The aggregate index of systemic inflammation may predict mortality in COVID-19 patients with chronic renal failure.

OBJECTIVE: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was first detected in December 2019 and then spread globally, resulting in a pandemic. Initially, it was unknown if chronic kidney disease (CKD) contributed to the mortality caused by COVID-19. The immunosuppression associated with this disease may minimize the COVID-19-described hyper-inflammatory state or immunological dysfunction, and a high prevalence of comorbidities may lead to a poorer clinical prognosis. Patients with COVID-19 have abnormal circulating blood cells associated with inflammation. Risk stratification, diagnosis, and prognosis primarily rely on hematological features, such as white blood cells and their subpopulations, red cell distribution width, mean platelet volume, and platelet count, in addition to their combined ratios. In non-small-cell lung cancer, the aggregate index of systemic inflammation (AISI), (neutrophils x monocytes x platelets/lymphocytes) is evaluated. In light of the relevance of inflammation in mortality, the objective of this study is to determine the impact of AISI on the hospital mortality of CKD patients. PATIENTS AND METHODS: This study is an observational retrospective study. Data and test outcomes of all CKD patients, stages 3-5, hospitalized for COVID-19 and followed between April and October 2021 were analyzed. RESULTS: Patients were divided into two groups according to death (Group 1-Alive, Group 2-Died). Neutrophil count, AISI and C-reactive protein (CRP) levels were increased in Group-2 [10.3±4.6 vs. 7.65±4.22; p=0.001, 2,084.1 (364.8-2,577.5) vs. 628.9 (53.1-2,275); p=0.00 and 141.9 (20.5-318) vs. 84.75 (0.92-195); p=0.00; respectively]. Receiver operating characteristic (ROC) analysis demonstrated 621.1 as a cut-off value for AISI to predict hospital mortality with 81% sensitivity and 69.1% specificity [area under ROC curve 0.820 (95% CI: 0.733-0.907), p<.005]. Cox regression analysis was used to analyze the effect of risk variables on survival. In survival analysis, AISI and CRP were identified as important survival predictors [hazard ratio (HR): 1.001, 95% CI: 1-1.001; p=0.00 and HR: 1.009, 95% CI: 1.004-1.013; p=0.00]. CONCLUSIONS: This study demonstrated the discriminative effectiveness of AISI in predicting disease mortality in COVID-19 patients with CKD. Quantification of AISI upon admission might assist in the early detection and treatment of individuals with a bad prognosis.

Investigation of long-term follow-up results of COVID-19 disease in kidney transplant patients and the effect of inactive COVID-19 vaccine

Objective: We aimed to evaluate the long-term graft functions of kidney transplant recepients (KTR) who have been cured of the COVID-19 and to investigate the role of inactivated COVID-19 vaccine in the clinical course of the disease. Materials and Methods: KTR who had COVID-19 pneumonia between March 2020 and September 2021 were included in the study.. The clinical course of the disease was evaluated in vaccinated patients and compared with those who were not vaccinated. The laboratory information of the patients at the time of admission to the hospital, 6 months and 12 months after the disease was recorded. Results: Of the 83 patients included, 67.5% were male. COVID-19 disease developed in 20 patients after vaccination. Vaccine;it decreased the development of acute kidney injury (AKI) 5.9 fold and hospitalization in the intensive care unit (ICU) 1.4 times fold (p < 0.05). In the follow-up, 10 patients died at the first admission to the hospital and no late death was recorded in the first year. Dialysis treatment was started in 5 patients due to graft loss. Conclusion: In kidney transplant patients, graft dysfunction may develop after COVID-19 infection. However, the inactivated COVID-19 vaccine;it can reduce the risks of hospitalization, AKI, and ICU admission.

Evaluation of the frequency and intensity of COVID-19 in patients with ankylosing spondylitis under anti-TNF therapy

BACKGROUND: This study aimed to investigate pregnancy frequency and evaluate the factors affecting live births in hemodialysis (HD) patients. METHODS: Female HD patients whose pregnancy was retrospectively reported between January 1, 2014, and December 31, 2019. The duration of HD, primary disease, and the information on whether the pregnancy resulted in abortion, stillbirth, or live birth, whether the HD duration was prolonged after diagnosing the pregnancy and whether it accompanied preeclampsia were recorded. RESULTS: In this study, we reached 9038 HD female patients' data in the study. A total of 235 pregnancies were detected in 145 patients. The mean age was 35.42 (35 ± 7.4) years. The mean age at first gestation was 30.8 ± 6.5 years. The average birth week was 32 (28 -36) weeks. A total of 53.8% (no = 78) of the patients had live birth, 51.7% (no = 70) had at least one abortion in the first 20 weeks, and 13.1% (no = 19) had at least one stillbirth after 20 weeks. The rate of patients' increased numbers of dialysis sessions during pregnancy was 71.7%. The abortion rate was 22.4% in those with increased HD sessions, whereas 79.3% in those not increased HD sessions (p < 0.001). Live birth frequency was 67.2% in the increased HD sessions group and 3.4% in those who did not differ in HD sessions (p < 0.001). DISCUSSION: For the first time, we reported pregnancy outcomes in HD female patients, covering all regions of Turkey. It has been observed that;increasing the number of HD sessions in dialysis patients will decrease fetal and maternal complications and increase live birth rates.

DOES ANGIOTENSIN II RECEPTOR BLOCKERS/ANGIOTENSIN CONVERTING ENZYME INHIBITORS INCREASE THE RISK OF COVID-19 INFECTED PATIENTS?

Objective: The study aims to determine whether ACEI/ARB use associated with an increased probability of viral infection and investigate whether there are differences in disease severity and mortality between ACEI/ARB users and non-ACEI/ARB users. Material and methods: In this retrospective study, 330 patients with severe acute respiratory syndrome coronavirus 2 disease were divided into two groups: patients using ACEI/ARB Blocker and patients not using it. Baseline features and prognoses were compared for the two groups. Results: The rate of intensive care hospitalization in the group using ACE/ARB was significantly (p<0.05) higher than the group not using ACEI/ARB on the day of hospitalization in the intensive care unit. The degree of clinical classification in the group using ACEI/ARB was significantly (p<0.05) higher than the group not using ACE/ARB. The mortality rate in the group using ACE/ARB was significantly (p<0.05) higher than the group not using ACEI/ARB. Conclusion: Although it has been determined that the use of antihypertensive ACEI/ARB in COVID 19 patients is associated with mortality and survival, it has been concluded that the continuation of ACEI/ARB use would be more appropriate for the continuation of antihypertensive treatment.

URIC ACID AND MORTALITY RELATIONSHIP IN COVID-19

Aim: The present study aims to investigate and compare the uric acid of the recovered/deceased and ICU/ward COVID-19 patients. Method: The study was conducted with 397 patients with COVID-19 diagnosis. Information about 157 deceased and 240 recovered COVID-19 patients was analyzed retrospectively. Relationship between serum uric acid, Na, K, urea, and creatinine was investigated between patients in the mortal/non-mortal and ICU/ward group. Result: Of the total 397 patients in the study, 158 (39,8%) were female and 239 (60,2%) were male. Statistically significant difference in mortality was found between males and females in order (107-239, 44.8%/50-158,31, 7%;p=0.009). Total mean age (std deviation), was 63.77±16,1, the mean age in the deceased group was 71,41±11, 39, and it was 58.78±16,8 in the survived group and that is statistically significant too (p=0.001). The mean values of Uric acid with order survivor and deceased group ((4,867±1,81 (n=222)- 7, 086±3,24(n=148), P=0,000). Mean age in ICU group 69.53±12,52, in the ward group 56.24±17,1 and this age differentiation between two groups is statistically significant (p=0,001), There is a statistically significant difference in ICU care or ward was found between males and females in order (107-239, 44.8%/50-158,31,7%;p=0.009). The mean values of Uric acid with order ICU care and ward group ((6,52 ±3,1(n=217) -4,66±1,46 (n=153), P=0,000)). Serum K+ (Potassium) (4,164±0,5 (n=239)) - 4,357±0,7 (n=157), P=0,002)) levels are higher in deceased groups. The cutoff value of uric acid, which may pose a risk of mortality, was found to be 5,15 mg/dl. And the cutoff value of creatinine, which may pose a risk of mortality, was found to be 0,9 mg/dl. Conclusion: The cutoff value of uric acid, which may pose a risk of mortality, was found to be 5,15 mg/dl and the cutoff value of creatinine, which may pose a risk of mortality, was found to be 0,9 mg/dl. Advanced age, uric acid, creatinine, and potassium increase were found to be associated with mortality. © 2022 A. CARBONE Editore. All rights reserved.

