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1.
Research Journal of Pharmaceutical, Biological and Chemical Sciences ; 14(1):27-31, 2023.
Article in English | EMBASE | ID: covidwho-2218114

ABSTRACT

Coronavirus disease 2019 is predominantly a respiratory illness that can cause hypercoagulable states with multisystem involvement. A single centre retrospective study was carried out in 37 patients who were diagnosed as COVID 19 with AKI from January 2022 to march 2022. Baseline D dimer was evaluated on hospital admission. Patients who were diagnosed with AKI on admission or during the stay in hospital were included in the study, In this study 37 COVID patients with AKI were analysed. Mean age of subjects was 62.51+/-15.18 years. Majority were in the age group 61-70 years (24.3%). 78.4% were males and 21.6% were females. Mean blood urea among subjects was 131.86+/-56.55(mmol/L), mean serum creatinine was 4.71+/-2.52(mg/dl). mean d dimer at admission was 3.701+/-4.48570(mg/L).70.3% of subjects had AKI at hospital admission and 29.7% developed AKI during hospital stay. Cause of AKI was prerenal in 89.2%, renal 18.9%,and post renal in 8.1%. D dimer levels >3.05 had highest validity in predicting the need for RRT with sensitivity 39.29%, specificity 100%, positive predictive value of 100% and negative predictive value of 34.6%. from this study it was concluded that d dimer has specificity of 100%in predicting the need of RRT Copyright © 2023, Research Journal of Pharmaceutical, Biological and Chemical Sciences.All Rights Reserved.

2.
Blood Purification ; 51(Supplement 2):21, 2022.
Article in English | EMBASE | ID: covidwho-2214200

ABSTRACT

Introduction: Sars-cov2 infection is commonly associated with acute kidney injury (AKI) which may be observed in up to 40% of cases. Pathogenesis of AKI during COVID-19 is yet not perfectly understood. Many risk factors have been proposed associated with AKI occurrence during COVID-19 infection. To date there is still limited data of AKI progression and long-term outcomes among these patients. We aim to describe risk factors for development of AKI and the progression of their renal function up to six months after hospital discharge. Methodology: This is a retrospective observational study in a tertiary car nephrology department in Barcelona, Spain. We evaluated data from 71 hospitalized patients with AKI occurrence during COVID-19 infection between 1st of March and 30th May 2020. Analysis of baseline characteristic, need of renal replacement therapy (RRT) and inflammatory parameters has been performed. Result(s): Of 71 patients (74,6% males;median age 71,9+/-11,15 years), 43 (60,6%) needed admission in the intensive care unit (ICU) for hemodynamic/respiratory support and 34 (47,9%) died during hospitalization. 13 (18,3%) needed RRT. 3 (23%) patients requiring RRT died during COVID-19 infection and 9 (69,2%) partially recovered renal function. Baseline serum creatinine of patients without RRT need during follow-up was 0,90+/-0,16 mg/dl with a peak serum creatinine 2,8+/-1,5 mg/dl. Patients that needed RRT support had a baseline serum creatinine 0,98+/-0,87 mg/dl and a peak serum creatinine of 4,34+/-3,35 mg/dl. Creatinine at discharge was of 1,5+/-0,59 mg/dl in the group of patients needing RRT and 1,2+/-0,52 mg/dl. At six months follow-up no significant differences were found in creatinine levels from discharge (p=0,65). Very poor correlation was observed between inflammatory parameters and serum creatinine peak levels (Dimer D levels and Serum creatinine peak R2=0,034;C reactive protein and creatinine peak levels R2=0,15 and Interleukin 6 and creatinine peak levels R2=0,042). Conclusion(s): COVID-19 infection is associated with AKI with and increased risk of chronic kidney disease after infection is resolved. No differences between renal function at discharge and at 6 months of follow-up was observed. No correlation between the studied inflammatory parameters and the worsening of renal function was observed.

3.
Hematology, Transfusion and Cell Therapy ; 44(Supplement 2):S267, 2022.
Article in English | EMBASE | ID: covidwho-2179131

ABSTRACT

Background: The four-drug combo has becoming one of the main induction treatment for TE NDMM patients (pts). We conducted a phase 2 study to assess the safety and preliminary efficacy of Cyclophosphamide (C), thalidomide (T), dexamethasone (d)-(CTd) and Dara combination. MAXDARA study has shown in the primary analysis with 21 included patients (pts), 4 and 8 pts MRD negativity after four induction cycles and two consolidation cycles post transplant, respectively. (Crusoe E et al ASH 2020, 2416 poster presentation). In the present analysis we evaluate the effect of deep response rate on PFS. Method(s): This is a phase II, open-label single-center clinical trial. The main inclusion criteria were: TE NDMM, creatinine clearance > 30 ml/min, normal cardiac, renal and liver function and the ECOG performance status = 0 - 2. The protocol was Dara-CTd for up to four 28-day induction cycles: C-500mg oral (PO) on days 1,8 and 15, T at 100-200mg PO on days 1 to 28, (d) at 40mg PO on days 1,8,15 and 22 and Dara at 16mg/Kg/dose intravenous (IV) on days 1,8,15 and 22 during cycles 1 - 2 and every other week in cycles 3 - 4, followed by ASCT. All pts received up to four 28-day consolidation cycles that was started at D+30 after ASCT: Dara at 16mg/Kg and (d) at 40mg every other week, associated with T at 100mg PO on days 1 - 28. Dara at 16mg/Kg was used monthly as maintenance until progression or limiting toxicity. The MRD was evaluated by next-generation flow (NGF) 10-6 and PET-CT was performed when the patient obtained NGF negativity or finished consolidation. PFS outcome was estimated using Kaplan-Meier method and PFS analysis were performed based on the different response rates. (Data cut-off was April 2022) Results: A total of 24 pts were included. The median age being 58 (range 37- 67 years), 15 (62.5%) pts were female, 22 (92%) were non-white, 6 (25%) had an R-ISS = 1, 12 (50%) had an R-ISS = 2 and 4 (16%), an R-ISS = 3. Sixteen (66.7%) pts were IgG isotype and Six (25%) had high-risk chromosomal abnormalities [1q+, del17p, t(4;14) or t(14;16)]. To date, 23 pts have completed induction, 21 performed transplant and 14 are still in treatment after one year of dara maintenance. By ITT analysis, 22 pts (91.6%) achieved (> PR) after 4 induction cycles. One pts achieved SD, one MR and one sCR. Eleven (39%) pts achieved PR, and 10 (35.7%) VGPR. After two consolidation cycles, ORR was 68%, 8 (28.6%) and 11 (39.3%) pts obtained sCR and VGPR, respectively. The best response during any time of the treatment were PR in 3 (12.5%) pts, VGPR in 12 pts (50%) and sCR in 8 (33.3%) pts. In a ITT analysis, NGF MRD 10-6 negativity were observed in 4(16.6%) after four induction cycles, and in 17 (70.8%) pts after two consolidation cycles post-ASCT. In a ITT analysis, after a median follow up (FU) of 26 months, the PFS was 37months for the entire group. The median PFS comparing sCR vs < VGPR were 37m vs 27m (p = 0.021), respectively, and comparing MRD negative by NGF vs no, had impacted even more on PFS with a median of 37m vs 16m (p = 0.004), respectively. The OS was not yet achieved and 83% of the patients still alive after a median FU of 27m. Four pts died from infection, two of them related with covid infection (one before transplant and one during maintenance). Another case post-transplant, considered not related to the investigational agent and one after consolidation, related to the investigational agent. Summary/Conclusion: The Daratumumab - CTd protocol is an active and safe regimen capable of producing deep and sustainable responses. The deeper response rate impacted on PFS, confirm that MRD negativity is critical to patient outcome. Copyright © 2022

