper, two different advanced data-driven statistical approaches along with standard statistical methods have been implemented to identify groups of patients most at-risk for death or severity of respiratory distress. First, the tree-based analysis allowed to identify profiles of patients with different risk of in-hospital death (by Survival Tree-ST analysis) and severity of respiratory distress (by Classification and Regression Tree-CART analysis), and to unravel the role on risk stratification of highly dependent covariates (i.e., demographic characteristics, admission values and comorbidities). The ST analysis identified as the most at-risk group for in-hospital death the patients with age > 65 years, creatinine [Formula: see text] 1.2 mg/dL, CRP [Formula: see text] 25 mg/L and anti-hypertensive treatment. Based on the CART analysis, the subgroups most at-risk of severity of respiratory distress were defined by patients with creatinine level [Formula: see text] 1.2 mg/dL. Furthermore, to investigate the multivariate dependence structure among the demographic characteristics, the admission values, the comorbidities and the severity of respiratory distress, the Bayesian Network analysis was applied. This analysis confirmed the influence of creatinine and CRP on the severity of respiratory distress.
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Affiliation(s)
- Federica Cugnata
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Giovanna Scarale
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Rebecca De Lorenzo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Simonini
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorena Citterio
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere Querini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy.
- Biomedical Faculty, Università Della Svizzera Italiana, Lugano, Switzerland.
| | - Chiara Lanzani
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Soto-Cabezas MG, Reyes-Vega MF, Soriano-Moreno AN, Ordoñez-Ibargüen L, Martel KS, Flores-Jaime N, Chirinos-Saire J, Velásquez JP, Munayco CV. Comorbidities associated with COVID-19 mortality in adults in Lima, Peru: a retrospective cohort study. Rev Peru Med Exp Salud Publica 2023; 40:132-140. [PMID: 38232259 PMCID: PMC10953670 DOI: 10.17843/rpmesp.2023.402.12170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/03/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVES. Motivation for the study. During the COVID-19 pandemic, the mortality rate from this disease was higher in adults and the elderly. Therefore, it is important to identify the factors that were associated with mortality from COVID-19 in adults, by age group. Main findings. Chronic neurological disease, kidney disease, liver disease, and cancer increased the risk of dying from COVID-19 in the three age groups we analyzed, which were made up of hospitalized patients from Lima and Callao. The risk of mortality associated with comorbidities was higher in patients aged 18 to 29. Implications. This study helps to identify the groups of patients with the highest risk of death from COVID-19, according to age group and type of comorbidity. . To evaluate comorbidities associated with mortality in adult patients hospitalized due to COVID-19 in hospitals in Lima and Callao. MATERIALS AND METHODS. In this retrospective cohort study, we analyzed data from adult patients hospitalized due to COVID-19 reported to the National Epidemiological Surveillance System of the Peruvian Ministry of Health from March to October 2020. We estimated relative risks with 95% confidence intervals using Poisson regression models with robust variance to assess comorbidities associated with mortality by age group: young adults (18-29 years), adults (30-59 years) and older adults (≥60 years). RESULTS. We included 2366 young adults, 23,781 adults and 25,356 older adults. Older adults had the highest mortality (63.7%) compared to adults (27.1%) and young adults (8.5%). Regardless of age group, the presence of neurological disease, renal disease, liver disease, and cancer was associated with an increased risk of mortality. Additionally, cardiovascular disease was also a risk factor in young adults; obesity, diabetes, cardiovascular disease, chronic lung disease, and immunodeficiency in adults; and obesity and chronic lung disease in the elderly. CONCLUSIONS. Regardless of age groups, individuals with chronic neurologic disease, renal disease, liver disease, and cancer were at high risk of death from COVID-19.
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Affiliation(s)
- M. Gabriela Soto-Cabezas
- Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud. Lima, PeruCentro Nacional de Epidemiología, Prevención y Control de EnfermedadesMinisterio de SaludLimaPeru
| | - Mary F. Reyes-Vega
- Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud. Lima, PeruCentro Nacional de Epidemiología, Prevención y Control de EnfermedadesMinisterio de SaludLimaPeru
| | - Anderson N. Soriano-Moreno
- Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud. Lima, PeruCentro Nacional de Epidemiología, Prevención y Control de EnfermedadesMinisterio de SaludLimaPeru
| | - Luis Ordoñez-Ibargüen
- Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud. Lima, PeruCentro Nacional de Epidemiología, Prevención y Control de EnfermedadesMinisterio de SaludLimaPeru
| | - Kevin S. Martel
- Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud. Lima, PeruCentro Nacional de Epidemiología, Prevención y Control de EnfermedadesMinisterio de SaludLimaPeru
| | - Noemi Flores-Jaime
- Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud. Lima, PeruCentro Nacional de Epidemiología, Prevención y Control de EnfermedadesMinisterio de SaludLimaPeru
| | - Jenny Chirinos-Saire
- Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud. Lima, PeruCentro Nacional de Epidemiología, Prevención y Control de EnfermedadesMinisterio de SaludLimaPeru
| | - J. Pierre Velásquez
- Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud. Lima, PeruCentro Nacional de Epidemiología, Prevención y Control de EnfermedadesMinisterio de SaludLimaPeru
| | - Cesar V. Munayco
- Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud. Lima, PeruCentro Nacional de Epidemiología, Prevención y Control de EnfermedadesMinisterio de SaludLimaPeru
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Evaluation of the Effect of Underlying Diseases on Mortality of COVID-19 Patients: A Study of 19,985 Cases. Jundishapur J Microbiol 2023. [DOI: 10.5812/jjm-133603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: The outbreak of a new coronavirus in China in 2019 (COVID-19) caused a global health crisis. Objectives: This study was performed to investigate the effect of different underlying diseases on mortality in patients with COVID-19. Methods: This retrospective cohort study was performed on COVID-19 patients admitted to the Shahid Rahimi and Sohada-ye Ashayer teaching hospitals in Khorramabad, Iran, from 2019 to 2021. Data on disease severity, clinical manifestations, mortality, and underlying disorders were collected and analyzed using the SPSS software version 22 at a 95% confidence interval and 0.05 significance level. Results: The study included 9653 men (48%) and 10332 women (52%). Patients with chronic kidney diseases, cancer, chronic obstructive pulmonary disease, hypertension, cardiovascular disease, and diabetes were at higher mortality risk than those without these underlying diseases, respectively. However, there was no significant relationship between asthma and mortality. Also, age > 50 years, male gender, oxygen saturation < 93 on admission, and symptoms lasting ≤ 5 days were associated with increased mortality. Conclusions: Since patients with underlying diseases are at higher mortality risk, they should precisely follow the advice provided by health authorities and receive a complete COVID-19 vaccination series.
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Guimarães RA, Pinheiro RS, de Paula HDSC, de Araújo LA, Gonçalves IADJ, Pedroso CF, Guilarde AO, de Oliveira GA, Batista KDA. Mortality Risk Factors for Coronavirus Infection in Hospitalized Adults in Brazil: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14074. [PMID: 36360957 PMCID: PMC9654637 DOI: 10.3390/ijerph192114074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic has presented high morbidity and mortality, with associated high socioeconomic costs. Brazil ranks third in the number of COVID-19 cases, behind only India and the United States. OBJECTIVE To analyze risk factors for mortality in adults hospitalized with COVID-19 in Brazil. METHODS Observational retrospective cohort study including data from all Brazilian states and regions. The study included information from 468,226 in-hospital patients from all regions of Brazil from 1 January 2021 to 31 July 2021. Data from the influenza epidemiological surveillance system were used. The participants were adults hospitalized with COVID-19. A Cox regression model was used to analyze factors associated with mortality in adults with COVID-19. RESULTS The in-hospital mortality lethality was 37.5%. The risk factors associated with COVID-19 mortality were older age, with a linear increase with increments in age, male sex, black or mixed race, low education level, comorbidities, use of ventilatory support, and living in the southeast, north, or northeast regions of the country. CONCLUSIONS Our results illustrate the severity of the COVID-19 pandemic in Brazil and reinforce that policies and practices to deal with this disease should focus on groups and regions with higher risk, whereas public policies should promote nonpharmacological measures and vaccination in the Brazilian population.
