ABSTRACT
BACKGROUND AND AIMS The SARS-CoV-2 pandemic has become one of the most serious health problems globally. Covid-19 poses a serious life-threatening risk, especially for immunocompromised patients such as kidney transplant recipients. However, the reason why some transplant recipients are asymptomatic while others are severely ill is still not clear. Genetic variation might affect the outcome and mortality of Covid-19 infection. Haptoglobin (Hp) is a plasma protein with antioxidant, immunomodulatory properties and has an important biological function in the host defense responses to infection and inflammation [1]. In humans, Hp is characterized by a molecular heterogeneity with three main genotypes/phenotypes: Hp1-1, Hp2-1, and Hp2-2 [2, 3]. This polymorphism might have important biological consequences in various bacterial and viral infections [3, 4]. In the present study, we aimed to evaluate whether haptoglobin gene polymorphisms effect Covid-19’s severity in kidney transplant patients. METHOD About 229 renal transplant recipients were evaluated in retrospective fashion. Patients with a history of Covid-19 infection (n:62) were included in the study. We investigated the relation between Hp phenotypes (Hp 1–1, Hp 1–2, Hp 2–2) and Covid-19 disease severity. RESULTS Baseline characteristics, laboratory and health parameters were similar between Hp 1–1, Hp 1–2 and Hp 2–2 groups. We found that Hp2-2 phenotype was a significant predictor of disease severity in renal transplant recipients with Covid-19 (p:0013). Hp 2–2 phenotype was significantly associated with longer hospitalizations and intensive care unit admissions (p:0012 and p:0032). CONCLUSION Renal transplant recipients with the Hp 2–2 phenotype might have worse outcomes with Covid-19. It has been suggested that the Hp2-2 phenotype predisposes to greater oxidative stress and more pronounced viral replication [5]. Thus, the HP 1–1 protein has been described superior antioxidant and anti-inflammatory properties compared with the other two genotypes. This difference and geographic variation in haptoglobin phenotypes may be one of the factors contributing to the geographical variation in Covid-19 disease severity and mortality. Hp phenotype may be useful in the risk stratification algorithm and management of Covid-19. Studies involving more patients will be welcome to enlighten Hp genes effect on this subject.Table 1. Clinical characteristics of renal transplant recipients with Covıd-19All patients (n = 62)Hp 1–1 (n = 8)Hp 1–2 (n = 28)Hp 2–2 (n = 26)P-valueHospitalization days, mean (SD)5 2 ± 6.52.5 ± 3.12.4 ± 4.39.1 ± 7.30.012Covid pneumonia, n (%)37 (59.7)5 (62.5)13 (46.4)19 (73.1)0.135Hypoxia, n (%)28 (45.2)3 (37.5)7 (25)18 (69.2)0.004Tachypnea, n (%)27 (43,5)4 (50)5 (17.9)18 (69.2)0.001Hypotension, n (%)17 (27,4)2 (25)4 (14.3)11 (42.3)0.069Tromboemboly, n (%)3 (4,8)0 (0)0 (0)3 (11.5)0.113HD/CRRT, n (%)10 (16,4)0 (0)4 (14.8)6 (23.1)0.292NIMV, n (%)17 (27,4)1 (12.5)4 (14.3)12 (46.2)0.019Intubation, n (%)15 (24,2)1 (12.5)4 (14.3)10 (38.5)0.083Íntensive care admission, n (%)16 (25.8)1 (12.5)3 (10.7)12 (46.2)0.032COVID severity, n (%)0.013MildModerateSevereCritic24 (38.7)12 (19.4)11 (17.7)15 (24.2)3 (37.5)2 (25)2 (25)1 (12.5)16 (57.1)7 (25)1 (3.6)4 (14.3)5 (19.2)3 (11.5)8 (30.8)10 (38.5)COVID-related death, n (%)15 (24.2)1 (12.5)4 (14.3)10 (38.5)0.083
ABSTRACT
BACKGROUND: 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. METHODS: 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 (CKD) (37.6%). 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 81.7% and partial in 17.2% 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%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). 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. CONCLUSIONS: 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. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.