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1.
Kidney Res Clin Pract ; 2022 Jun 21.
Article in English | MEDLINE | ID: covidwho-1924897

ABSTRACT

Background: Hemodialysis (HD) patients are more vulnerable to viral epidemics, experiencing higher mortality rates compared to individuals without chronic kidney disease (CKD). This retrospective cohort study sought to demonstrate clinical outcomes and associated factors among coronavirus disease 2019 (COVID-19) confirmed Korean HD patients. Methods: From February 2020 to November 2021, the COVID-19 Task Force Team collected clinical data for HD patients with confirmed COVID-19 via a self-report survey of nephrologists. The composite outcome included in-hospital mortality, admission to the intensive care unit (ICU), and use of mechanical ventilation. Risk factors associated with clinical outcomes were analyzed among HD patients and compared to those of individuals without CKD using the COVID-19 database from the Korea Disease Control and Prevention Agency. Results: A total of 380 HD patients from 206 facilities were diagnosed with COVID-19. Fever (49.5%) and cough (25.7%) were the two most common initial symptoms. The overall in-hospital fatality rate was 22.4% and even higher among ICU admission cases (64.7%). Non-survivors were older, more frequently developed shortness of breath, and were more likely to come from a nursing hospital. Compared to the age- and sex-matched non-CKD population, HD patients showed greater risk of in-hospital mortality (hazard ratio, 2.07; 95% confidence interval, 1.56-2.75; p < 0.001) and composite outcome (hazard ratio, 3.50; 95% confidence interval, 2.56-4.77; p < 0.001). Conclusion: HD patients have a greater risk of in-hospital mortality and morbidity from COVID-19. Special attention should be paid to COVID-19 HD patients when they are older or present with symptoms.

2.
Kidney Res Clin Pract ; 40(3): 501-504, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1464165
3.
Medicine (Baltimore) ; 100(18): e25900, 2021 May 07.
Article in English | MEDLINE | ID: covidwho-1216700

ABSTRACT

ABSTRACT: Aged population with comorbidities demonstrated high mortality rate and severe clinical outcome in the patients with coronavirus disease 2019 (COVID-19). However, whether age-adjusted Charlson comorbidity index score (CCIS) predict fatal outcomes remains uncertain.This retrospective, nationwide cohort study was performed to evaluate patient mortality and clinical outcome according to CCIS among the hospitalized patients with COVID-19 infection. We included 5621 patients who had been discharged from isolation or had died from COVID-19 by April 30, 2020. The primary outcome was composites of death, admission to intensive care unit, use of mechanical ventilator or extracorporeal membrane oxygenation. The secondary outcome was mortality. Multivariate Cox proportional hazard model was used to evaluate CCIS as the independent risk factor for death.Among 5621 patients, the high CCIS (≥ 3) group showed higher proportion of elderly population and lower plasma hemoglobin and lower lymphocyte and platelet counts. The high CCIS group was an independent risk factor for composite outcome (HR 3.63, 95% CI 2.45-5.37, P < .001) and patient mortality (HR 22.96, 95% CI 7.20-73.24, P < .001). The nomogram showed that CCIS was the most important factor contributing to the prognosis followed by the presence of dyspnea (hazard ratio [HR] 2.88, 95% confidence interval [CI] 2.16-3.83), low body mass index < 18.5 kg/m2 (HR 2.36, CI 1.49-3.75), lymphopenia (<0.8 x109/L) (HR 2.15, CI 1.59-2.91), thrombocytopenia (<150.0 x109/L) (HR 1.29, CI 0.94-1.78), anemia (<12.0 g/dL) (HR 1.80, CI 1.33-2.43), and male sex (HR 1.76, CI 1.32-2.34). The nomogram demonstrated that the CCIS was the most potent predictive factor for patient mortality.The predictive nomogram using CCIS for the hospitalized patients with COVID-19 may help clinicians to triage the high-risk population and to concentrate limited resources to manage them.


