ABSTRACT
Patients receiving renal replacement therapy (RRT) in the form of maintenance hemodialysis (MHD) belong to a group of particularly high risk of infection and the course of COVID-19. The new coronavirus infection also has a great impact on long-term outcomes. Material(s) and Method(s): A retrospective observational study included 510 patients on MHD, hospitalized from April 1, 2020 to April 01, 2021. The outcome of hospitalization was chosen as the primary endpoint of the study: discharge or 28-day mortality. Death within 6 months after discharge and the development of complications related to COVID-19 during this period were considered as secondary endpoints. Data collection was carried out by analyzing electronic and archival medical records. Quantitative variables: age, duration of hospitalization, days in the intensive care unit, laboratory blood parameters: the level of D-Dimer, Glucose, Interleukin-6, Procalcitonin, Lymphocytes and Platelets, CRP, CPK, CPK-MB, LDH, Fibrinogen, Ferritin. Qualitative indicators: gender, ventilator, ARDS, the presence of diabetes, the presence of obesity, the presence of complications: cardiovascular, gastrointestinal, septic, macrothrombotic, stage of pneumonia. To identify statistically significant predictors of the risk of an event, the odds ratio (OR) method was used. Result(s): average age 57.8+/-14 years, men - 59.5%, average bed day 17.6+/-10.6 days. In concomitant diseases, diabetes mellitus was indicated in 24% of patients, obesity was registered in 4.3% of patients. Hospital mortality (28-day) in the total cohort of follow-up was 16.05%, in total with out-of-hospital mortality of 22%. Mortality in intensive care reached 62.7%, on ventilator more than 86%, with ARDS 94.3%. No statistical significance was revealed by gender and the presence of diabetes mellitus (DM) in concomitant diseases. When comparing short-term outcomes, the age groups over 65 differed statistically. The following laboratory blood parameters showed a significant difference (P<0.001): D-Dimer, Glucose, IL-6 lymphocytes, Leukocytes, Neutrophils, Platelets, LDH, Ferritin. The following odds ratios (OR) were obtained: ARDS (OR 143.78;95% CI 33.4-616.2;p=0.0001), on ventilator (OR 57.96;95% CI 23.1-144.5;p=0.0001), the presence of septic complications (OR 26.4;95% CI 13.8-50;p=0.0001), the course of the disease is defined as severe (OR 25;95% CI 12.9-48.2;p=0.0001), the course of the disease is defined as complicated (OR 11.6;95% CI 6.8-19.7;p=0.0001), the presence of gastrointestinal complications (OR 6.5;95% CI 2.28-18.4;p=0.0007), the presence of obesity (OR 2.57;95% CI 1.0-6.5;p=0.039). Mortality of patients receiving two main treatment regimens T-1 and T-2 did not differ (15.8% vs 15.7%). Significant differences (p=0.0001) appeared when compared with the T-0 and T-4 schemes, in which mortality was recorded at 8.8% and 85.7%, respectively. When comparing long-term outcomes, the analysis did not reveal statistical significance by gender. The statistical difference was noted by age. Among laboratory indicators, the PCT level was higher in survivors with complications. A significant difference among all survivors and deceased (P<0.001) was shown by: D-Dimer, blood glucose level, IL-6, CRP. The highest OR was calculated for the following indicators: the presence of gastrointestinal complications (OR 7.7;95% CI 1.0-57.7;p=0.03), the initial LDH blood level of 622 units /l (OR 4.7;95% CI 1.63-13.63;p=0.0086), the course of the disease defined as complicated (OR 4.05;95% 1.97-8.33;p=0.003), the course of the disease is defined as severe (OR 2.4;95% CI 1.17-5.0;p=0.03). Conclusion(s): gastrointestinal complications had the greatest impact on unfavorable short-term and long-term outcomes in patients on programmed hemodialysis. In relation to such laboratory markers as Ferritin, CRH, LDH, threshold values of a significant increase in the chances characteristic of dialysis patients were obtained. During the first year of the epidemic, therapy remained largely supportive and aimed at prevent ng complications, the main isolated treatment regimens showed no significant differences in the impact on the outcomes of COVID-19.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.