4.
Atherosclerosis ; 355:118, 2022.
Article in English | EMBASE | ID: covidwho-2176613

ABSTRACT

Background and Aims : Cardiovascular disease (CVD) affects approximately one third of type 2 diabetes mellitus (T2DM) patients. We aimed to evaluate treatment targets of T2DM patients with CVD. Method(s): This retrospective study included 469 T2DM patients attending a Diabetes Center before COVID-19 (08.2016-12.2019). Data regarding diabetes history, complications and comorbidities, anthropometric parameters, metabolic profile were collected from medical records. Result(s): The patients' mean age was 62.27+/-9.98 and 48.8% were men. The mean diabetes duration was 6.81+/-7.04 years and the metabolic parameters were: BMI 31.78+/-5.32 kg/m2, HbA1c 7.5+/-1.47%, glycaemia 159.96+/-49.31 mg/dl, LDL-cholesterol 99.60+/-42.68 mg/dl, triglycerides 200.33+/-143.37 mg/dl. 203 patients had atherosclerotic CVD (angina, cardiac ischemic disease, peripheral arterial disease). A comparative analysis revealed higher values in CVD patients for age, diabetes duration, abdominal circumference, glycaemia, urinary albumin to creatinine ratio (ACR), p <0.05. Diabetes duration and ACR seemed to be predictive factors for CVD (AUC=0.579, p <0.01, CI=0.52 - 0.63, respectively AUC=0.607, p <0.01, CI=0.52 - 0.68). Regarding treatment targets of CVD patients, 45.5% had systolic blood pressure <130 mmHg, 14.8% had LDL-cholesterol <55 mg/dl, and 26.6% had HbA1c <7%. Conclusion(s): In clinical practice, some T2DM patients fail to achieve cardio-metabolic control even if managed according to the latest ESC recommendations. Copyright © 2022

5.
European Geriatric Medicine ; 13(Supplement 1):S188-S189, 2022.
Article in English | EMBASE | ID: covidwho-2175554

ABSTRACT

Introduction: Mortality is high in older patients hospitalised with COVID-19. Previous studies observed lower mortality during the Omicron wave, yet no data is available on older patients. We aim to assess in-hospital mortality of older patients hospitalised with COVID-19 during the Omicron wave, and compare it with the previous waves. Method(s): This retrospective observational multicentre cohort study used data from electronic health records of 38 hospitals within the Greater Paris Public Hospitals Group's data warehouse from 01/03/ 2020 to 31/01/2022. All adults >= 75 years hospitalised with confirmed COVID-19 diagnosis were included. Primary endpoint was inhospital mortality. The fifth wave was considered as the Omicron wave as it was the predominant variant (>= 50%), and was compared with waves 1-4. Multivariate logistic regression was performed, with a sensitivity analysis according to variant type. Result(s): 19,909 patients were included, age 85 (SD 7) years, 53% of women, Charlson score 3 [IQR 2-5]. Overall mortality occurred in 4,337 patients (22%), 345 patients (17%) during the fifth wave. Using multivariate analysis, after adjustment on sex, age, Charlson score components, serum creatinine, CRP and lymphocyte, only waves 1 and 3 were associated with an increased mortality risk: OR 1.45 (95% CI 1.24-1.71) and OR 1.59 (95% CI 1.35-1.87), respectively. Sensitivity analysis found that Omicron variant was associated with a decreased mortality risk, in comparison with the previous variants. Key conclusions: Although mortality was high during wave 5, death risk was lower in comparison with waves 1 and 3, suggesting that Omicron variant is milder, but not mild.

