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Journal of Istanbul Faculty of Medicine / &Iacute ; stanbul Tıp Fakültesi Dergisi; 0(0):0-0, 2022.
Article in English | Web of Science | ID: covidwho-2091521


Objective: Multisystem Inflammatory Syndrome (MIS) is a con-dition seen in the early post-COVID-19 period and thought to develop with an impaired immune response. It has been usually reported in children but rarely in adults. Here we report the first MIS-A case series from Turkiye.Material and Methods: Six patients who met the Centers for Disease Control and Preventions MIS-A diagnostic criteria were included in the study. The demographic, clinical, laboratory, ra-diological characteristics and therapy regimes and outcomes of the patients were recorded.Results: All of our cases had a history of mild COVID-19. They presented with fever, severe fatigue and hypotension. Abnormal echocardiography findings were detected in five patients. Only one patient had multiple mucocutaneous findings. Common lab-oratory features were lymphopenia, markedly increased C-Reak-tive Protein, procalcitonin, pro-brain natriuretic peptide (pro-BNP), D-dimer, and ferritin. All patients had positive SARS-CoV-2 antibody result. Corticosteroids and/or anakinra were used in five, Intravenous immunoglobulin was used in two patients. Low-mo-lecular-weight heparin (LMWH) was used for all cases. Empirically initiated antibiotic treatments were discontinued after cultures were negative. After anti-inflammatory treatment, the hypoten-sion of the patients resolved, they did not need intensive care follow-up and no mortality was seen in our cases.Conclusions: MIS-A is a severe and mortal condition that causes various clinical pictures and can be confused with sepsis. Anakin-ra, a recombinant IL-1 receptor antagonist, is a significant agent that can be used in the treatment of MIS-A since it blocks the cytokine cascade at an early stage. The satisfactory respons-es will be obtained with early diagnosis and anti-inflammatory treatment. In this period when the pandemic is not over yet, it is necessary to increase the awareness of clinicians about MIS-A, which can be fatal.

Int Urol Nephrol ; 53(10): 2117-2125, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1064574


BACKGROUND: The prognostic factors for COVID-19 in patients with chronic kidney disease (CKD) are uncertain. We conducted a study to compare clinical and prognostic features between hospitalized COVID-19 patients with and without CKD. METHODS: Fifty-six patients with stage 3-5 CKD and propensity score-matched fifty-six patients without CKD were included in the study. Patients were followed-up at least fifteen days or until death after COVID-19 diagnosis. The endpoints were death from all causes, development of acute kidney injury (AKI) or cytokine release syndrome or respiratory failure, or admission to the intensive care unit (ICU). RESULTS: All patients were reviewed retrospectively over a median follow-up of 44 days (IQR, 36-52) after diagnosis of COVID-19. Patients with CKD had higher intensive care unit admission and mortality rates than the patients without CKD, but these results did not reach statistical significance (16 vs. 19; p = 0.54 and 11 vs. 16, p = 0.269, respectively). The frequency of AKI development was significantly higher in predialysis patients with CKD compared to the other group (8 vs. 5; p < 0.001), but there was no significant difference between the groups in terms of cytokine release syndrome (13 vs. 8; p = 0.226), follow-up in the ICU (19 vs. 16; p = 0.541), and respiratory failure (25 vs. 22, p = 0.566). Multivariate logistic regression analysis revealed that respiratory failure and AKI were independent risk factors for mortality. CONCLUSION: The mortality rates of COVID-19 patients with CKD had higher than COVID-19 patients without CKD. Also, AKI and respiratory failure were independently related to mortality.

COVID-19/complications , COVID-19/epidemiology , Renal Insufficiency, Chronic/complications , Acute Kidney Injury/epidemiology , Adult , Aged , COVID-19/therapy , Critical Care , Cytokine Release Syndrome/epidemiology , Female , Hospital Mortality , Hospitalization , Humans , Male , Middle Aged , Propensity Score , Renal Insufficiency, Chronic/mortality , Renal Insufficiency, Chronic/therapy , Respiratory Insufficiency/epidemiology , Retrospective Studies , Risk Factors , Survival Rate