Subject(s)
COVID-19/complications , Comorbidity , Hospitalization , Pneumonia, Viral/complications , Adult , Aged , COVID-19/mortality , Female , Humans , Male , Middle Aged , Nomograms , Pneumonia, Viral/mortality , Predictive Value of Tests , Prognosis , Republic of Korea/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2
4.
Ann Med ; 53(1): 357-364, 2021 12.
Article in English | MEDLINE | ID: covidwho-1083303

ABSTRACT

BACKGROUND: This study was performed to compare severe clinical outcome between initially asymptomatic and symptomatic infections and to identify risk factors associated with high patient mortality among initially asymptomatic patients. METHODS: In this retrospective, nationwide cohort study, we included 5621 patients who had been discharged from isolation or died from COVID-19 by 30 April 2020. The mortality rate and admission rate to intensive care unit (ICU) were compared between initially asymptomatic and symptomatic patients. We established a prediction model for patient mortality through risk factor analysis among initially asymptomatic patients. RESULTS: The prevalence of initially asymptomatic patients upon admission was 25.8%. The mortality rates were not different between groups (3.3% vs. 4.5%, p = .17). However, initially symptomatic patients were more likely to receive ICU care compared to initially asymptomatic patients (4.1% vs. 1.0%, p < .0001). The age-adjusted Charlson comorbidity index score (CCIS) was the most potent predictor for patient mortality in initially asymptomatic patients. CONCLUSIONS: The mortality risk was not determined by the initial presence of symptom among hospitalized COVID-19 patients. The CCIS was the most potent predictors for mortality. The clinicians should predict the risk of death by evaluating age and comorbidities but not the initial presence of symptom. Key messages The mortality rate was not different between initially asymptomatic and symptomatic patients. Symptomatic patients were more likely to admitted to the intensive care unit. Age and comorbidities were the potent risk factors for mortality.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19/epidemiology , Hospitalization/statistics & numerical data , Intensive Care Units/statistics & numerical data , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/mortality , COVID-19/physiopathology , Child , Cohort Studies , Comorbidity , Female , Humans , Male , Middle Aged , Republic of Korea/epidemiology , Retrospective Studies , Risk Factors , Young Adult
5.
J Am Soc Nephrol ; 31(7): 1398-1408, 2020 07.
Article in English | MEDLINE | ID: covidwho-459123

ABSTRACT

BACKGROUND: Health care-associated infections during previous coronavirus epidemics involving severe acute respiratory syndrome and Middle East respiratory syndrome resulted from human-to-human transmission in hemodialysis (HD) facilities. The effect of a strategy of HD with cohort isolation-separate dialysis sessions for close contacts of patients with confirmed coronavirus disease 2019 (COVID-19)-on the prevention of secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in HD units is unknown. METHODS: Our multicenter cohort study of an HD with cohort isolation strategy enrolled close contacts of patients with confirmed COVID-19, including patients on HD and health care workers in HD units. Close contacts had been identified by epidemiologic investigation and tested negative on an immediate screening test for SARS-CoV-2. RESULTS: As of March 14, 11 patients on HD and 7 health care workers from 11 HD centers were diagnosed as having COVID-19. The immediate screening test was performed in 306 people, and among them, 302 close contacts with negative test results were enrolled. HD with cohort isolation was performed among all close contacts for a median of 14 days in seven centers. During cohort isolation, nine patients showed symptoms but tested negative for SARS-CoV-2. Two health care workers in the HD units (0.66% of the total group) were diagnosed at the termination test for SARS-CoV-2. CONCLUSIONS: The transmission of COVID-19 can be controlled without closure of HD centers by implementing preemptive activities, including early detection with rapid testing, cohort isolation, collaboration between institutions, and continuous monitoring of infection. Our strategy and experience may provide helpful guidance for circumstances involving the rapid spread of infectious diseases such as COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Disease Outbreaks , Disease Transmission, Infectious/prevention & control , Kidney Failure, Chronic/therapy , Patient Isolation/organization & administration , Pneumonia, Viral/epidemiology , Renal Dialysis/methods , Adult , COVID-19 , Chi-Square Distribution , Cohort Studies , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Health Personnel/statistics & numerical data , Humans , Incidence , Infection Control/organization & administration , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Occupational Health , Pandemics , Patient Safety , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Program Evaluation , Renal Dialysis/statistics & numerical data , Republic of Korea/epidemiology , Retrospective Studies , Risk Assessment , Secondary Prevention/organization & administration , Statistics, Nonparametric , Survival Rate
6.
Kidney Res Clin Pract ; 39(2): 145-150, 2020 Jun 30.
Article in English | MEDLINE | ID: covidwho-266301

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a highly contagious viral disease that is caused by the novel virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). COVID-19 has become pandemic since December 2019, when the first case developed in Wuhan, China. Patients receiving hemodialysis are more vulnerable to viral transmission because their immune functions are impaired and they receive treatment within a narrow space. Calling on previous experience with Middle East Respiratory Syndrome during the 2015 outbreak, the joint committee of the Korean Society of Nephrology and the Korean Society of Dialysis Therapy quickly formed a COVID-19 task force team to develop a manual before the first index case was diagnosed in the hemodialysis unit. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within hemodialysis facilities, which were developed to protect patients, healthcare workers, and caregivers from this highly transmissible virus. The areas of infection control covered by these guidelines include standard precautions, performing dialysis therapy for confirmed or suspected cases, performing cohort isolation for contact patients, and disease monitoring and contact surveillance. We hope these guidelines help healthcare workers and hemodialysis patients around the world cope with the COVID-19 pandemic.