6.
Journal of medical virology ; 07, 2023.
Article in English | EMBASE | ID: covidwho-2173235

ABSTRACT

OBJECTIVE: To analyze the dynamic changes of renal function longitudinally and investigate the cytokine profiles at 6 months in patients with Omicron COVID-19. METHOD(S): 47 patients with a proven diagnosis of Omicron COVID-19 from January 2022 to February 2022 attended a 6-month follow-up after discharge at Tianjin first Central Hospital. The demographic parameters, clinical features, and laboratory indexes were collected during hospitalization and 6 months after discharge. The serum cytokine levels at 6 months were also assessed. Patients were grouped according to with or without kidney involvement at admission. RESULT(S): The levels of serum creatinine and estimated glomerular filtration rate (eGFR) were all normal both in the hospital and at follow-up. Whereas, compared with renal function in hospital, serum creatinine levels at 6 months increased remarkably;meanwhile, eGFR decreased significantly in all patients. The serum levels of IL-2, IL-4, IL-5, IL-6, IL-10, and TNF-alpha and IFN-gamma significantly decreased and TGF-beta remarkably increased in the kidney involvement group. The serum levels of IL-2 and IL-5 were positively correlated with age;contrarily, TGF-beta showed a negative correlation with aging. The younger was an independent risk factor of the higher TGF-beta levels. CONCLUSION(S): Omicron patients showed a decline in renal function at follow-up reflecting the trend of CKD. Serum cytokine profiles were characterized with the majority of cytokines decreased and TGF-beta increased in the kidney involvement group;the latter may be used as a sign of CKD. The tendency of CKD is one of the manifestations of long COVID and deserves attention. This article is protected by copyright. All rights reserved.

7.
JACCP Journal of the American College of Clinical Pharmacy ; 5(12):1399, 2022.
Article in English | EMBASE | ID: covidwho-2173042

ABSTRACT

Introduction: COVID19 was originally thought to be solely a respiratory disease, however, other organs, such as the kidneys, are often also affected. While acute kidney injury (AKI) and augmented renal clearance (ARC) have both been documented, the incidence, renal characteristics, and outcome of each derangement have not been fully elucidated. Research Question or Hypothesis: What are the incidences, characteristics, and outcomes of AKI, ARC, and no AKI/ARC in patients hospitalized with COVID19? Study Design: Retrospective, observational cohort study Methods: Inpatient data from the National COVID Cohort Collaborative database with laboratory confirmed COVID19 who were >18 years old were utilized. Patients who had all data to calculate creatinine clearance (CrCl) via Cockcroft-Gault equation were screened. Exclusion criteria were pregnancy, body mass index <18kg/m2, history of end-stage renal disease on dialysis or nephrectomy. Episodes of AKI and ARC were defined using AKIN criteria and CrCl >130mL/min, respectively. Renal function characteristics and outcomes included days with episode, hospital length of stay (LOS), and mortality. Descriptive statistics and Mann-Whitney U tests were used for statistical analysis where appropriate with p<0.05 indicating statistical significance. Result(s): 15,608 patients from 11 sites were included. Overall, 57.3% were male with median age 62.7[50.1-73.2] years. The incidence of No AKI/ARC, AKI, and ARC was 43.5%, 22.9%, and 33.6%, respectively. Episodes of ARC lasted longer than AKI (4[2-7] vs 3[1-6] days;p<0.0001) Patients with AKI and ARC both had longer LOS compared to no AKI/ARC (19[10-34] and 6[4-11] vs 6[4-10];p<0.001). Patients with AKI had the highest mortality followed by no AKI/ARC then ARC (41.7% vs 10.1% vs 5.4%;p<0.001). Conclusion(s): A significant proportion of patients with COVID19 exhibit altered renal function throughout hospitalization. Clinicians should be mindful of these alterations given their associations with increased LOS and mortality with AKI. Future research should explore the impact of ARC on medication therapy in patients with COVID19.

8.
Pakistan Journal of Medical and Health Sciences ; 16(11):564-566, 2022.
Article in English | EMBASE | ID: covidwho-2207097

ABSTRACT

Objective: To assess the outcomes of coronavirus disease-2019 patients with acute renal damage who received remdesivir against placebo at a private hospital in Karachi, Pakistan. Methodology: At the COVID-19 ICU of Hussain Lakhni Hospital, a cohort study was conducted from July 2021 to February 2022. Male and female study participants with COVID-19 and acute renal injury ranged in age from 40 to 80. Remdesivir-treated individuals with COVID-19 acute kidney injury were exposed, but placebo-treated patients with COVID-19 acute kidney injury were not exposed. In-hospital mortality, elevated serum creatinine levels, and prolonged hospital stays were the results. The data was analyzed using SPSS version 23. Result(s): Patients who took remdesivir had a lower mortality rate than those who were placebo (32.2% vs 67.8%, OR=0.38, 95 percent CI=0.27-0.52), with a p-value of 0.001. Remdesivir was also associated with a shorter hospital stay (4.2% versus 95.8%, OR=0.005, 95 percent CI=.003-0.009) with a p-value of 0.001). However, increased serum creatinine revealed statistically insignificant differences between groups. The odds of in-hospital mortality were 0.376 times lower (AOR=0.376, 95 percent CI=0.275-0.514, p=0.0001) and the odds of a prolonged hospital stay were 0.030 times lower (AOR=0.030, 95 percent CI=0.012-0.074, p=0.001) in the remdesivir group than in the placebo group after controlling for covariates. Practical implication: In literature Remdesvir was associated with acute kidney injury (rise in serum creatinine) and in many centres,it was not used in patients with acute kidney injury although it has very beneficial effect in patients of severe covid pneumonia,many centres were not using it in patients of acute renal failure. in our study, rise in serum creatinine was not significant in remdesvir group in patient with acute kidney injury,so remdesvir must not be withheld in this group of patients as it can decrease the severity of covid pneumonia and saves patients lives Conclusion(s): Remdesivir is an effective medicine in COVID-19 patients with acute renal damage in terms of in-hospital mortality and duration of stay. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

9.
Journal of the Nepal Medical Association ; 61(257):39-42, 2023.
Article in English | EMBASE | ID: covidwho-2205809

ABSTRACT

Introduction: Coronavirus disease can affect the renal system in various forms ranging from mild proteinuria to acute kidney injury, some even needing renal replacement therapy. This study aimed to find out the prevalence of acute kidney injury in patients admitted with COVID-19 at a tertiary care centre. Method(s): This descriptive cross-sectional study was done in patients admitted in COVID-19 ward in our hospital from July 2021 to June 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 066-077/078). The serum creatinine level was used for the diagnosis of acute kidney injury. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Result(s): Out of 80 patients with COVID-19, the prevalence of acute kidney injury was 25 (31.25%) (21.09-41.41, 95% Confidence Interval). Conclusion(s): The prevalence of acute kidney injury in COVID-19 patients was similar to other studies done in similar settings. Copyright © 2023, Nepal Medical Association. All rights reserved.

10.
Journal of Clinical and Diagnostic Research ; 17(1):OC13-OC17, 2023.
Article in English | EMBASE | ID: covidwho-2203495

ABSTRACT

Introduction: Known independent predictors of extended Length Of Stay (LOS) in Coronavirus Disease 2019 (COVID-19) included older age, chronic kidney disease, elevated maximum temperature, and low minimum oxygen saturation. Additional known predictors of prolonged hospitalisation included male sex, chronic obstructive pulmonary disease, hypertension, and diabetes. Elevated levels of C-Reactive Protein (CRP), creatinine, and ferritin are proven determinants of hospitalisation and LOS. Determining predictors of LOS will aid in triaging and management of COVID-19 patients. Aim(s): To assess the clinical, biochemical and radiological profile of admitted COVID-19 patients and determine the predictors of prolonged length of stay at hospital. Material(s) and Method(s): It was a retrospective, cross-sectional observational, record-based study included hospital records of 544 confirmed COVID-19 patients, above age of 18 years admitted at Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India, during February 2021 to June 2021. Possible determinants of LOS were studied including their demographic, epidemiological, clinical and radiological characteristics. The patients were divided into two groups as per median LOS i.e, group I with LOS <10 days (n=277) and group II with LOS >=10 days (n=267). Statistical analysis was done using Chi-square test, proportion test, Z test, Mann-Whitney U test, regression analysis by Statistical Package for the Social Sciences (SPSS) software version 23.0. Result(s): Mean age in group I and II was 47.83+/-16.34 years and 53.21+/-15.63 years (p-value <0.0001), respectively. The fatigue was significantly more in group II than group I (p-value=0.018). Diabetes mellitus was more (p-value=0.026) and severity of illness (p-value<0.0001) was significantly higher in group II than group I. In univariate analysis, mean Neutrophil/Lymphocyte ratio (p-value<0.0001), serum LDH (p-value<0.018), blood urea level (p-value<0.0001), random blood sugar (p-value=0.003), glycated haemoglobin (HbA1c) (p-value=0.072) and serum creatinine (p-value=0.41) were significantly more in group II. Median CRP (p-value<0.0001), D-dimer (p-value<0.0001), serum ferritin (p-value<0.0001), procalcitonin (p-value<0.0001), Serum Glutamic Oxaloacetic Transaminase (SGOT) (p-value=0.002) was significantly higher in group II. Lung involvement {chest radiograph or High-Resolution Computed Tomography (HRCT) chest} was significantly (p-value<0.0001) more in group II. Conclusion(s): Fatigue, older age, diabetes mellitus, severity of illness, mean neutrophil/lymphocyte ratio, CRP, D-dimer, serum ferritin, serum Lactate Dehydrogenase (LDH), procalcitonin, blood urea, SGOT were associated with prolonged LOS among hospitalised COVID-19 patients. Copyright © 2023 Journal of Clinical and Diagnostic Research. All rights reserved.

11.
Journal of Medical Biochemistry ; 42(1):35-46, 2023.
Article in Bosnian | Academic Search Complete | ID: covidwho-2202968

ABSTRACT

Background: COVID-19 is a new pandemic that has infected millions of people worldwide and caused a high morbidity and mortality rate. COVID-19 may have a harmful effect on organs, especially the kidneys. Aims: The main aim of our research is to study the association between the severity of COVID-19 disease and biochemical parameters related to kidney function and to investigate certain risk factors of COVID-19-associated kidney disease. Methods: A total of 174 individuals, 121 COVID-19 positive and 53 COVID-19 negative, were enrolled in this study. The relation between COVID-19 infection, severity, kidney function test, and hematological indicators were examined. Results: The most prominent symptoms among COVID-19 were fever (95%) and fatigue (92%). Regarding biochemical parameters, median creatinine, MPV, and CRP were significantly higher in COVID-19 patients, whereas median eGFR, Na+, WBC, MCH, MCHC, and eosinophil percentages were significantly lower in this group. Severely infected patients were observed to have higher urea, creatinine, neutrophils, and NLR. However, median sodium, eGFR, hemoglobin, hematocrit, RBC, lymphocytes, and platelet count were significantly lower in the severe group. Urine examination of the severe group showed a significantly lower specific gravity, while urine pH, protein, and glucose were significantly higher. Conclusions: Our analysis indicates that COVID-19 infection affects kidney function, mainly creatinine level, urea, eGFR, Na+ and urine protein. Additionally, comorbidities such as older age (≥65), hypertension, taking medications, and CRP (≥33.55 mg/L) are considered risk factors that are more likely to contribute to kidney impairment in COVID-19 positive patients. (English) [ FROM AUTHOR]

12.
Anatolian Journal of Cardiology ; 25(Supplement 1):S91-S92, 2021.
Article in English | EMBASE | ID: covidwho-2202566

ABSTRACT

Background and Aim: Comorbidities accompany the majority of COVID-19 patients. Studies have shown that between 15% and 40% of them have a history of heart disease, and it has been reported that the course of the disease is more severe in those with heart disease.The aim of our study is to compare the clinical presentations and outcomes of patients with and without cardiac disease hospitalized for COVID-19 infection and to share our single center experience. Method(s): 184 COVID-19 patients who were admitted to Antalya Kepez State Hospital between 15 March and 01 June and whose diagnosis was confirmed by a positive PCR test were included in the study. The data of the patients were obtained retrospectively from patient files and hospital information management system. Patients were divided into two groups as those with and without cardiac disease. Demographic characteristics, clinical presentations, laboratory tests, radiological imaging results and in-hospital outcomes of the patients were recorded. The data of 30 patients with cardiac disease and 154 patients without cardiac disease were compared. Result(s): 176 of 184 patients were hospitalized. Coronary artery disease was present in 66.7%, atrial fibrillation in 46%, and heart failure in 40% of COVID-19 patients with accompanying cardiac disease. The mean age of patients with cardiac disease was higher than those without cardiac disease (72.5 +/- 15.8 vs 45.4 +/- 15.4, p<0.001). There was no significant difference in presentation symptoms between the two groups. Oxygen saturation at admission was lower and respiratory rate was higher in patients with cardiac disease. Serum creatinine, Hs troponin, D-Dimer, C-reactive protein levels were significantly higher in patients with cardiac disease. When the findings of 174 patients evaluated with thorax computed tomography at the time of admission were compared, no significant difference was found between the groups. The rate of death (20% vs 0% p<0.004), thromboembolic events (13.3% vs 0% p=0.025), acute respiratory distress syndrome (26.7% vs 1.3% p=0.002) and septic shock (33.3% vs 1.3% p<0.001) during hospitalization was higher in patients with cardiac disease. Conclusion(s): Patients with cardiac disease with COVID-19 have higher rates of mortality, thromboembolic events, ARDS and septic shock than those without a history of cardiac disease, and the prognosis of these patients is quite poor.

13.
Journal of Health Research and Reviews in Developing Countries ; 9(1):22-29, 2022.
Article in English | ProQuest Central | ID: covidwho-2201979

ABSTRACT

Aim: This study aimed to describe the clinical characteristics, survival outcome, and its correlation with biochemical parameters in coronavirus disease-2019 (COVID-19)-infected patients with end-stage kidney disease (ESKD). Materials and Methods: A prospective observational study was on hospitalized patients with confirmed COVID-19 infection from September 1, 2020 to October 31, 2020. Data related to demographics, baseline history of comorbid conditions, dialysis-specific data, details on hospital admissions, COVID-19 treatment regimen, laboratory investigations, computed tomography (CT) severity score, COVID-19 Reporting and Data System score, and clinical outcomes (improved/death), duration of hospital stay, oxygen/vasopressor support were collected. Results: A total of 216 ESKD patients with COVID-19 infection were included in this study. The median age was 48.0 years (74.5% men, 25.5% women). Severe acute respiratory infection (44.7%), hypertension (28.2%), and type 2 diabetes mellitus (22.4%) were the most common comorbidities. Elevated levels of serum creatinine (9.3 mg/dL) and blood urea nitrogen (84.8 mg/dL) were observed in the patients with COVID-19 infection. The change in mean levels of serum creatinine and estimated glomerular filtration rate from baseline to post-treatment was significant (0.9 [95% CI: 0.7, 1.1;P < 0.001] and 3.4 [95% CI: 3.2, 3.6;P < 0.001], respectively). Approximately, 79.6% (n = 172) of patients improved post-treatment. Serum creatinine (1.786, 95% CI: 1.031, 3.095;0.039) and ferritin levels (51.959, 95% CI: 7.901, 341.685;P < 0.001) remained significantly and independently associated with survival. The median time to clinical survival was 17.0 days. Conclusion: Serum creatinine and ferritin levels were independently associated with survival.

14.
Indian Journal of Nephrology ; 32(7 Supplement 1):S15-S16, 2022.
Article in English | EMBASE | ID: covidwho-2201608

ABSTRACT

BACKGROUND: Different vaccines have been developed against SARS nCoV 19 and deployed in mass immunization campaigns across the world. In India, Covishield (ChAdOx1 nCoV-19) manufactured by Serum Institute of India) and Covaxin (BBV152) manufactured by Bharat Biotech are two such vaccines that have been made available. The former is a replication-deficient adenovirus vaccine while the latter is an inactivated whole virion vaccine. There has been many case reports of new onset or relapse of glomerular disease occurring after Covid-19 vaccination. This is attributed to heighten off target effect of immune response of the vaccine. AIM OF THE STUDY: We present a case series of four patients where glomerular disease manifested for the first time after Covid-19 vaccination in our center. METHOD(S): We have included in our case series those patients whose clinical features manifested for the first time within 1 month of Covid-19 vaccination and whose renal biopsy showed glomerular pathology. RESULT(S): Case 1: A 12-year-old male presented to us with abrupt onset of edema leading to anasarca on 30/4/2022. He had received first dose of Covid-19 vaccine (Covaxin) on 26/4/2022. His labs showed urine protein of 3+ and nil RBC, serum creatinine 0.7 mg/dl, serum albumin 1.9 mg/dl, and dyslipidemia (total cholesterol 378 mg/dl, triglycerides 191 mg/ dl). He underwent renal biopsy in view of nephrotic syndrome. It was suggestive of minimal change disease. He was started on prednisolone at 2 mg/kg/day. Case 2: A 39-year-old female presented to us with abrupt onset of maculopapular rash, fever, and bilateral lower limb swelling on 25/1/2022. She had received second dose of Covid-19 vaccine (Covishield) on the same day in the morning. She was found to have hypertension with BP of 160/100 mm Hg. Her labs showed urine protein of 2+ and 18-20 RBC/high power field, serum creatinine 1.9 mg/dl, serum albumin 3.7 mg/dl, negative ANA and ANCA, and normal complement levels. She underwent renal biopsy in view of renal failure with active urinary sediments. It was suggestive of focal and segmental glomerulosclerosis (FSGS). Case 3: A 37-year-old male patient with history of hypertension (on irregular treatment) presented to us with history of gross hematuria without passage of clots in May 2022 about three days after receiving booster dose of Covishield vaccine. He did not have edema, rash, joint pain, or decreased urine output. His labs showed urine protein of 2+ and 5-6 RBC/high power field, serum creatinine 2.0 mg/dl, serum albumin 4.0 mg/dl, negative ANA and ANCA, and normal complement levels. He underwent renal biopsy in view of renal failure with active urinary sediments. It was suggestive of IgA nephropathy (M1E0S1T1C0). Case 4: An 18-year-old female with family history of nail patella syndrome presented to us with history of abrupt onset of edema of both lower limbs on 21/11/2021. She also had rash at the time of presentation. She had received first dose of Covid-19 vaccine (Covaxin) on 20/11/2021. Her labs showed urine protein of 2+ and numerous RBC/high power field, serum creatinine 1.4 mg/dl, serum albumin 2.98 mg/dl, negative ANA, and dsDNA and low complement levels (C3 14.1 mg/dl, C4 10.1 mg/dl: both being low). She underwent renal biopsy in view of renal failure with active urinary sediments. It was suggestive of membranoproliferative glomerulonephritis (MPGN). She was started on prednisolone at 1 mg/kg/day. CONCLUSION(S): Different vaccines have different mechanisms of action, but their target remains the spike protein of the SARS Cov2 virus. Glomerular disease has mostly been reported with mRNA-based vaccines. Here we have reported glomerular disease occurring in close temporal relation to Covishield and Covaxin which have different mechanism of action. There have been reports of IgA nephropathy, minimal change disease and FSGS which manifested soon after vaccination. MPGN after Covid-19 vaccination is rarely seen. Thus, this case series shows that post- Covid vaccination glomerular disease can have varied pathologies.

