ABSTRACT
Introduction: Sars-cov2 infection is commonly associated with acute kidney injury (AKI) which may be observed in up to 40% of cases. Pathogenesis of AKI during COVID-19 is yet not perfectly understood. Many risk factors have been proposed associated with AKI occurrence during COVID-19 infection. To date there is still limited data of AKI progression and long-term outcomes among these patients. We aim to describe risk factors for development of AKI and the progression of their renal function up to six months after hospital discharge. Methodology: This is a retrospective observational study in a tertiary car nephrology department in Barcelona, Spain. We evaluated data from 71 hospitalized patients with AKI occurrence during COVID-19 infection between 1st of March and 30th May 2020. Analysis of baseline characteristic, need of renal replacement therapy (RRT) and inflammatory parameters has been performed. Result(s): Of 71 patients (74,6% males;median age 71,9+/-11,15 years), 43 (60,6%) needed admission in the intensive care unit (ICU) for hemodynamic/respiratory support and 34 (47,9%) died during hospitalization. 13 (18,3%) needed RRT. 3 (23%) patients requiring RRT died during COVID-19 infection and 9 (69,2%) partially recovered renal function. Baseline serum creatinine of patients without RRT need during follow-up was 0,90+/-0,16 mg/dl with a peak serum creatinine 2,8+/-1,5 mg/dl. Patients that needed RRT support had a baseline serum creatinine 0,98+/-0,87 mg/dl and a peak serum creatinine of 4,34+/-3,35 mg/dl. Creatinine at discharge was of 1,5+/-0,59 mg/dl in the group of patients needing RRT and 1,2+/-0,52 mg/dl. At six months follow-up no significant differences were found in creatinine levels from discharge (p=0,65). Very poor correlation was observed between inflammatory parameters and serum creatinine peak levels (Dimer D levels and Serum creatinine peak R2=0,034;C reactive protein and creatinine peak levels R2=0,15 and Interleukin 6 and creatinine peak levels R2=0,042). Conclusion(s): COVID-19 infection is associated with AKI with and increased risk of chronic kidney disease after infection is resolved. No differences between renal function at discharge and at 6 months of follow-up was observed. No correlation between the studied inflammatory parameters and the worsening of renal function was observed.
ABSTRACT
OBJECTIVE: Describes a case of an adult COVID-19, who was addmited patient admitted to an intensive care unit (ICU) and submitted to the prone position. CASE REPORT: Female patient, 44 years old, with a previous metabolic syndrome and acquired immuno-deficiency syndrome, arrived at the emergency department. She had fever, nasal congestion, but without dyspnea. After clinical and imaging tests, she was transferred to an ICU, with suspected COVID-19. Upon arrival at the intensive unit, she was breathing spontaneously with low flow oxygen therapy, presenting hypoxemia. In addition to the established medical therapies, he was instructed to position himself in the PP for a period of 15 to 30 minutes, performed once when turning. Arterial blood gases increase to 96mmHg in PaO2 and consequently 18% in the PaO2 / FiO2 ratio, in addition to the favorable clinical evolution. CONCLUSIONS: The early indication of PP as an additional therapy in the treatment of COVID-19 patients, can have contributed to the favorable clinical outcome, especially with regard to oxygenation, evidenced by the improvement of PaO2 parameters, PaO2/FiO2 ratio and progress discharged. © 2021 Editora Universitaria da PUCRS. All rights reserved.
ABSTRACT
Introduction: Delineating antiviral T-cell responses to SARS-CoV-2 may shed light on the heterogeneity of clinicaloutcomes and inform vaccine or therapeutic approaches. Viral antigens can be predicted using computational toolsthat calculate the binding affinity between viral peptides and antigen presentation machinery. However, in order toaccount for the role of host genetics in the diversity of responses, this analysis must be performed withconsideration of the global diversity of the human leukocyte antigen (HLA) proteins responsible for antigenpresentation. Methods: We deployed binding predictions across the SARS-CoV-2 peptidome for 9,360 Class I HLA alleles (2,987HLA-A;3,707 HLA-B;2,666 HLA-C;9-mers) using a consensus approach of 7 algorithms and 3,486 Class II HLAalleles (15-mers) using a consensus approach of 4 algorithms. All pMHC predictions were filtered to include onlythose with consensus binding less than 500 nM. Results: There were 368,145 unique combinations of peptides and HLA alleles (pMHCs) with a predicted bindingaffinity of less than 500nM, including 1,103 unique 9-mer and 2,547 15-mer peptides and 1,022 MHC Class I and8,075 MHC Class II HLA proteins. Of these pMHCs, 82% of 9-mers overlapped with 15-mers, suggesting cross-presentation to both CD4 and CD8 T cells in a subset of individuals. We evaluated this filtered dataset with respectto the population frequency of HLA haplotypes. While the predicted susceptibility of SARS-CoV-2 antigenpresentation differed greatly across countries, there was a subset of 21 Class I antigens shared by common HLAtypes across 30 or more countries (out of 79 countries with reported population frequency data). Our database hasbeen made publicly available, and we have developed a user interface to explore the results based upon viralproteins, HLA alleles, or country populations of interest. Conclusions: With the ongoing SARS-CoV-2 pandemic, there are worldwide efforts to generate a successfulvaccine and to evaluate clinical samples to understand the viral pathogenesis and diverse outcomes in patients.This application can serve as a guide to identify responses of putative SARS-CoV-2-specific T cells across patients with a broad range of HLA haplotypes internationally.