7.
Biopsychosoc Med ; 14: 9, 2020.
Article in English | MEDLINE | ID: covidwho-60487

ABSTRACT

BACKGROUND: Post-traumatic stress symptoms can occur in patients with medical illness. During the Middle East Respiratory Syndrome (MERS) outbreak in South Korea in 2015, some dialysis patients in three centers who were incidentally exposed to patients or medical staff with confirmed MERS-CoV infection were isolated to interrupt the spread of the infection. We aimed to investigate post-traumatic stress symptoms and risk factors among these patients. MATERIALS AND METHODS: In total, 116 hemodialysis (HD) patients in contact with MERS-CoV-confirmed subjects were isolated using three strategies, namely, single room isolation, cohort isolation, and self-quarantine. We used the Impact of Event Scale-Revised-Korean (IES-R-K) to examine post-traumatic stress symptoms at 12 months after the isolation period. RESULTS: Of the 116 HD patients, 27 were lost to follow-up. Of the 89 patients, 67 (75.3%) completed the questionnaires. Single room isolation was used on 40 (58.8%) of the patients, cohort isolation on 20 (29.4%), and self-imposed quarantine on 8 (11.8%). In total, 17.9% of participants (n = 12) reported post-traumatic stress symptoms exceeding the IES-R-K's cutoff point (≧18). Prevalence rates of IES-R-K ≧18 did not differ significantly according to isolation method. However, isolation duration was linearly associated with the IES-R-K score (standardized ß coefficient - 0.272, P = 0.026). Scores in Avoidance, Emotional numbing and Dissociation subscale were higher in patients with longer isolation period. CONCLUSION: MERS was a traumatic experience for quarantined HD patients. IES-R-K scores were not significantly different by isolation methods. However, short isolation was associated with post-traumatic stress symptoms.

8.
Medicine (Baltimore) ; 99(3): e18782, 2020 Jan.
Article in English | MEDLINE | ID: covidwho-287

ABSTRACT

Hemodialysis (HD) patients had a high rate of infection transmission and mortality during the middle east respiratory syndrome coronavirus (MERS-CoV) outbreak in Saudi Arabia. A standardized guideline on isolation technique for exposed HD patients is not available. Thus, this study aimed to evaluate the effect of different isolation strategies on the prevention of secondary viral transmission and clinical outcomes among exposed HD patients.During the 2015 MERS-CoV outbreak in Korea, 116 patients in 3 HD units were incidentally exposed to individuals with confirmed MERS-CoV infection and underwent different types of isolation, which were as follows: single-room isolation (n = 54, 47%), cohort isolation (n = 46, 40%), and self-imposed quarantine (n = 16, 13%). The primary outcome was rate of secondary viral transmission. The secondary outcome measures were changes in clinical and biochemical markers during the isolation period, difference in clinical and biochemical markers according to the types of isolation practice, and effect of isolation practice on patient survival.During a mean isolation period of 15 days, no further cases of secondary transmission were detected among HD patients. Plasma hemoglobin, serum calcium, and serum albumin levels and single-pool Kt/V decreased during the isolation period but normalized thereafter. Patients who were subjected to self-imposed quarantine had higher systolic and diastolic blood pressure, lower total cholesterol level, and lower Kt/V than those who underwent single-room or cohort isolation. During the 24-month follow-up period, 12 patients died. However, none of the deaths occurred during the isolation period, and no differences were observed in patient survival rate according to different isolation strategies.Although 116 participants in 3 HD units were incidentally exposed to MERS-CoV during the 2015 outbreak in Korea, strict patient surveillance and proper isolation practice prevented secondary transmission of the virus. Thus, a renal disaster protocol, which includes proper contact surveillance and isolation practice, must be established in the future to accommodate the needs of HD patients during disasters or outbreaks.


Subject(s)
Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Middle East Respiratory Syndrome Coronavirus , Patient Isolation , Renal Dialysis , Aged , Coronavirus Infections/blood , Coronavirus Infections/mortality , Coronavirus Infections/transmission , Cross Infection/blood , Cross Infection/mortality , Cross Infection/transmission , Female , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Patient Isolation/methods , Prospective Studies , Quarantine , Treatment Outcome
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