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Affiliation(s)
| | - Raquel Silva Pinheiro
- Federal Institute of Education, Science and Technology of Goiás, Campus Goiânia Oeste, Goiânia 74395-160, GO, Brazil
| | | | - Lyriane Apolinário de Araújo
- Federal Institute of Education, Science and Technology of Goiás, Campus Goiânia Oeste, Goiânia 74395-160, GO, Brazil
| | | | - Charlise Fortunato Pedroso
- Federal Institute of Education, Science and Technology of Goiás, Campus Goiânia Oeste, Goiânia 74395-160, GO, Brazil
| | - Adriana Oliveira Guilarde
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Geraldo Andrade de Oliveira
- Federal Institute of Education, Science and Technology of Goiás, Valparaíso Campus, Valparaíso 72876-601, GO, Brazil
| | - Karla de Aleluia Batista
- Federal Institute of Education, Science and Technology of Goiás, Campus Goiânia Oeste, Goiânia 74395-160, GO, Brazil
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Hussaini H, Rogers S, Kataria S, Uddin K, Mohamed KH, Mohamed AS, Tariq F, Ahmad S, Awais A, Ahmed Z, Chukwurah A, Khan A. COVID-19-Induced Seizures: A Meta-Analysis of Case Series and Retrospective Cohorts. Cureus 2022; 14:e28633. [PMID: 36196331 PMCID: PMC9524720 DOI: 10.7759/cureus.28633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/30/2022] Open
Abstract
The adverse events and complications of coronavirus disease 2019 (COVID-19) continue to challenge the medical profession despite the worldwide vaccination against the severe acute respiratory coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. Other than typical respiratory manifestations, COVID-19 also presents a wide range of neurological manifestations. This article underlines the pooled incidence of COVID-19-induced seizures in patients with epilepsy and without epilepsy. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols, we conducted a bibliographical search, and an initial search revealed 1,375 articles. In total, 21 articles were included in the final analysis by following the inclusion criteria. A total of 11,526 patients from 21 published articles that met the predetermined search criteria were included. The median age of the patients was 61.9 years, of whom 51.5% were males. A total of 255 patients presented with seizures as the first manifestation of COVID-19 with a prevalence of 2.2% (95% confidence interval = 0.05-0.24, p < 0.01) (I2 = 97%), of which 71 patients had previously been diagnosed with epilepsy. Among patients with epilepsy, 49 patients had seizures as an initial presentation of SARA-CoV-2 with an incidence of 72% (0.54-0.85, p = 0.1) (I2 = 34). Although the incidence of COVID-19-induced seizures is not high compared to other neurological manifestations, seizure incidence in epileptic patients with COVID-19 is remarkably high. New-onset seizures in any patient should be considered a presentation of COVID-19 in the absence of other causative factors.
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Moss P, Berenbaum F, Curigliano G, Grupper A, Berg T, Pather S. Benefit-risk evaluation of COVID-19 vaccination in special population groups of interest. Vaccine 2022; 40:4348-4360. [PMID: 35718592 PMCID: PMC9135663 DOI: 10.1016/j.vaccine.2022.05.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/06/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
Several population groups display an increased risk of severe disease and mortality following SARS-CoV-2 infection. These include those who are immunocompromised (IC), have a cancer diagnosis, human immunodeficiency virus (HIV) infection or chronic inflammatory disease including autoimmune disease, primary immunodeficiencies, and those with kidney or liver disease. As such, improved understanding of the course of COVID-19 disease, as well as the efficacy, safety, and benefit-risk profiles of COVID-19 vaccines in these vulnerable groups is paramount in order to inform health policy makers and identify evidence-based vaccination strategies. In this review, we seek to summarize current data, including recommendations by national health authorities, on the impact and benefit-risk profiles of COVID-19 vaccination in these populations. Moving forward, although significant efforts have been made to elucidate and characterize COVID-19 disease course and vaccine responses in these groups, further larger-scale and longer-term evaluation will be instrumental to help further guide management and vaccination strategies, particularly given concerns about waning of vaccine-induced immunity and the recent surge of transmission with SARS-CoV-2 variants of concern.
