ABSTRACT
BACKGROUND: The impact of immunosuppression in solid organ transplant recipients with SARS CoV-2 infection is unknown. The knowledge about the behavior of different immunosuppression schemes in clinical outcomes is scarce. This study aimed to determine the risk of death in kidney transplant recipients with COVID-19 under two different schemes of immunosuppression. METHODS: We describe our experience in kidney transplant recipients with SARS CoV-2 infection in seven transplant centers during the first year of the pandemic before starting the vaccination programs in the city of Bogotá. Demographic characteristics, clinical presentation, immunosuppression schemes at presentation, and global treatment strategies were compared between recovered and dead patients; survival analysis was carried out between calcineurin inhibitors based regimen and free calcineurin inhibitors regimen. RESULTS: Among 165 confirmed cases, 28 died (17%); the risk factors for mortality identified in univariate analysis were age older than 60 years (p = .003) diabetes (p = .001), immunosuppression based on calcineurin inhibitors (CNI) (p = .025) and patients receiving steroids (p = .041). In multivariable analysis, hypoxemia (p = .000) and calcineurin inhibitors regimen (p = .002) were predictors of death. Survival analysis showed increased mortality risk in patients receiving CNI based immunosuppression regimen vs CNI free regimens (mortality rates were, respectively, 21.7% and 8.5% (p .036). CONCLUSIONS: Our results suggest that the calcineurin inhibitors probably do not provide greater protection compared to calcineurin inhibitor free schemes being necessary to carry out analyzes that allow us to evaluate the outcomes with different immunosuppression schemes in solid organ transplant recipients with SARS CoV-2 infection.
ABSTRACT
ABSTRACT BACKGROUND The effectiveness of rosuvastatin plus colchicine, emtricitabine/tenofovir, and of their combined use in hospitalized patients with coronavirus disease 2019 (Covid-19) pneumonia is unclear. METHODS In each hospital, hospitalized adults with Covid-19 pneumonia, were randomly assigned, in a 1:1 ratio, to receive: a) standard of care; or b) emtricitabine/tenofovir; or c) colchicine + rosuvastatin; or d) emtricitabine/tenofovir + colchicine + rosuvastatin. The primary outcome was all-cause mortality within the first 28 days after randomization. Severe adverse events (SAE) were those with a high probability of being treatment-related. RESULTS 633 patients were randomized in 6 hospitals in Bogota, Colombia. Overall, 98% of the patients received glucocorticoids during hospitalization. The cumulative incidence of death through day 28 was 10.7% in the emtricitabine/tenofovir + colchicine + rosuvastatin arm, 14.4% in the colchicine + rosuvastatin arm, 13.8% in the emtricitabine/tenofovir arm, and 17.4% in the standard of care arm, with adjusted risk differences (aRD) against the standard treatment of -0.07 (95% confidence interval [CI], -0.17 to 0.04), aRD -0.03 (95%CI: -0.11 to 0.05) and aRD: -0.05 (95%CI: -0.15 to 0.05), respectively. Need for invasive mechanical ventilation was lower in the emtricitabine/tenofovir + colchicine + rosuvastatin arm compared to the standard treatment arm, aRD: -0.06 (95%CI: -0.11 to -0,01), but no differences were found between the other comparisons. SAE occurred in 3 patients distributed in the 3 treatment arms. CONCLUSIONS Among patients hospitalized with moderate and severe SARS Covid-19, the use of the emtricitabine/tenofovir + colchicine + rosuvastatin combination emerges as a treatment alternative. ClinicalTrials.gov number: NCT04359095
Subject(s)
COVID-19 , PneumoniaABSTRACT
Background: Coronavirus disease (COVID-19) represents an unprecedented challenge for both people and health systems. Latin America is the current epicentre of the pandemic; however, there is little published clinical information on the clinical characteristics and outcomes.Objective: To analyse the clinic characteristics, risk factors and evolution of the first cohort of hospitalised patients with confirmed infection by COVID-19 in 5 Colombian institutions.Methods: In the present retrospective observational study, information was acquired from consecutive hospitalized patients with a diagnosis of COVID-19 confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) from March 01 to May 30, 2020 in Colombia.Results: A total of 44 patients were included. The median age was 62 years, and 65.9% of the patients were male. A total of 69.8% of the patients were overweight or obese, and 13.6% of the patients had high blood pressure and diabetes. The presence of systemic symptoms and cough were the most common. Ground-glass opacity was frequent finding upon chest imaging. The 30-day mortality rate was 47.7% with a median of 11 days. The composite outcome (critical care requirement, mechanical ventilation and death) occurred in 36.4% of the patients. The biomarkers associated with mortality risk included troponin higher than 14 ng/L (RR: 5.25; 95% CI 1.37-20.1, p = 0.004) and D-dimer higher than 1000 ng/ml (RR: 3.0; 95% CI 1.4-6.3, p = 0.008). Cardiovascular complications, acute respiratory distress syndrome (ARDS) and acute kidney injury were the most frequent comorbidities in patients with severe pneumonia.Conclusion: The clinical course of SARS-CoV-2 infection diagnosis confirmed by RT-PCR in Colombian patients admitted to a high-complexity hospital was similar to that reported in the literature; however, the population was characterised by a more advanced stage of the infection.