15.
Indian Journal of Nephrology ; 32(7 Supplement 1):S42, 2022.
Article in English | EMBASE | ID: covidwho-2201607

ABSTRACT

BACKGROUND: Severe acute respiratory coronavirus-2 (SARS-CoV-2) affected multiple organs including kidney. SARSCoV- 2 open reading frame protein 3a induces necroptosis in infected cell leading release of mtDNA which binds to TLR9 and trigger innate immunity which may lead to acute allograft injury. AIM OF THE STUDY: To determine the specificity and sensitivity of urinary mitochondrial DNA (umt-DNA) and neutrophil gelatinase-associated lipocalin (NGAL) in predicting COVID-19-associated acute kidney injury (AKI) mitochondrial stress and inflammation. METHOD(S): Live-related RTRs (n = 66) who acquired SARSCoV- 2 infection and were admitted to a COVID hospital were included and subclassified into AKI (N = 19) with >25% spike in serum creatinine level from the pre-COVID-19 serum creatinine level and non-AKI (N = 47) whose serum creatinine value remained stable similar to the baseline value or a rise of < 25% of the baseline values of pre-COVID-19. A 50 ml urine sample was collected and umt-DNA and N-GAL was determined by the RT-PCR and ELISA methods respectively. A 1 x 106 PBMCs were stimulated for 24 hrs. with 1mug/ml of urinary DNA or CpG oligodeoxynucleotide (5) in duplicate. Unstimulated PBMCs served as control. The gene expression of IL-10 IL-6 and MYD88 was analyzed by the RT-PCR and IL-6 IL-10 level in supernatants by the ELISA. RESULT(S): Both the urinary mitochondrial gene ND-1 and NGAL level were significantly higher in AKI group compared to non-AKI. The mean ND-1 gene Ct in AKI group was (19.44 +/- 2.58 a.u) compared to non-AKI (21.77 +/- 3.60;p = 0.013). The normalized ND-1 gene Ct in AKI was (0.79 +/- 0.11 a.u) compared to non- AKI (0.89+0.14;P = 0.007). The median urinary NGAL level in AKI group was (453.53;range, 320.22-725.02, 95% CI) ng/ml compared to non-AKI (212.78;range, 219.80-383.06, 95%CI;p = 0.015). The median urine creatinine normalized uNGAL was 4.78 (0.58-70.39) ng/mg in AKI group compared to 11.26 ng/mg (0.41-329.71) in non-AKI group. The area under curve of ND-1 gene Ct was 0.725, normalized ND-1 Ct was 0.713, and uNGAL was 0.663 and normalized uNGAL was 0.667 for detecting the AKI and mitochondrial stress. The IL-10 gene expression was downregulated in umt-DNA-treated PBMCs compared to control (-3.5 +/- 0.40 vs 1.02 +/- 0.02, p < 0.001). IL-6 and Myd88 gene expression was upregulated. The culture supernatant IL-10 and IL-6 level in umt-DNA treatment PBMCs vs control was 10.65 +/- 2.02 vs 30.3 +/- 5.47, p = 0.001 pg/ml;and 200.2 +/- 33.67 vs 47.6 +/- 12.83pg/ml, p = 0.001 respectively. CONCLUSION(S): Urinary mt-DNA quantification can detect the Covid-associated AKI and mitochondrial distress with higher sensitivity than uNGAL in RTRs and induces inflammation in PBMCs.