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Affiliation(s)
- Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK; Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - Francis Berenbaum
- Sorbonne University, INSERM, AP-HP Saint-Antoine Hospital, Paris, France
| | - Giuseppe Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ayelet Grupper
- Department of Nephrology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany
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Singh R, Rathore SS, Khan H, Karale S, Chawla Y, Iqbal K, Bhurwal A, Tekin A, Jain N, Mehra I, Anand S, Reddy S, Sharma N, Sidhu GS, Panagopoulos A, Pattan V, Kashyap R, Bansal V. Association of Obesity With COVID-19 Severity and Mortality: An Updated Systemic Review, Meta-Analysis, and Meta-Regression. Front Endocrinol (Lausanne) 2022; 13:780872. [PMID: 35721716 PMCID: PMC9205425 DOI: 10.3389/fendo.2022.780872] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
Background Obesity affects the course of critical illnesses. We aimed to estimate the association of obesity with the severity and mortality in coronavirus disease 2019 (COVID-19) patients. Data Sources A systematic search was conducted from the inception of the COVID-19 pandemic through to 13 October 2021, on databases including Medline (PubMed), Embase, Science Web, and Cochrane Central Controlled Trials Registry. Preprint servers such as BioRxiv, MedRxiv, ChemRxiv, and SSRN were also scanned. Study Selection and Data Extraction Full-length articles focusing on the association of obesity and outcome in COVID-19 patients were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used for study selection and data extraction. Our Population of interest were COVID-19 positive patients, obesity is our Intervention/Exposure point, Comparators are Non-obese vs obese patients The chief outcome of the study was the severity of the confirmed COVID-19 positive hospitalized patients in terms of admission to the intensive care unit (ICU) or the requirement of invasive mechanical ventilation/intubation with obesity. All-cause mortality in COVID-19 positive hospitalized patients with obesity was the secondary outcome of the study. Results In total, 3,140,413 patients from 167 studies were included in the study. Obesity was associated with an increased risk of severe disease (RR=1.52, 95% CI 1.41-1.63, p<0.001, I2 = 97%). Similarly, high mortality was observed in obese patients (RR=1.09, 95% CI 1.02-1.16, p=0.006, I2 = 97%). In multivariate meta-regression on severity, the covariate of the female gender, pulmonary disease, diabetes, older age, cardiovascular diseases, and hypertension was found to be significant and explained R2 = 40% of the between-study heterogeneity for severity. The aforementioned covariates were found to be significant for mortality as well, and these covariates collectively explained R2 = 50% of the between-study variability for mortality. Conclusions Our findings suggest that obesity is significantly associated with increased severity and higher mortality among COVID-19 patients. Therefore, the inclusion of obesity or its surrogate body mass index in prognostic scores and improvement of guidelines for patient care management is recommended.
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Affiliation(s)
- Romil Singh
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Sawai Singh Rathore
- Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, India
| | - Hira Khan
- Department of Neurology, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Smruti Karale
- Department of Internal Medicine, Government Medical College-Kolhapur, Kolhapur, India
| | - Yogesh Chawla
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Abhishek Bhurwal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Aysun Tekin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States
| | - Nirpeksh Jain
- Department of Emergency Medicine, Marshfield Clinic, Marshfield, WI, United States
| | - Ishita Mehra
- Department of Internal Medicine, North Alabama Medical Center, Florence, AL, United States
| | - Sohini Anand
- Department of Internal Medicine, Patliputra Medical College and Hospital, Dhanbad, India
| | - Sanjana Reddy
- Department of Internal Medicine, Gandhi Medical College, Secunderabad, India
| | - Nikhil Sharma
- Department of Nephrology, Mayo Clinic, Rochester, MI, United States
| | - Guneet Singh Sidhu
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MI, United States
| | | | - Vishwanath Pattan
- Department of Medicine, Division of Endocrinology and Metabolism, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States
| | - Vikas Bansal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MI, United States
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Rocans RP, Ozolina A, Battaglini D, Bine E, Birnbaums JV, Tsarevskaya A, Udre S, Aleksejeva M, Mamaja B, Pelosi P. The Impact of Different Ventilatory Strategies on Clinical Outcomes in Patients with COVID-19 Pneumonia. J Clin Med 2022; 11:2710. [PMID: 35628835 PMCID: PMC9143826 DOI: 10.3390/jcm11102710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: The aim was to investigate the impact of different ventilator strategies (non-invasive ventilation (NIV); invasive MV with tracheal tube (TT) and with tracheostomy (TS) on outcomes (mortality and intensive care unit (ICU) length of stay) in patients with COVID-19. We also assessed the impact of timing of percutaneous tracheostomy and other risk factors on mortality. Methods: The retrospective cohort included 868 patients with severe COVID-19. Demographics, MV parameters and duration, and ICU mortality were collected. Results: MV was provided in 530 (61.1%) patients, divided into three groups: NIV (n = 139), TT (n = 313), and TS (n = 78). Prevalence of tracheostomy was 14.7%, and ICU mortality was 90.4%, 60.2%, and 30.2% in TT, TS, and NIV groups, respectively (p < 0.001). Tracheostomy increased the chances of survival and being discharged from ICU (OR 6.3, p < 0.001) despite prolonging ICU stay compared to the TT group (22.2 days vs. 10.7 days, p < 0.001) without differences in survival rates between early and late tracheostomy. Patients who only received invasive MV had higher odds of survival compared to those receiving NIV in ICU prior to invasive MV (OR 2.7, p = 0.001). The odds of death increased with age (OR 1.032, p < 0.001), obesity (1.58, p = 0.041), chronic renal disease (1.57, p = 0.019), sepsis (2.8, p < 0.001), acute kidney injury (1.7, p = 0.049), multiple organ dysfunction (3.2, p < 0.001), and ARDS (3.3, p < 0.001). Conclusions: Percutaneous tracheostomy compared to MV via TT significantly increased survival and the rate of discharge from ICU, without differences between early or late tracheostomy.