ABSTRACT
Patients receiving renal replacement therapy (RRT) in the form of maintenance hemodialysis (MHD) belong to a group of particularly high risk of infection and the course of COVID-19. The new coronavirus infection also has a great impact on long-term outcomes. Materials and methods: A retrospective observational study included 510 patients on MHD, hospitalized from April 1, 2020 to April 01, 2021. The outcome of hospitalization was chosen as the primary endpoint of the study: discharge or 28-day mortality. Death within 6 months after discharge and the development of complications related to COVID-19 during this period were considered as secondary endpoints. Data collection was carried out by analyzing electronic and archival medical records. Quantitative variables: age, duration of hospitalization, days in the intensive care unit, laboratory blood parameters: the level of D-Dimer, Glucose, Interleukin-6, Procalcitonin, Lymphocytes and Platelets, CRP, CPK, CPK-MB, LDH, Fibrinogen, Ferritin. Qualitative indicators: gender, ventilator, ARDS, the presence of diabetes, the presence of obesity, the presence of complications: cardiovascular, gastrointestinal, septic, macrothrombotic, stage of pneumonia. To identify statistically significant predictors of the risk of an event, the odds ratio (OR) method was used. Results: average age 57.8±14 years, men – 59.5%, average bed day 17.6±10.6 days. In concomitant diseases, diabetes mellitus was indicated in 24% of patients, obesity was registered in 4.3% of patients. Hospital mortality (28-day) in the total cohort of follow-up was 16.05%, in total with out-of-hospital mortality of 22%. Mortality in intensive care reached 62.7%, on ventilator more than 86%, with ARDS 94.3%. No statistical significance was revealed by gender and the presence of diabetes mellitus (DM) in concomitant diseases. When comparing short-term outcomes, the age groups over 65 differed statistically. The following laboratory blood parameters showed a significant difference (P<0.001): D-Dimer, Glucose, IL-6 lymphocytes, Leukocytes, Neutrophils, Platelets, LDH, Ferritin. The following odds ratios (OR) were obtained: ARDS (OR 143.78;95% CI 33.4-616.2;p=0.0001), on ventilator (OR 57.96;95% CI 23.1-144.5;p=0.0001), the presence of septic complications (OR 26.4;95% CI 13.8-50;p=0.0001), the course of the disease is defined as severe (OR 25;95% CI 12.9-48.2;p=0.0001), the course of the disease is defined as complicated (OR 11.6;95% CI 6.8-19.7;p=0.0001), the presence of gastrointestinal complications (OR 6.5;95% CI 2.28-18.4;p=0.0007), the presence of obesity (OR 2.57;95% CI 1.0-6.5;p=0.039). Mortality of patients receiving two main treatment regimens T-1 and T-2 did not differ (15.8% vs 15.7%). Significant differences (p=0.0001) appeared when compared with the T-0 and T-4 schemes, in which mortality was recorded at 8.8% and 85.7%, respectively. When comparing long-term outcomes, the analysis did not reveal statistical significance by gender. The statistical difference was noted by age. Among laboratory indicators, the PCT level was higher in survivors with complications. A significant difference among all survivors and deceased (P<0.001) was shown by: D-Dimer, blood glucose level, IL-6, CRP. The highest OR was calculated for the following indicators: the presence of gastrointestinal complications (OR 7.7;95% CI 1.0-57.7;p=0.03), the initial LDH blood level of 622 units /l (OR 4.7;95% CI 1.63-13.63;p=0.0086), the course of the disease defined as complicated (OR 4.05;95% 1.97-8.33;p=0.003), the course of the disease is defined as severe (OR 2.4;95% CI 1.17-5.0;p=0.03). Conclusions: gastrointestinal complications had the greatest impact on unfavorable short-term and long-term outcomes in patients on programmed hemodialysis. In relation to such laboratory markers as Ferritin, CRH, LDH, threshold values of a significant increase in the chances characteristic of dialysis patients were obtained. During the first year of the epidemic, therapy remained largely supportive and aimed at preventing comp ications, the main isolated treatment regimens showed no significant differences in the impact on the outcomes of COVID-19. © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.
