Predictors of mortality in hemodialysis patients with COVID-19: A single-center experience.

INTRODUCTION: The COVID-19 pandemic has disproportionately affected patients with preexisting comorbidities, particularly dialysis patients. The aim of this study was to determine predictors of mortality in this population. METHODOLOGY: We conducted an observational, retrospective, cohort study collecting data from pre and post-vaccine from the electronic medical records of a single dialysis center at Hygeia International Hospital Tirana, Albania. RESULTS: Of 170 dialysis patients, 52 were diagnosed with COVID-19. The prevalence of COVID-19 infection in our study was 30.5%. The mean age was 61.5 ± 12.3 years and 65.4% were men. The mortality rate in our cohort was 19.2%. Mortality rates were higher in patients with diabetic nephropathy (p < 0.04) and peripheral vascular disease (p < 0.01). Elevated C- reactive protein (CRP) (p < 0.018), high red blood cell distribution width (RDW) (p < 0.03), and low lymphocyte and eosinophil counts, were found to be risk factors for severe COVID-19 disease. ROC analysis identified lymphopenia and eosinopenia as the strongest predictors of mortality. After the vaccine administration, the mortality rate in the vaccinated population was 8%, in contrast to the 66.7% mortality rate that was found in the unvaccinated group (p < 0.001). CONCLUSIONS: Our study revealed that risk factors for the development of severe COVID-19 infection were RDW, low lymphocyte and eosinophil counts, elevated levels of CRP. Lymphopenia and eosinopenia were determined as the most important predictors of mortality, in our cohort. Mortality was notably lower among vaccinated patients.

IgA Vasculitis Following COVID-19 Vaccination.

As new variants of SARS-CoV-2 continue to emerge worldwide, countries are striving to fully vaccinate their population in a bid to prevent severe disease, subsequent hospitalizations, and the associated strain on their healthcare systems and death. In this context, there is growing evidence of rare, potential side effects associated with COVID-19 vaccines. IgA vasculitis is a systemic, IgA-mediated vasculitis characterized by palpable purpura, arthralgia, abdominal pain, and renal involvement. It is the most common type of vasculitis in childhood, sporadically affecting the adult population. However, there have been multiple reports of IgA vasculitis following vaccination against COVID-19. Herein, we present the case of a 72-year-old patient with palpable purpura that developed two weeks after receiving the Pfizer BioNTech vaccine. Laboratory investigations revealed elevated serum creatinine (2.6 mg/dL), macroalbuminuria (8.6 g/24 h), and macroscopic hematuria. Histopathological examination confirmed necrotizing vasculitis, and a diagnosis of IgA vasculitis was established. Considering the clinical presentation, the laboratory and histopathological findings, and the time interval between the vaccination and the development of symptoms, we strongly believe that IgA vasculitis in this patient arose as a side effect of the Pfizer BioNTech vaccine.

Predictors of Mortality of COVID-19 in Haemodialysis Patients

BACKGROUND AND AIMS The COVID-19 pandemic has disproportionately affected patients with pre-existing comorbidities, particularly dialysis patients. These patients appear to be more susceptible to severe forms of the infection, due to underlying, coexisting pathologies and their immunocompromised status. The aim of this study was to determine predictors of mortality in this population. METHOD We conducted an observational, retrospective, cohort study collecting data from the electronic medical records of a single dialysis centre at Hygeia Hospital Tirana, Albania. Baseline patient characteristics, including demographic, clinical and laboratory data were recorded. The receiver operating characteristic (ROC) analysis was used to determine predictors of mortality, their respective sensitivity, specificity and cut-off values. RESULTS Of 170 haemodialysis patients, 52 were diagnosed with COVID-19. The prevalence of COVID-19 infection in haemodialysis patients in our study was 30.5%. The mean age was 61.5 ± 12.3 years and 65.4% were men. The mortality rate in our cohort was 19.2%. Mortality rates were higher in patients with Diabetic Nephropathy (P < 0.04) and Peripheral Vascular Disease (P < 0.01). High BMI (P < 0.024), high RDW (P < 0.03), elevated C-reactive protein (P < 0.018) and elevated serum ferritin (P < 0.021) levels, were found to be risk factors for severe COVID-19 disease. ROC analysis identified lymphopenia and eosinopenia as the strongest predictors of mortality. AUC for lymphopenia was 0.739. It showed a sensitivity of 80% and a specificity of 85.7%, at a cut-off value of 13.15%. AUC for eosinopenia was 0.814. At a cut-off value of 0.185%, it revealed a sensitivity and specificity of 72.7% and 75%, respectively. CONCLUSION Our study revealed that risk factors for the development of severe COVID-19 infection were high BMI, high RDW, elevated levels of C-reactive protein (CRP) and serum ferritin. Lymphopenia and eosinopenia were determined as the most important predictors of mortality, in our cohort. Early recognition during the course of the infection, of a declining tendency of lymphocyte and eosinophil counts is paramount, in identifying high-risk patients for severe disease and poor outcomes among haemodialysis patients.