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Affiliation(s)
- Rihards P. Rocans
- Anesthesiology and Intensive Care Clinics, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia; (A.O.); (E.B.); (J.V.B.); (B.M.)
- Department of Anaesthesia and Intensive Care, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Agnese Ozolina
- Anesthesiology and Intensive Care Clinics, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia; (A.O.); (E.B.); (J.V.B.); (B.M.)
- Department of Anaesthesia and Intensive Care, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Denise Battaglini
- Anesthesiology and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (D.B.); (P.P.)
| | - Evita Bine
- Anesthesiology and Intensive Care Clinics, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia; (A.O.); (E.B.); (J.V.B.); (B.M.)
- Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia
| | - Janis V. Birnbaums
- Anesthesiology and Intensive Care Clinics, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia; (A.O.); (E.B.); (J.V.B.); (B.M.)
- Department of Anaesthesia and Intensive Care, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Anastasija Tsarevskaya
- Department of Anaesthesia and Intensive Care, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
- Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia
| | - Sintija Udre
- Faculty of Medicine, University of Latvia, Raina Boulevard 19, LV-1586 Riga, Latvia; (S.U.); (M.A.)
| | - Marija Aleksejeva
- Faculty of Medicine, University of Latvia, Raina Boulevard 19, LV-1586 Riga, Latvia; (S.U.); (M.A.)
| | - Biruta Mamaja
- Anesthesiology and Intensive Care Clinics, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia; (A.O.); (E.B.); (J.V.B.); (B.M.)
- Department of Anaesthesia and Intensive Care, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Paolo Pelosi
- Anesthesiology and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (D.B.); (P.P.)
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16145 Genoa, Italy
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10
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Al Argan R, Alkhafaji D, Al Elq A, Albaker W, Alqatari S, Alzaki A, Alwaheed A, Al Said A, Bukhari H, Al Warthan S, Zeeshan M, AlRubaish F, AlElq Z, Alsahlawi A, Alalwan M, AlHwiesh A, Alabdrabalnabi FI. The Impact of Diabetes Mellitus and Hyperglycemia on the Severity and Outcome of Patients with COVID-19 Disease: A Single-Center Experience. Int J Gen Med 2021; 14:9445-9457. [PMID: 34908871 PMCID: PMC8664338 DOI: 10.2147/ijgm.s338800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/08/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose Diabetes mellitus (DM) has been reported to be associated with a worse outcome of COVID-19 infection. The evidence is scarce in the Middle East and Saudi Arabia. We aimed to evaluate the impact of diabetes mellitus and hyperglycemia in non-diabetic individuals on the severity and outcome of COVID-19 infection. Methods This is a retrospective observational study, which included patients with confirmed COVID-19 infection [RT-PCR positive for SARS-CoV2] who were admitted to King Fahd Hospital of the University-Khobar-Eastern Province-Saudi Arabia from March to September 2020. Baseline demographic data, laboratory investigations, and markers of the severity of COVID-19 were analyzed. The collected data were categorized according to the Saudi Arabian Ministry of Health COVID-19 infection severity criteria. Patients were divided into three groups as follows: patients in Group 1 had pre-existing DM, patients in Group 2 did not have DM but were documented to have hyperglycemia at presentation, and patients in Group 3 were neither diabetics nor hyperglycemics at presentation and served as the control group. The severity and outcome of the control group were compared with the other two groups. The effect of risk factors on the severity and outcome of COVID-19 infection was studied in the DM group. Results A total of 414 patients were included (70.5% males and 29.5% females). The mean age (SD) of patients was 52.3 (±15.5) years. Compared to the control group, pre-existing DM was found to be significantly associated with severe (OR 3.61), critical disease (OR 4.32), intensive care unit (ICU) admission (OR 2.0), and death (OR 2.0) from COVID-19 infection. Hyperglycemia without known DM was also found to be associated with critical COVID-19 pneumonia (P 0.001), and had longer duration of hospitalization (P 0.014), higher ICU admission, mechanical ventilation, and death from COVID-19 infection (P < 0.0001). Conclusion Diabetes mellitus and hyperglycemia at presentation, even in the absence of pre-existing DM, are independent risk factors for disease severity and worse outcome of COVID-19 infection. These patients should be identified and managed accordingly. The COVID-19 vaccination program should also target those populations to improve their outcomes.
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Affiliation(s)
- Reem Al Argan
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Dania Alkhafaji
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Abdulmohsen Al Elq
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Waleed Albaker
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Safi Alqatari
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Alaa Alzaki
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Abrar Alwaheed
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Abir Al Said
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Huda Bukhari
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Sara Al Warthan
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Mohammad Zeeshan
- Department of Medical Education, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Fatimah AlRubaish
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Zainab AlElq
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Ahmed Alsahlawi
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Mohannad Alalwan
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Amani AlHwiesh
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Fatimah I Alabdrabalnabi
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
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11
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S J, G B, M S, Balasubramanian S. A Spectrum of Biopsy - Proven Renal Disorders and Their Clinicopathological Correlation in Elderly Population From a Tertiary Care Center in South India. Cureus 2021; 13:e17031. [PMID: 34381661 PMCID: PMC8351875 DOI: 10.7759/cureus.17031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Chronic kidney disease (CKD) has become a health concern with an extensive burden on incidence and prognosis. While the increasing lifespan contributes to a higher incidence of CKD among the elderly, the diagnostic picture in this age group is complicated by senescence-related changes. A better understanding of the etiology and progression of the disease warrants renal biopsy in such patients. This study aims to explore the histopathological spectrum of native renal biopsies leading to CKD in elderly patients in a tertiary care hospital. Methods Among the list of patients who had undergone renal biopsy at our institute from January 2015 to March 2020, elderly patients aged ≥ 60years were chosen for this study. Their demographic details, lab investigations and histopathological reports were collected. The sex distribution and prevalence of different renal diseases was calculated. The subjects were classified into four broad diagnostic groups - primary glomerular disease, diabetic nephropathy, hypertensive nephropathy, and tubulointerstitial disease. The estimated glomerular filtration rate (eGFR) values were calculated and used to stage chronic kidney disease in these patients. Statistical analysis was carried out to find a correlation between diagnostic groups and CKD presence and between serum C3 values and immunofluorescence for the same on biopsy. Results One hundred thirty-two patients formed the study sample with a male to female ratio of 1.28:1, showing a slight male predominance. The most common diagnostic group was primary glomerular disease (46%), among which focal segmental glomerulosclerosis (FSGS) was the most common entity (12%). 47.7% and 66.6% of patients in the study sample showed elevated serum blood urea nitrogen (BUN) and creatinine values, respectively. 86% of our study sample had low eGFR values, and the majority (35%) of the patients were classified under CKD stage 3. CKD incidence was high among patients with primary glomerular diseases, but no significant statistical correlation was found. 43.5% of all IF positive cases showed low serum C3 values and established a positive correlation between IF and serum C3 values. Conclusion There is no statistically significant correlation of the four diagnostic groups to the CKD. CKD in the elderly may be multifactorial, and a collaborative study across the nations may be needed to further evaluate the etiology.