Experience with hemodialysis patients in the COVID-19 pandemic in Sakarya, Turkey

The novel coronavirus disease 2019 (COVID-19) is a newly discovered infectious disease. Severe Acute Respiratory Syndrome Infection Coronavirus 2 (SARS-CoV-2) initially manifests as an acute respiratory disease with interstitial and alveolar pneumonia;however, it can affect multiple organs such as kidneys, heart, digestive tract, blood and nervous system.The infection started in Wuhan, Hubei province in China, in December 2019 and has spread rapidly, raising concerns since it became a pandemic global. COVID-19 progresses with increased morbidity and mortality in patients with chronic disease. In addition, this infection deserves special evaluation and a plan of action for dialysis patients, kidney transplant patients, chronic kidney disease patients and other nephrology patients. At public and private dialysis centers in Sakarya province, Turkey, 852 patients have been treated and followed up in chronic hemodialysis programs. Since the epidemic of this disease and the identification of the first case in Sakarya, Turkey, the Department of Nephrology contacted all dialysis centers in province. Since patients are transported collectively with the service system across the province, they provide all drivers with digital thermometers, so they can take each patient's temperature before boarding the bus. Therefore, they sent all their regular dialysis patients to other centers to prevent healthy patients from meeting patients infected with COVID-19. Thus, the pooled all symptomatic patients in one center and protected the other. All dialysis patients diagnosed with COVID-19 were hospitalised. They were treated with oseltamivir, hydroxychloroquine, and azithromycin. In addition, they all have had pulmonary CT scans (low dose). In the clinic, seven patients are still being treated and followed;38 patients have been discharged;however, they are still receiving dialysis treatment in the ambulatory centre. In Sakarya, six dialysis patients died from the COVID-19 infection. Although, they are not sure what the future holds in this long running process, they think that with this strategy, that they planned and executed, they can overcome this process with minimum loss of life.

Super levels and covid-19: Is there a relationship between supar levels and prognosis of covid-19 infection?

Objective: SuPAR is known as a marker for inflammation. In this study, we aimed to analyse suPAR levels and its correlation with disease prognosis in COVID-19 patients. Method: Demographical, clinical and laboratory data of the 36 patients were recorded. Existence of suPAR levels and other parameters along with prognosis was studied. Result: Of 36 patients included in this study, 15 were female (42%) and 21 were male (58%). The median age of the patients with mortality was 73 (min-max ,IR;49-88, 25), and the median age of the patients with no mortality was 72 (min-max ,IR;47- 83, 21) revealing a statistically non-significant difference (p=0,596). Among lab tests, hemoglobin (p=0,044), urea (p=0,011), troponin(p=0,033), LDH (p=0,005), and procalcitonin (p=0,036) were significantly associated with mortality. Median suPAR level was 102 (min-max, IR;29-540, 274) for the patients with no mortality whereas, median suPAR level was 61 (min-max, IR;29-540, 355) for the patients with mortality, and the difference was statistically non-significant (p=0,607). Conclusion: SuPAR levels seem to be ineffective to predict disease severity and prognosis of COVID-19. More randomised controlled trials with larger groups are needed to clarify the association of suPAR levels and COVID-19. © 2021 A. CARBONE Editore. All rights reserved.

Acute kidney injury in hospitalized COVID-19 patients: A multicentre study by Turkish society of nephrology

BACKGROUND AND AIMS: Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI. METHOD: In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. RESULTS: The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (41.5%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 80.7% and partial in 17% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality. The in-hospital mortality rates across AKI stages by age, gender, and diabetes mellitus were shown in the Figure. CONCLUSION: Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. Renal problems continue in a significant portion of the patients who were discharged.