16.
Indian Journal of Nephrology ; 32(7 Supplement 1):S30-S31, 2022.
Article in English | EMBASE | ID: covidwho-2201603

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a clinical syndrome denoted by an abrupt decline in glomerular filtration rate (GFR) sufficient to decrease the elimination of nitrogenous waste products (urea and creatinine) and other uremic toxins. Based on the type of setting AKI can be Community Acquired (CA-AKI) or Hospital Acquired (HA-AKI). These two types have different epidemiological etiological and outcome profiles and these characteristics have remained inconclusive. As far as the etiological spectrum is concerned;previous studies have demonstrated a varied spectrum in both these groups. Very few studies comparing the outcome of CA-AKI and HA-AKI were found in the literature search. There is a paucity of relevant comparative Indian studies on these two types of AKI. Hence this prospective observational study was undertaken to compare the demographic and clinical spectrum and short-term in-hospital outcomes of patients belonging to both these groups who were admitted to the largest tertiary care government teaching hospital in the state of Uttarakhand. AIM OF THE STUDY: To compare the demographic and clinical spectrum and short-term in-hospital outcomes of community-acquired versus hospital-acquired Acute Kidney Injury in hospitalized patients METHODS: It is a prospective cohort study conducted from October 2020 to December 2021. The study was conducted in the In-Patient Department (IPD) areas of the Department of Nephrology and all those departments whose consultations for patients with suspected AKI were sent to the Department of Nephrology at AIIMS Rishikesh. Patients fulfilling the following inclusion criteria were enrolled in this study- Age -18 years and the patients diagnosed as having AKI as per KDIGO 2012 definition. Those aged <18 years of age and those with CKD or Acute on CKD were excluded from the study. CKD was defined as per the KDIGO 2012 definition. Each enrolled patient was classified as having Community-acquired AKI (CA-AKI) or Hospital-acquired AKI (HA-AKI). Those admitted to the hospital with AKI were denoted as having CA-AKI. In contrast, patients were identified as having HA-AKI when AKI was not apparent upon hospital admission but was diagnosed beyond 24 hours of hospitalization. The sample size of 65 in community-acquired AKI and 32 in the hospital-acquired AKI group was calculated. Study subjects underwent detailed history clinical examination and relevant investigations required in the management of AKI episodes. The stage of AKI at presentation was assessed as per KDIGO Clinical Practice Guidelines for Acute Kidney Injury 2012. Ethical clearance was obtained. RESULT(S): A total of 65 patients with CA-AKI and 32 patients with HA-AKI were enrolled. The mean age of patients in the CA-AKI group was 46.7 years and in the HA-AKI group was 45.5 years. The CA-AKI group had significantly higher-baseline serum creatinine (P < 0.001), serum creatinine at admission (P < 0.001), proportion of male patients (P = 0.09), proportion of patients requiring renal replacement therapy (P = 0.02), proportion of patients getting admitted to medical IPDs (P < 0.001), proportion of patients whose baseline creatinine was unknown (P < 0.001), proportion of patients presenting in Stage 3 of AKI (P = 0.001), proportion of patients having oligoanuria (P = 0.09) and hyperkalemia (P = 0.06) at presentation. The HA-AKI group, on the other hand, was found to have a significantly higher- proportion of patients getting admitted to surgical IPDs (P < 0.001), proportion of patients who underwent a prior surgical procedure (P < 0.001), proportion of patients having coexisting lung disease (P = 0.09), liver disease (P = 0.03), heart disease (P = 0.06) and COVID-19 (P = 0.04). Sepsis was found to be the most common cause (70.7%) in the CA-AKI group and was also one of the common causes (28.12%) in the HA-AKI group. Despite more patients in the CA-AKI group being in AKI-Stage 3 at presentation, in-hospital mortality was observed to be lower in this group (35.4% versus 62.5%, P = 0.04). The median survival time of patients was und to be more than double in the CA-AKI than in the HA-AKI group (59 days versus 23 days). However, on comparing the overall survival using the log-rank test, both groups were found to be comparable (chi-square value 1.82, p-value 0.18). Univariate analysis for predictors of mortality showed that the type of AKI (CA vs HA) (P = 0.01), type of admission (ward vs ICU) (P = 0.001), surgical procedure prior to AKI onset (P = 0.018), presence of comorbidities such as DM (P = 0.038), lung disease (P = 0.000), and COVID-19 (P = 0.018) and requirement of vasopressor support (P = 0.009) were significant predictors of mortality of patients with AKI admitted to our center. Also, the length of hospital stay (P = 0.037), serum creatinine at admission (P = 0.002) and serum creatinine at discharge/death (P = 0.003) have been found to predict the mortality of these patients. However, Cox proportional hazard regression analysis for finding out independent predictors of mortality showed that only two factors, i.e., the presence of lung disease (HR 2.65, 95% CI 1.03-6.79, P = 0.042) and the requirement of vasopressor support at presentation (HR 5.28, 95% CI 1.75- 15.97, P = 0.003) predicted the survival of AKI patients. Thus, the present study showed that type of AKI was not an independent predictor of mortality in AKI patients admitted to our center. CONCLUSION(S): The majority of patients in both groups of AKI presented in Stage 3. Sepsis was found to be the most common cause in the CA-AKI group and was also one of the common causes in the HA-AKI group. On comparing the inhospital outcomes of AKI episodes, it was observed that both recovery (complete or partial) and dialysis dependency were more common in the patients with CA-AKI while mortality was found to be more in the HA-AKI group. However, on Cox proportional hazard regression analysis it was found that only two factors, i.e., the presence of lung disease and the requirement of vasopressor support at presentation predicted the survival of AKI patients admitted to our center. Thus, the present study showed that type of AKI was not an independent predictor of mortality in such patients. Further, more long-term and larger multi-center studies are required to study the course and outcome of patients with AKI and to outline the regional variances in its patterns in the Indian population.

17.
Indian Journal of Nephrology ; 32(7 Supplement 1):S53, 2022.
Article in English | EMBASE | ID: covidwho-2201594

ABSTRACT

BACKGROUND: Covid-19 has been associated with worsened prognosis in patients with kidney involvement. The incidence of acute kidney injury (AKI) in Coronavirus-19 disease (COVID-19) patients ranges from 0.5% to 35%. AIM OF THE STUDY: We evaluated the prevalence severity risk factors and prognosis in patients with COVID-19 having AKI or CKD. METHOD(S): We conducted a retrospective analysis of 70 patients with Covid-19 presenting to nephrology department. Outcome of patients with CKD stage 1-2 was compared with that of patients with AKI kidney transplant and CKD stage G3a-G5D. RESULT(S): In this study, 15 (21.4%) patients had CKD stage G1-2, 18 (25.71%) had CKD stage G3a-5c and 11 (15.7%) had CKD stage G5d. Eight patients (11.4%) were with functioning renal allograft (CKD-T). Four (5.71%) developed AKI and 14 patients (20%) had acute on CKD. Overall;in-hospital mortality was 27.14% (n = 19). Of these, 3 patients (15.78%) had CKD stage G1-G2, 7 (36.84%) had CKD stage G3a-5c, 3 had CKD G5D, 2 (10.55%) had acute on CKD, one had AKI and 3 patients had a functioning kidney allograft. Baseline & nadir serum creatinine & eGFR of CKD stage 1-2, CKD Stage 3a-5c and stage CKD-t was 0.87 (eGFR 82), 7.34 (eGFR 11.61), 3.24 (eGFR-24.86);and 0.74 (eGFR 93.55), 5.37 (eGFR 16.55) and 1.85 (eGFR 42.28) respectively. CONCLUSION(S): A rather low prevalence of AKI in our Covid-19 patients, lower mortality in acute on CKD patients & improvement in eGFR in CKD & transplant patient in our study suggest that coronavirus has minimal, if any direct toxic effect on kidney. But presence of renal failure worsens the outcome of Covid-19 disease.