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Affiliation(s)
- Josephine S
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Barathi G
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Susruthan M
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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12
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Chung EY, Palmer SC, Natale P, Krishnan A, Cooper TE, Saglimbene VM, Ruospo M, Au E, Jayanti S, Liang A, Deng DJJ, Chui J, Higgins GY, Tong A, Wong G, Teixeira-Pinto A, Hodson EM, Craig JC, Strippoli GF. Incidence and Outcomes of COVID-19 in People With CKD: A Systematic Review and Meta-analysis. Am J Kidney Dis 2021; 78:804-815. [PMID: 34364906 PMCID: PMC8339603 DOI: 10.1053/j.ajkd.2021.07.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/29/2021] [Indexed: 01/08/2023]
Abstract
Rationale & Objective Coronavirus disease 2019 (COVID-19) disproportionately affects people with chronic diseases such as chronic kidney disease (CKD). We assessed the incidence and outcomes of COVID-19 in people with CKD. Study Design Systematic review and meta-analysis by searching MEDLINE, EMBASE, and PubMed through February 2021. Setting & Study Populations People with CKD with or without COVID-19. Selection Criteria for Studies Cohort and case-control studies. Data Extraction Incidences of COVID-19, death, respiratory failure, dyspnea, recovery, intensive care admission, hospital admission, need for supplemental oxygen, hospital discharge, sepsis, short-term dialysis, acute kidney injury, and fatigue. Analytical Approach Random-effects meta-analysis and evidence certainty adjudicated using an adapted version of GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results 348 studies (382,407 participants with COVID-19 and CKD; 1,139,979 total participants with CKD) were included. Based on low-certainty evidence, the incidence of COVID-19 was higher in people with CKD treated with dialysis (105 per 10,000 person-weeks; 95% CI, 91-120; 95% prediction interval [PrI], 25-235; 59 studies; 468,233 participants) than in those with CKD not requiring kidney replacement therapy (16 per 10,000 person-weeks; 95% CI, 4-33; 95% PrI, 0-92; 5 studies; 70,683 participants) or in kidney or pancreas/kidney transplant recipients (23 per 10,000 person-weeks; 95% CI, 18-30; 95% PrI, 2-67; 29 studies; 120,281 participants). Based on low-certainty evidence, the incidence of death in people with CKD and COVID-19 was 32 per 1,000 person-weeks (95% CI, 30-35; 95% PrI, 4-81; 229 studies; 70,922 participants), which may be higher than in people with CKD without COVID-19 (incidence rate ratio, 10.26; 95% CI, 6.78-15.53; 95% PrI, 2.62-40.15; 4 studies; 18,347 participants). Limitations Analyses were generally based on low-certainty evidence. Few studies reported outcomes in people with CKD without COVID-19 to calculate the excess risk attributable to COVID-19, and potential confounders were not adjusted for in most studies. Conclusions The incidence of COVID-19 may be higher in people receiving maintenance dialysis than in those with CKD not requiring kidney replacement therapy or those who are kidney or pancreas/kidney transplant recipients. People with CKD and COVID-19 may have a higher incidence of death than people with CKD without COVID-19.
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Affiliation(s)
- Edmund Ym Chung
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Patrizia Natale
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anoushka Krishnan
- Department of Nephrology, Sir Charles Gairdner Hospital, Nedlands, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Tess E Cooper
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Valeria M Saglimbene
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Marinella Ruospo
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Eric Au
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Sumedh Jayanti
- Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Amy Liang
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | | | - Juanita Chui
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Gail Y Higgins
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Germaine Wong
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | | | - Elisabeth M Hodson
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Giovanni Fm Strippoli
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Sydney School of Public Health, The University of Sydney, Sydney, Australia
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13
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Clinical outcomes of hospitalized COVID-19 patients with renal injury: a multi-hospital observational study from Wuhan. Sci Rep 2021; 11:15205. [PMID: 34312430 PMCID: PMC8313555 DOI: 10.1038/s41598-021-94570-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023] Open
Abstract
Renal injury is common in patients with coronavirus disease 2019 (COVID‐19). We aimed to determine the relationship of estimated glomerular filtration rate (eGFR) and acute kidney injury (AKI) with the characteristics, progression, and prognosis of COVID-19 in-patients. We retrospectively reviewed 1851 COVID-19 patients admitted to 3 hospitals in Wuhan, China. Clinical, laboratory, radiological, treatment, complication, and outcome data were analyzed. Patients were stratified according to levels of eGFR (≥ 90 vs. 60–89 vs. < 60 mL/min/1.73 m2). The risk of reaching the composite endpoint—intensive care unit admission, invasive ventilation, or death—was compared. On admission, 25.5% patients had renal impairment (eGFR < 90 mL/min/1.73 m2), but only 2.6% patients had chronic kidney disease (CKD). The overall in-hospital AKI incidence was 6.7%. Severe illness and comorbidities (hypertension, diabetes, CKD, and cardiovascular/cerebrovascular diseases) were more common among patients with low eGFR (< 90 mL/min/1.73 m2). Despite the more frequent use of intensive oxygen therapy, continuous blood purification, and glucocorticoid treatment, the prognosis of these patients was unsatisfactory, with the incidence of the composite endpoint (15.4% vs. 19.6% vs. 54.5%; P = 0.000) and complications (AKI, respiratory failure, cardiac injury, coagulation disorders, sepsis, etc.) increasing with decreasing eGFR. Kaplan–Meier survival analysis revealed that patients with eGFR < 90 mL/min/1.73 m2 or AKI had significantly escalated risks of reaching the composite endpoint. Multivariate regression analysis showed that renal insufficiency (eGFR < 60 mL/min/1.73 m2) on admission and in-hospital AKI independently predicted poor prognosis among COVID-19 in-patients. And renal impairment on admission was a greater predictor of poor prognosis in non-elderly patients than that in elderly patients. Early and continuous renal-function monitoring and early AKI diagnosis are necessary to predict and prevent the progression of COVID-19.
