ABSTRACT
Introduction. Patients with chronic kidney disease (CKD) and COVID-19 are at high risk of adverse outcomes due to the presence of comorbidities. However, it is still unclear whether dialysis therapy is associated with a worse prognosis in patients infected with SARSCoV- 2. The objectives were to assess mortality and risk factors associated with a worse prognosis of these patients (e.g., age, sex, comorbidities, Intensive Care Admission [ICU] admission, and need for invasive mechanical ventilation [IMV]). Methods. An observational, descriptive, retrospective study was conducted in the private healthcare maintenance organization (Unimed-BH) of Belo Horizonte and 33 surrounding cities in Brazil. We used data collected from the organization's database. We included adult inpatients with CKD on previous dialysis therapy who tested positive for COVID-19, from February 2020 to June 2021. Results. During the period, 16182 patients were admitted to Unimed-BH with a diagnosis of COVID-19. Of these, 333 (2%) had dialysis CKD. Male patients were 180 (54%), age ranged from 22.85 to 95.75 years and the mean was 60.91 years. Of the 333 patients, 109 (32.7%) were admitted to the ICU, and 56 (16.8%) required IMV. Among the 14 comorbidities analysed, the mean number of comorbidities was 6, with 93 (27.9%) dyslipidaemia, 74 (22%) diabetic, 270 (81%) hypertensive, 25 (7.5%) asthmatic, 42 (12.6%) with chronic pulmonary disease (CPD) and 122 (36.6%) with congestive heart failure (CHF). There were 66 (19.8%) deaths, 29 (43.9%) were male, the mean age was 60.8 years, and 23 patients (34.8%) were elderly (>60 years). Among the patients who died, 55 (83.3%) were in the ICU and 46 (69.7%) on IMV. The mean number of comorbidities was 9.27 being 16 (24.2%) dyslipidaemia, 44 (66.6%) diabetic, 60 (90.9%) hypertensive, 5 (7%) asthmatic, 10 (15%) with CPD and 32 (48.5%) with CHF. Conclusions. Dialysis patients appear more susceptible to unfavourable outcomes than the general population. Our findings are similar to those reported in the world literature which is still scarce. It is important to conduct more studies on this population.
ABSTRACT
Introduction. Life expectancy is increasing worldwide. However, during the COVID-19 pandemic, people 100 years or more (centenaries) were challenged by a potentially fatal disease. We evaluated the outcome of centenaries hospitalized due to COVID-19 in a private healthcare system of Belo Horizonte/Brazil (Unimed-BH). Methods. Administrative data were collected from the hospital database. Patients were included if they had a severe adult respiratory syndrome due to coronavirus type 2 (SARS-CoV-2) ribonucleic acid identified by quantitative real-time reverse transcriptase polymerase chain reaction (RT-qPCR) or by the International Code of Disease- 10th review (ICD-10) hospitalization codes U07.1, B34.2, or B97.2. Results. From March 1 2020 to October 31 2021, 316.4 & plusmn;12.9 centenaries/month were registered. Eighteen hospitalizations due to COVID-19 were identified. Median age was 101.8 years (interquartile range [IQR]:100.7,103.0). Most patients were female (83%). There was a median of 6.0 morbidities per patient (IQR:5.3,7.8), range 2-12 morbidities, among 71 possible morbidities. The most described morbidities were systemic arterial hypertension (94%), dementia (61%), and congestive heart failure (61%). Median length of hospitalization was 6.5 days (IQR:3.3,8.0). No patient was dialyzed. Seven (39%) patients died during hospitalization, of whom 3 (17%) were admitted to the Intensive Care Unit and 2 (11%) were oxygenated by invasive mechanical ventilation. No other patients were admitted to the Intensive Care Unit or invasively mechanically ventilated. Conclusions. Although the hospitalization rate was low, the mortality rate during hospitalization was high among centenaries. Further research is required to evaluate the actual risks of centenaries to be infected by SARS-CoV-2 and the subsequent outcomes.
ABSTRACT
Background : During the current COVID-19 pandemic, thrombocytopenia was noted in up to one third of hospitalized patients, being lower in those with very severe disease. In most COVID-19-related thrombocytopenia, the platelet count does not fall below 100 × 109 /L. Severe degree of thrombocytopenia (<20 × 109 /L, or a sudden drop >50% over 24-48 h) is likely to indicate an immune aetiology. Aims : We described a rare case of immune thrombocytopenic purpura (ITP) associated with COVID-19. Methods : Patient medical files were retrospectively reviewed. Results : A previously healthy 23-year-old woman visited the Emergency Department after 2 days of sneezing, cough, sorethroat, shivers, and fever. She also complained petechiae and spontaneous mild gingival hemorrhage, with a normal blood count. Three days later, she was admitted due to worsening of the petechiae and a drop in the platelet (231.9 × 109 /L to 5.8 × 109 /L). Nasopharynxswab RT-qPCR detected SARS-CoV-2. Reticulocyte count was normal and no schistocyte was observed. Clotting assays and fibrinogen were normal, and D-dimers were slightly increased. She had microscopic hematuria with normal renal function tests. Total/fractionated bilirubin, and transaminases were normal, although lactic dehydrogenase was slightly elevated. Thyroid function was normal. Protein electrophoresis was normal. Folate and vitamin B12 levels were normal. Anti-nuclear antibodies, syphilis, human immunodeficiency virus, and hepatitis C virus tests were non-reagent. She was immunized against hepatitis B virus. Anticardiolipin antibodies were negative, but direct Coombs and lupus anticoagulant tests were positive. Thoracic computed tomography was normal. Prednisone was administered and she was discharged home with a platelet count of 191.9 × 109 /L. Two months after prednisone withdrawal, direct Coombs and lupus anticoagulant tests were negative, while platelets were 354.0 × 109 /L. Conclusions : Although thrombocytopenia may be a predictor of worse prognosis in COVID-19, no relationship between ITP and outcome was described yet. Currently, after excluding other causes of (severe) thrombocytopenia, the treatment of COVID-19-associated ITP should be similar the treatment of non-COVID-19 individuals.