Tocilizumab did not reduce mortality in severe COVID-19 patients but caused thrombocytosis

Background: TCZ is a monoclonal antibody against Interleukin-6 receptor (IL-6R) which is used for relieving inflammation and reducing mortality in COVID-19 patients. Safety and efficacy of Tocilizumab (TCZ) in Covid-19 pneumonia is uncertain yet. In this study, we aimed to determine clinical outcomes in patients treated with TCZ. Objectives: In this study we aimed to share our retrospective results which we had obtained from patients with COVID-19 diagnosis received TCZ. Methods: We performed a retrospective case control study between May and August 2020 in Turkey. We compared outcomes in patients who received TCZ with those who did not. Death in hospital and intensive care unit (ICU) requirements were evaluated as endpoints. Demographic data, comorbidities, additional treatment, treatment side effects, laboratory and clinical results were retrospectively assessed. There are no significant differences between groups according to age, gender and Charlson Comorbidity Index (CCI). Results: 12 (27.3%) patients died in standard group and eight (18.6%) patients died in TCZ group (p=0.150).Days of staying in the hospital were eight days in standard treatment group and 12 days in TCZ group (p=0.03). 10 of 43 patients in TCZ group were admitted to ICU. MV support was needed in 8 of these patients. 18 of 44 patients (40.9%) within the standard group were admitted to ICU and 12 patients (27.3%) were intubated (p=0.125,p=0.480). Significant IL-6 decrease was not observed post treatment in TCZ group according to pretreatment period (p=0.60). Significant decreases were examined in CRP and ferritin values through TCZ treatment. However, D-dimer and thrombocyte values increased. Conclusion: TCZ may not be an effective treatment for reducing ICU requirement, to prevent intubation or death, for shortening period for staying in hospital. The patients should be followed up closely for possible thrombosis because of increased D-dimer and thrombocytes with TCZ treatment.

Is It Possible To Predict Mortality Using Initial Data Of Adult Patients Hospitalized with COVID-19? A Mortality Prediction Model in the Early Phase of COVID-19

Objective: In this study, we aimed to determine the factors that contribute to the early determination of mortality risk in patients hospitalized with COVID-19. Methods: We included 941 adult inpatients (474 male [50.4%], mean age, 53.5 +/- 17.0. The patients were divided into two groups: the discharge group and the death group. Epidemiological data, medical history, underlying comorbidities, laboratory findings, chest computed tomographic scans, real-time reverse transcription polymerase chain reaction detection results, and survival data were obtained with retrospective recordings on admission and follow-up. The statistical relationship between survival data and parameters was analyzed. A mathematical model was created from the data of both groups. Results: While 863 patients survived, 78 were non-survivors. During the study period, the preliminary case fatality rate of the inpatients was 8.3%. The mean age of the non-survivors was 71.7 +/- 11.2 SD (P<0.001). Laboratory findings showed that mortality was high in those with high D-dimer, sodium, lactate dehydrogenase (LDH), troponin, creatine kinase-myocardial band (CK-MB), ferritin, blood lactate, activated partial thromboplastin time, and high blood glucose levels (P<0.05). Furthermore, mortality was high in patients with low albumin, lymphocyte, and platelet levels (P<0.05). The logistic regression model showed that advanced age, hypertension, high D-Dimer (>1000 ng/ml), high C-reactive protein (CRP), CK-MB, and LDH, and low lymphocyte count were associated with poor prognosis. Conclusions: According to week 1 data of patients with COVID-19, advanced age, hypertension, D-Dimer, CRP, CK-MB, high LDH, and low lymphocyte were associated with poor prognosis. We believe that this model will be useful in predicting patient mortality.