ABSTRACT
Patients receiving renal replacement therapy (RRT) in the form of maintenance hemodialysis (MHD) belong to a group of particularly high risk of infection and the course of COVID-19. The new coronavirus infection also has a great impact on long-term outcomes. Material(s) and Method(s): A retrospective observational study included 510 patients on MHD, hospitalized from April 1, 2020 to April 01, 2021. The outcome of hospitalization was chosen as the primary endpoint of the study: discharge or 28-day mortality. Death within 6 months after discharge and the development of complications related to COVID-19 during this period were considered as secondary endpoints. Data collection was carried out by analyzing electronic and archival medical records. Quantitative variables: age, duration of hospitalization, days in the intensive care unit, laboratory blood parameters: the level of D-Dimer, Glucose, Interleukin-6, Procalcitonin, Lymphocytes and Platelets, CRP, CPK, CPK-MB, LDH, Fibrinogen, Ferritin. Qualitative indicators: gender, ventilator, ARDS, the presence of diabetes, the presence of obesity, the presence of complications: cardiovascular, gastrointestinal, septic, macrothrombotic, stage of pneumonia. To identify statistically significant predictors of the risk of an event, the odds ratio (OR) method was used. Result(s): average age 57.8+/-14 years, men - 59.5%, average bed day 17.6+/-10.6 days. In concomitant diseases, diabetes mellitus was indicated in 24% of patients, obesity was registered in 4.3% of patients. Hospital mortality (28-day) in the total cohort of follow-up was 16.05%, in total with out-of-hospital mortality of 22%. Mortality in intensive care reached 62.7%, on ventilator more than 86%, with ARDS 94.3%. No statistical significance was revealed by gender and the presence of diabetes mellitus (DM) in concomitant diseases. When comparing short-term outcomes, the age groups over 65 differed statistically. The following laboratory blood parameters showed a significant difference (P<0.001): D-Dimer, Glucose, IL-6 lymphocytes, Leukocytes, Neutrophils, Platelets, LDH, Ferritin. The following odds ratios (OR) were obtained: ARDS (OR 143.78;95% CI 33.4-616.2;p=0.0001), on ventilator (OR 57.96;95% CI 23.1-144.5;p=0.0001), the presence of septic complications (OR 26.4;95% CI 13.8-50;p=0.0001), the course of the disease is defined as severe (OR 25;95% CI 12.9-48.2;p=0.0001), the course of the disease is defined as complicated (OR 11.6;95% CI 6.8-19.7;p=0.0001), the presence of gastrointestinal complications (OR 6.5;95% CI 2.28-18.4;p=0.0007), the presence of obesity (OR 2.57;95% CI 1.0-6.5;p=0.039). Mortality of patients receiving two main treatment regimens T-1 and T-2 did not differ (15.8% vs 15.7%). Significant differences (p=0.0001) appeared when compared with the T-0 and T-4 schemes, in which mortality was recorded at 8.8% and 85.7%, respectively. When comparing long-term outcomes, the analysis did not reveal statistical significance by gender. The statistical difference was noted by age. Among laboratory indicators, the PCT level was higher in survivors with complications. A significant difference among all survivors and deceased (P<0.001) was shown by: D-Dimer, blood glucose level, IL-6, CRP. The highest OR was calculated for the following indicators: the presence of gastrointestinal complications (OR 7.7;95% CI 1.0-57.7;p=0.03), the initial LDH blood level of 622 units /l (OR 4.7;95% CI 1.63-13.63;p=0.0086), the course of the disease defined as complicated (OR 4.05;95% 1.97-8.33;p=0.003), the course of the disease is defined as severe (OR 2.4;95% CI 1.17-5.0;p=0.03). Conclusion(s): gastrointestinal complications had the greatest impact on unfavorable short-term and long-term outcomes in patients on programmed hemodialysis. In relation to such laboratory markers as Ferritin, CRH, LDH, threshold values of a significant increase in the chances characteristic of dialysis patients were obtained. During the first year of the epidemic, therapy remained largely supportive and aimed at prevent ng complications, the main isolated treatment regimens showed no significant differences in the impact on the outcomes of COVID-19.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.
ABSTRACT
Coronavirus infection (COVID-19) is an acute infectious disease caused by a new strain of the virus of the genus coronavirus SARS-CoV-2 with the aerosol-droplet and contact-household transmission mechanism;patogenetically local and systemic inflammatory process, hyperactive impulsive cascade, endotheliopathy, hypoxia, leading to the development of micro - and microthrombosis;it occurs from asymptomatic to clinically significant forms of intoxication, vascular lesions, lungs, heart, kidneys, and GI tract with risk of complications (ARF, ARDS, sepsis, shock, multiple organ dysfunction SYNDROME, pulmonary embolism).Currently, there are few data on the course of this disease in patients undergoing treatment with program hemodialysis, as well as methods of specific treatment of this group of patients.The article describes the case of the first patient in the Clinical Infectious Hospital named after S.P. Botkin with end-stage chronic kidney disease corrected by program hemodialysis, who had a COVID-19. Коронавирусная инфекция (COVID-19) - острое инфекционное заболевание, вызываемое новым штаммом вируса из рода коронавирусов SARS-CoV-2 с аэрозольно-капельным и контактно-бытовым механизмом передачи, патогенетически характеризуется локальным и системным иммуновоспалительным процессом, гиперактивностью коагуляционного каскада, эндотелиопатией, гипоксией, приводящим к развитию микро- и макротромбозов, протекает от бессимптомных до клинически выраженных форм с интоксикацией, поражением сосудов, легких, сердца, почек, желудочно-кишечного тракта с риском развития осложнений (острая дыхательная недостаточность, острый респираторный дистресс-синдром, сепсис, шок, синдром полиорганной недостаточности, тромбоэмболия легочной артерии). В настоящее время имеются немногочисленные данные о течении данного заболевания у пациентов, находящихся на лечении программным гемодиализом, а также методах специфического лечения данной группы больных.В статье описан случай первого пациента в Клинической инфекционной больнице имени С.П. Боткина с хронической болезнью почек терминальной стадии, корригируемой программным гемодиализом, перенесшего COVID-19.