18.
Indian Journal of Nephrology ; 32(7 Supplement 1):S87, 2022.
Article in English | EMBASE | ID: covidwho-2201584

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a major risk factor for mortality in ICU patients. The aim of this study was to evaluate the spectrum and outcomes of non-COVID related AKI admitted to non-COVID intensive care units of a tertiary care hospital during COVID pandemic. AIM OF THE STUDY: To study the Spectrum and Outcomes of Acute Kidney Injury in a Non-COVID Intensive Care Unit during COVID Pandemic METHODS: Patients were prospectively enrolled from February 2020 to June 2021 using a predesigned standardized pro forma as per the inclusion and exclusion criteria. Demographic details, comorbid conditions, biochemical parameters, urine output system affection, renal replacement therapy (RRT) details, and fluid replacement were recorded. Outcome measures assessed were serum creatinine at transfer-out from ICU serum creatinine at discharge days of ICU stay and days of hospital stay death/ discharge and requirement of RRT after discharge. RESULT(S): 200 patients of AKI getting admitted to ICU were included in this study. Diabetes mellitus (19.5%) was the most common comorbidity. AKI was most seen in the post-surgery setting (33%), and severe non-surgical sepsis (37%). The most important risk factors predicting in-hospital mortality in AKI patients were hepatic dysfunction (HR-3.471, p = 0.001), septicemia (HR-3.342, p = 0.0001), age >60 years (HR-4.000, p = 0.026), higher baseline SOFA score (HR-1.107, p = 0.001), anemia (HR-0.879, p = 0.003), and reduced serum iron levels (HR- 0.982, p = 0.001). CONCLUSION(S): Presence of age >60 years, hepatic dysfunction, septicemia, higher baseline SOFA score, anemia, and reduced serum iron emerged to be the most important predictors of mortality among intensive care requiring AKI patients. The surgical AKI incidence was less due to lesser number of elective surgeries during the COVID pandemic.

19.
Indian Journal of Clinical Medicine ; 12(1-2):24-27, 2022.
Article in English | ProQuest Central | ID: covidwho-2195969

ABSTRACT

Minimal change disease has been associated with different types of vaccinations, and several case reports have associated the development of this disease with COVID vaccinations as well. We present here a case report of a 19-year-old male who developed minimal change nephrotic syndrome following the second dose of Covishield ChAdOx1 nCoV vaccine. He had received his first dose 2 months prior which was uneventful. He developed fever 3 days after second vaccination and 1 week later developed edema, frothuria, and oliguria. His reports showed a 24-h urine protein of 3.7 g per day, serum creatinine of 1.9 mg/dL, and serum albumin of 1.9 g/dL. He underwent a kidney biopsy which showed features consistent with minimal change disease. He was started on prednisolone at 1 mg/kg body weight. He responded well to treatment and attained complete remission after 33 days of steroids with 24-h urine protein of 195 mg/day, serum creatinine of 0.6 mg/dL, and serum albumin of 5.1 g/dL. This case highlights the possibility of occurrence of minimal change disease post Covishield vaccination even after the second dose despite an uneventful first dose.

20.
Critical Care Medicine ; 51(1 Supplement):561, 2023.
Article in English | EMBASE | ID: covidwho-2190676

ABSTRACT

INTRODUCTION: The CURE Drug Repurposing Collaboratory (CDRC) partnered with the SCCM Discovery VIRUS COVID-19 Registry (VIRUS) to develop and build a minimal dataset for drug repurposing research for COVID-19. This use case required a cross-sectional dataset to avoid the perceived risk of identifiability through serial laboratory results or vital sign patterns. The work took place as part of the early stages of a project funded by HHS Assistant Secretary for Planning and Evaluation to automate data extraction from the electronic health record. METHOD(S): As part of an ongoing evaluation of the dataset's utility, CDRC performed factor selection analysis to explore relationships between baseline, median, and peak laboratory values and the patient outcomes. The primary outcomes of interest in this analysis were 28-day all-cause mortality and hospital length of stay (LOS). Serum creatinine, leukocyte count, lactate dehydrogenase (LDH), international normalized ratio (INR), and PaO2:FiO2 (P:F) ratio were examined as predictors of key outcomes. Data for 17,144 patients were obtained from VIRUS: COVID-19 Registry. Data were cleaned and an analysis dataset was constructed. Records with excessive missingness were excluded and liberal clinical plausibility rules were applied. Analysis used logistic regression with least absolute shrinkage and selection operator (LASSO) along with 10-fold cross validation. The cohort was randomly divided into training and testing sets at a 9:1 ratio. The study was IRB exempted. RESULT(S): Following a year-long Delphi process, the investigators identified 35 key data elements including primary outcomes. Modeling for 28-day mortality: median creatinine (n=4,304), baseline leukocytes (n=3,731), median LDH (n=1,854), maximum INR (n=1,972), and median PF ratio (n=1,000) were most predictive. Modeling for LOS: median creatinine, maximum leukocytes, baseline LDH, baseline INR, and median PF ratio were most predictive. CONCLUSION(S): This analysis provides guidance for the evaluation of the CURE ID dataset. The data will ultimately be displayed in a publicly explorable interface through the CURE ID application and website hosted by the National Center for Advancing Translational Science at NIH in partnership with the FDA.

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