ABSTRACT
BACKGROUND AND AIMS: Sleep disorders, depression and anxiety are commonly reported in patients with systemic lupus erythematosus (SLE). Public health emergencies such as pandemics can also increase these psychosocial distresses. Early diagnosis and treatment of these disorders will substantially affect patients' quality of life and medication adherence. The aim of this study was to evaluate both medication non-adherence and the incidence of perceived stress, anxiety, depression, sleep quality and insomnia during the COVID pandemic in patients with SLE. METHOD: This was a cross-sectional, descriptive survey study. A total of 211 participants, including 160 SLE patients aged 18 years and older and 51 healthy volunteers who were similar in age and gender, were included. A questionnaire of socio-demographics and COVID-19 status, Medication Compliance Reporting Scale (MARS-5), Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale (HADA and HAD-D), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) scales was assessed. The participants were interviewed face to face, and the answers were recorded by the researcher. RESULTS: The mean age of the patients was 41.85 ± 12.97 years and 142 (88.7%) of the patients were female. There was no significant difference between the patient and control groups in terms of the history of COVID-19 infection, symptoms and hospitalization. Fifty-nine (36.9%) patients had high perceived stress, 16 (10.0%) had anxiety, 45 (28.1%) had depression, 77 (48.1%) had poor sleep quality and 62 (38.8%) patients had insomnia. PSS (23.64 ± 7.86 versus 19.73 ± 4.80, P = .001), HAD-D (5.60 ± 3.40 versus 4.08 ± 2.21, P = .003), PSQI (6.31 ± 3.62 versus 4.43 ± 2.20, P = .001) and ISI (6.81 ± 4.98 versus 4.53 ± 2.83, P = .002) scores were significantly higher in the patient group than controls. Patients with PSS score ≥ 25 were categorized as patients with a high PSS score. Presence of anxiety, depression, poor sleep quality and insomnia were significantly higher in patients with a high PSS score. Medication non-adherence was detected in 79 (49.4%) of the patients. Interestingly, there was no difference in MARS-5 scores between high and low PSS groups. Comparison of baseline characteristics and clinical data of the patients according to PSS score is shown in Table 1. The high PSS score was positively correlated with HAD-A, HAD-D, PSQI and ISI scores. Regression analysis revealed that high perceived stress is an independent predictor of depression [Exp(β) 95% CI: 1.488 (1.245-1.779), P < .001], and anxiety [Exp(β) 95% CI: 1.235 (1.026-1.487), P = .026]. CONCLUSION: SLE patients demonstrated increased levels of perceived stress, depression, poor sleep quality and insomnia compared to the healthy population during the COVID-19 pandemic. SLE patients with high perceived stress had more depression, anxiety, poor sleep quality and insomnia than those without. It needs to be determined whether these findings will have an impact on patient outcomes during long-term follow-up.
ABSTRACT
BACKGROUND AND AIMS: Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI. METHOD: In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. RESULTS: The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (41.5%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 80.7% and partial in 17% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality. The in-hospital mortality rates across AKI stages by age, gender, and diabetes mellitus were shown in the Figure. CONCLUSION: Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. Renal problems continue in a significant portion of the patients who were discharged.