ABSTRACT
Background: Acute kidney injury (AKI) occurs in about 10-15 % of hospitalized patients and represents a significant cause of death. This percentage, during the Covid-19 pandemic, seems to have increased. A meta-analysis reports an overall incidence of AKI, in patients with SARS-CoV2 infection, of 20.4%. The determining cause is not yet clear: direct and indirect damage (from cytokines cascade, iatrogenic damage, organ cross-talk, sepsis, mechanical ventilation, endothelial dysfunction and hypercoagulation) participate in the determination of the loss of renal function. Material(s) and Method(s): We have selected all patients, including SARS-CoV2 infection, admitted to the AOU Polyclinic 'G.Martino' from February 2022 to April 2022, who needed renal replacement therapy (RRT). Result(s): Twelve patients (50%) had SARS-CoV2 infection. Table 1 reports the characteristics of the patients divided according to SARS-CoV2 infection at admission;no significant difference is present. In accordance to the know negative prognostic value of AKI stage 3, 18 patients (75%) died during hospitalization. We then divided the patients into two groups according to death (tab.2). In death patients median creatinine was higher than in survival patients, but, on the other hand, in death patients hemodialytic therapy was done later. Conclusion(s): Our data show the importance of timing in the start of renal replacement therapy and the impossibility of reducing the choice to laboratory indications. Patients with increased renal impairment may be clinically more stable so starting dialysis treatment may not be an emergency. Conversely, patients who do not have a major alteration of the laboratory parameters, but with a more complex clinical picture, may have a better prognosis if, after an overall evaluation, the renal replacement treatment is started early. Moreover, our data show that blood chemical analysis data at admission in Covid-19 patients are not different from patients without Covid-19. Additionally, patients with SARS-CoV2 infection, may have clinical features (related for example to organ cross-talk or the need for mechanical ventilation) that could benefit from an early start of hemodialytic treatment with better outcomes.
ABSTRACT
The Coronavirus disease 2019 (COVID-19) pandemic continues to affect millions worldwide and has posed unique challenges to healthcare professionals. Caring for patients during a pandemic may have negative impacts on their mental health. We describe the first part of a study using a mixed-method sequential explanatory design (QUANT->QUAL). This quantitative part examines the experiences of healthcare professionals during the pandemic in a University Hospital in Italy. We performed a cross-sectional hospital-based survey involving all healthcare professionals between 19 May 2020 and 3 June 2020. Perceived Stress Scale, Patient Health Questionnaire, and General Anxiety Disorder scores were calculated, in order to assess how the pandemic emergency changed the occupational and social habits of the healthcare professionals. The mean age of the 275 respondents was 47 years and females accounted for 80.2%. A total of 29.8% had a Perceived Stress Scale (PSS) score >=25, 22.9% scored >=15 on the Patient Health Questionnaire (PHQ-9) scale, and 17.1% scored >=15 on the General Anxiety Disorder (GAD) scale. Stress symptoms were mostly manifested for interviewees over 55, females, those who live far from their family, those who have only one child, and those who had a qualification lower than high school or who had a medical specialization. Our findings show a relevant level of psychological distress, anxiety, and depression in up to 30% of the sample, highlighting a significant psychological burden in all professionals.