The Effectiveness of Favipiravir Treatment in Severe COVID-19 Pneumonia: a Single Centre Experience

Objective: The aim of this study was to investigate the efficacy of favipiravir (FVP) in severe COVID-19. Methods: This is a retrospective study of 142 COVID-19 patients with severe pneumonia signs, who received inpatient treatment between March 15 and May 20, 2020. The patients were divided into two groups according to the use of FVP treatment;group 1 (n = 99) included patients who treated with FVP and group 2 (n = 43) who didn't receive FVP. Results: Mean age was 66.47 +/- 11.89 in group 1, and 68.58 +/- 14.78 in group 2. Forty patients (40.4%) in group 1 and 22 (51.2%) in group 2 were treated in the intensive care unit (P > 0.05). The proportion of eosinophil, tendency of increasing thrombocyte counts and eosinophil/neutrophil ratio in FVP group was significantly higher than non-FVP group (p < 0.05). In Group 1, patients had significantly reduced erythroid series, and elevated uric acid levels as side effects of FVP. With respect to complications during hospitalization, there was no significant difference among the groups for mechanical ventilator requirement, acute kidney injury, dialysis requirement and sepsis (P > 0.05). The mortality rates in Group 1 (n = 26 [26.3%]) were lower than those in group 2 (n = 16 [37.2%]), but it was not statistically significant. Conclusions: While the treatment of COVID-19 pneumonia options were limited during the initial stages of the pandemic, the FVP may be effective in severe cases. To confirm this effect, randomized controlled studies are needed in patients of all disease severities.

Evaluation of covid-19 thorax computed tomography findings in hemodialysis patients

Aim: Coronavirus disease 2019 (COVID-19) is an unprecedented cause of pandemics affecting all segments of society. It is not known whether hemodialysis patients form a different patient group in terms of susceptibility to COVID-19 infection or severe disease. In this study, thorax computed tomography (CT) findings were evaluated in hemodialysis patients diagnosed with COVID-19 infection during the pandemic period. Material and Methods: CT findings of 32 hemodialysis patients diagnosed with COVID-19 with real-time polymerase chain reaction or thorax CT examination were evaluated retrospectively. Radiological findings were classified as ground glass, consolidation, mixed type involvement (ground glass and consolidation), crazy paving appearance, interlobular septal thickening, nodule, halo-reverse halo finding, air bronchogram finding, subpleural curvilinear opacities and tree-in-bud views. Results: A total of 32 patients were included in the study. Twenty-one (65.6%) of the patients were male and 11 (34.4%) were female. The mean age was 67.5±8.5 years. All patients had chronic kidney failure. Thorax CT examination revealed ground-glass opacities in 14 (43.8%) patients, consolidation in 3 (9.4%) patients, and mixed type involvement (ground-glass opacities and consolidation) in 15 (46.9%) patients. The accompanying CT findings were pleural effusion in 23 (71.9%) patients, subpleural curvilinear opacities in 13 (40.6%) patients, bronchial wall thickening in 11 (34.4%) patients, lymphadenopathy in 7 (21.9%) patients, bronchiectasis in 4 (12.5%) patients and pleural thickening in 4 (12.5%) patients. Conclusion: When hemodialysis patients are infected with COVID-19 infection, they differ significantly from other COVID-19 patients in terms of symptoms, clinical course, and prognosis, as well as imaging findings. © 2020, Duzce University Medical School. All rights reserved.

Experience with Hemodialysis Patients in the COVID-19 Pandemic in Sakarya, Turkey

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The effectiveness of dexamethasone on the prognosis of dialysis patients with severe COVID-19

OBJECTIVE: This study aimed to investigate the effectiveness of dexamethasone in dialysis patients with COVID-19 and whether it predicts mortality. METHODS: This is a comparative cross-sectional study of 113 consecutive patients with COVID-19 with severe pneumonia signs. The patients were divided into two groups according to the use of dexamethasone treatment: group 1 (n=45) included patients who were treated with dexamethasone and group 2 (n=68) who did not receive dexamethasone. RESULTS: The mean age of both groups was 67.0+/-10.6 and 67.2+/-13.0 years, respectively (p=0.947). With respect to demographic and laboratory findings, there were no significant differences between the two groups (p>0.05). The hospitalization time of patients in group 1 was longer than that in group 2 (11 [7-17] days vs. 8 [5.3-14] days, p=0.093]. The 28-day survival rate was 54.2% in the group receiving dexamethasone treatment and 79.5% in the group not receiving dexamethasone treatment (p=0.440). CONCLUSION: Dexamethasone did not reduce mortality rates and the requirement for intensive care unit in dialysis patients with COVID-19. Larger prospective randomized clinical trials are required to associate personalized medicine with the corticosteroid treatment to select suitable patients who are more likely to show a benefit.