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14
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Khalid MZ, Rogers S, Fatima A, Dawe M, Singh R. A Flare of Systemic Lupus Erythematosus Disease After COVID-19 Infection: A Case of Lupus Cerebritis. Cureus 2021; 13:e16104. [PMID: 34350072 PMCID: PMC8325872 DOI: 10.7759/cureus.16104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 01/10/2023] Open
Abstract
The association between coronavirus disease 19 (COVID-19) and autoimmune disease has been mounting, and literature on COVID-19-induced flare-up of systemic lupus erythematosus (SLE) disease is lacking. We describe a case of lupus cerebritis triggered by COVID-19 in a young female with SLE, who presented with fluctuated mentation, psychomotor retardation, slow speech, and intermittent choreiform movement in the upper part of the body. She had a history of COVID-19 infection three weeks back. Her serum immunoglobulin G antibodies were positive against COVID-19. On examination, she had psychomotor agitation, intermittent choreiform movements of upper limbs, and poor speech. Brain magnetic resonance imaging revealed hyperintense signals in the white matter of both hemispheres, suggestive of lupus cerebritis secondary to COVID-19 infection and lack of any other identifiable risk factor. Management included methylprednisolone, prednisone, and olanzapine. The patient was also placed on monthly intravenous cyclophosphamide, and her condition started improving gradually.
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Affiliation(s)
| | - Sylvette Rogers
- Family Medicine, Caribbean Medical University, Des Plaines, USA
| | - Ayesha Fatima
- Gynaecology & Obstetrics, Fauji Foundation Hospital, Rawalpindi, PAK
| | - Manal Dawe
- Internal Medicine, Capital Medical University, Beijing, CHN
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15
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Ehsan P, Haseeb M, Khan Z, Rehan A, Singh R. Coronavirus Disease 2019 Pneumonia and Acute Pancreatitis in a Young Girl. Cureus 2021; 13:e15374. [PMID: 34249527 PMCID: PMC8249145 DOI: 10.7759/cureus.15374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 pneumonia and acute pancreatitis are rarely reported in patients with coronavirus disease 2019 (COVID-19). We present the case of a 13-year-old girl who presented with nausea, vomiting, and abdominal pain for the last two days, along with a cough for the last week. She had a fever and tachycardia. Lung examination revealed reduced breath sounds, and abdominal examination showed tenderness in the epigastrium. COVID-19 polymerase chain reaction was positive, and her serum chemistry revealed elevated serum amylase and lipase. Abdominal computed tomography revealed diffuse inflammation of the pancreas with peripancreatic edema, and chest X-ray demonstrated diffuse infiltrates and pneumonic patches in both lungs. Her initial management included bowel rest, intravenous fluids, intravenous remdesivir, and azithromycin with supplemental oxygen based on the provisional diagnosis of COVID-19 pneumonia and acute pancreatitis. Her abdominal symptoms started improving, and dexamethasone was added to her regimen due to her worsened respiratory condition. She was symptom-free on day seven except for a mild cough. She was discharged on day eight with follow-up.
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Affiliation(s)
- Paghunda Ehsan
- Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | | | - Zaraq Khan
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Aiman Rehan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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