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Acta méd. peru ; 38(4): 249-256, oct.-dic 2021. tab
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-1791272


RESUMEN Antecedentes y objetivo: La insuficiencia renal es una de las complicaciones extrapulmonares más frecuente en pacientes hospitalizados con COVID-19 condicionando peores desenlaces. Sin embargo, estudios comparan pacientes con insuficiencia renal aguda (IRA) o crónica (ERC) con pacientes sanos. Determinar características clínicas de pacientes con COVID-19 e insuficiencia renal hospitalizados y evaluar el efecto del tipo de insuficiencia renal y el recibir hemodiálisis en los desenlaces clínicos negativos. Métodos: Cohorte descriptiva que incluyó pacientes con algún tipo de insuficiencia renal y COVID-19 hospitalizados durante marzo y julio del 2020, que tuvieron una interconsulta con nefrología. La insuficiencia renal se clasificó como aguda, crónica, y crónica en estadio V con hemodiálisis crónica. Se recolectó información sobre mortalidad, uso de inotrópicos, ventilación mecánica y recibir hemodiálisis aguda. Resultados: Se analizó a 279 pacientes, 22.6 % tenían IRA, 33.3 % tenían ERC, y 44.1 % tenían ERC V. Se describe una mortalidad general de 32.9 %. Entre los pacientes con IRA y ERC el 12.9 % recibió hemodiálisis por primera vez. El desarrollo de IRA se asoció a ventilación mecánica (RPa: 6.46), uso de inotrópicos (RPa: 7.02) y fallecer (RPa: 2.41), en comparación con los que tenían sólo ERC. Entre quienes tenían IRA o ERC, aquellos que recibieron hemodiálisis por primera vez tienen mayor prevalencia de fallecer (RPa: 2.95; IC95%:2.20 a 3.94) en comparación con los que no recibieron hemodiálisis. La hemodiálisis aguda podría ser un modificador de efecto de la asociación entre tipo de insuficiencia renal (IRA o ERC) y desenlaces clínicos negativos (p<0.001). Conclusión: Es importante identificar a pacientes hospitalizados por COVID-19 que desarrollan IRA y/o necesitan hemodiálisis aguda pues se encuentran en alto riesgo de tener una mala evolución clínica.

ABSTRACT Introduction: Kidney failure is one of the most frequent extrapulmonary complications in patients hospitalized with COVID-19, leading to poorer outcomes, and this may have serious consequences for the Peruvian health system. Nonetheless, there are studies comparing patients with acute kidney failure (AKF) and chronic kidney failure (CKF) against healthy subjects. Objective: To determine the clinical characteristics of hospitalized patients with COVID-19 and kidney failure, and to assess the effect of the type of kidney failure and undergo hemodialysis with respect to negative clinical outcomes. Methods: This is a descriptive cohort study that included patients with some kind of kidney failure and COVID-19 who were hospitalized between March and June 2020, and who had a consultation with the nephrology service. Kidney failure was classified as acute, chronic, and stage V chronic undergoing chronic hemodialysis. Data with respect to mortality, inotrope use, mechanical ventilation, and acute hemodialysis was collected. Results: Two-hundred and seventy-nine patients were included, 22.6% had acute kidney failure, 33.3% had chronic kidney failure, and 44.1 had stage V chronic kidney failure. General mortality rate was 32.0%, and 27% received inotrope agents and underwent mechanical ventilation. Amongst patients with AKF and CKF, 12.9% underwent hemodialysis for the first time. Studied adult subjects with CKD and stage V CKD undergoing hemodialysis had lower frequency of diabetes mellitus (23.7% and 43.9%, respectively) and high blood pressure (31.2% and 59.4%, respectively) compared with adult subjects with AKF (81.0 and 73%, respectively) (p<0.001). The occurrence of AKF was associated with mechanical ventilation (RPa: 6.46), inotrope use (RPa: 7.02), and death (RPa: 2.41), compared with those who had CKF. Amongst those subjects who had AKF or CKF, those who underwent dialysis for the first time were more likely to die (RPa: 2.95; 95% CI: 2.20-3.94) compared with those who did not undergo hemodialysis. Acute hemodialysis may be an effect modifier for the association between the type of kidney failure (AKF or CKF) and negative clinical outcomes (p<0.001). Conclusion: It is important to identify hospitalized patients with COVID-19 that may develop AKF and/or who may need acute hemodialysis, since they are at high risk for a poor clinical outcome.

JAMA Netw Open ; 4(3): e211489, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1130417


Importance: There is evidence of central nervous system impairments associated with coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Multimodal monitoring of patients with COVID-19 may delineate the specific features of COVID-19-related encephalopathy and guide clinical management. Objectives: To investigate clinical, biological, and brain magnetic resonance imaging (MRI) findings in association with electroencephalographic (EEG) features for patients with COVID-19, and to better refine the features of COVID-19-related encephalopathy. Design, Setting, and Participants: This retrospective cohort study conducted in Pitié-Salpêtrière Hospital, Paris, France, enrolled 78 hospitalized adults who received a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) and underwent EEG between March 30 and June 11, 2020. Exposures: Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription-polymerase chain reaction assay or, in the case of associated pneumonia, on a computed tomography scan of the chest. Main Outcomes and Measures: Data on the clinical and paraclinical features of the 78 patients with COVID-19 were retrieved from electronic patient records. Results: Of 644 patients who were hospitalized for COVID-19, 78 (57 men [73%]; mean [SD] age, 61 [12] years) underwent EEG. The main indications for EEG were delirium, seizure-like events, and delayed awakening in the intensive care unit after stopping treatment with sedatives. Sixty-nine patients showed pathologic EEG findings, including metabolic-toxic encephalopathy features, frontal abnormalities, periodic discharges, and epileptic activities. Of 57 patients who underwent brain MRI, 41 showed abnormalities, including perfusion abnormalities, acute ischemic lesions, multiple microhemorrhages, and white matter-enhancing lesions. Fifty-five patients showed biological abnormalities, including dysnatremia, kidney failure, and liver dysfunction, the same day as the EEG. The results of cerebrospinal fluid analysis were negative for SARS-Cov-2 for all tested patients. Nine patients who had no identifiable cause of brain injury outside COVID-19 were further isolated; their brain injury was defined as COVID-19-related encephalopathy. They represented 1% (9 of 644) of patients with COVID-19 requiring hospitalization. Six of these 9 patients had movement disorders, 7 had frontal syndrome, 4 had brainstem impairment, 4 had periodic EEG discharges, and 3 had MRI white matter-enhancing lesions. Conclusions and Relevance: The results from this cohort of patients hospitalized with COVID-19 suggest there are clinical, EEG, and MRI patterns that could delineate specific COVID-19-related encephalopathy and guide treatment strategy.

Brain Diseases/diagnostic imaging , COVID-19/diagnostic imaging , SARS-CoV-2 , Cohort Studies , Electroencephalography , Electronic Health Records , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged