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Objectives: This study aimed to identify the clinical features of cardiac injury complicating with acute kidney injury (AKI) and its risk for a fatal outcome in patients infected with coronavirus disease 2019 (COVID-19) pneumonia. Methods: Initial signs and symptoms and clinical laboratory, radiological, and treatment information were obtained from seven hospitals in China from January 23, 2020, to March 15, 2020. Results: Of 438 patients, 36 (8.22%) displayed isolated cardiac injury, 17 (3.88%) had isolated AKI, and 17 (3.88%) displayed cardiac injury complicating with AKI. Compared with patients without cardiac injury or AKI, patients with isolated cardiac injury, isolated AKI, and cardiac injury complicating with AKI were older (55, 65, 74 vs. 48 years, P < 0.0001) and critically severe. More patients displayed fatigue, dyspnea, and comorbidities in the group with cardiac injury complicating with AKI. Moreover, the indexes reflecting myocardial, renal, liver, and coagulation dysfunctions and infection-related factors were significantly different among the four groups. After adjustment for covariates, patients with cardiac injury complicating with AKI had a higher hazard ratio for mortality (6.64;95% confidence interval, 1.51–29.30). Conclusion: Cardiac injury complicating with kidney injury significantly increased the risk for in-hospital mortality in COVID-19 pneumonia patients. Therefore, early detection at admission and careful monitoring of myocardial and renal injury through biomarkers during hospitalization is recommended to reduce the harm to patients.
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BACKGROUND: Coronavirus Disease 2019 (COVID-19) is currently a global pandemic. Information about predicting mortality in severe COVID-19 remains unclear. METHODS: A total of 151 COVID-19 in-patients from January 23 to March 8, 2020, were divided into severe and critically severe groups and survival and mortality groups. Differences in the clinical and imaging data between the groups were analyzed. Factors associated with COVID-19 mortality were analyzed by logistic regression, and a mortality prediction model was developed. RESULTS: Many clinical and imaging indices were significantly different between groups, including age, epidemic history, medical history, duration of symptoms before admission, routine blood parameters, inflammatory-related factors, Na+, myocardial zymogram, liver and renal function, coagulation function, fraction of inspired oxygen and complications. The proportions of patients with imaging Stage III and a comprehensive computed tomography score were significantly increased in the mortality group. Factors in the prediction model included patient age, cardiac injury, acute kidney injury, and acute respiratory distress syndrome. The area under the receiver operating characteristic curve of the prediction model was 0.9593. CONCLUSIONS: The clinical and imaging data reflected the severity of COVID-19 pneumonia. The mortality prediction model might be a promising method to help clinicians quickly identify COVID-19 patients who are at high risk of death.
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Introduction: The present study systematically reviewed the clinical features and risk factors in patients undergoing maintenance hemodialysis (MHD) who also acquired coronavirus disease 2019 (COVID-19). More specifically, clinical manifestations, prognosis, and risk factors for death among this population were explored. Method: A literature search using the PubMed, Web of Science, and Embase databases, for articles involving patients with laboratory-confirmed COVID-19 and undergoing MHD published between January 1, 2020, and March 13, 2022, was performed. Random-effects meta-analyses were performed to calculate the weighted mean prevalence and corresponding 95% confidence interval (CI) or weighted means and 95% CI. Heterogeneity among studies was assessed using I2 statistics. Results: Twenty-two studies including 13,191 patients with COVID-19 undergoing MHD were selected. The most common symptoms included fever (53% [95% CI 41%-65%]) and cough (54% [95% CI 48%-60%]); however, 17% (95% CI 11%-22%) of the cases were asymptomatic. In subgroup analysis, the proportion of male patients (65% [95% CI 58%-71%]), and patients with coronary artery disease (30% [95% CI 17%-44%) and chronic obstructive pulmonary disease (9% [95% CI 4%-15%]) was greater in the non-survivor group compared with the survivor group. Furthermore, patients undergoing MHD, who were also positive for COVID-19, exhibited a high mortality rate (24% [95% CI 19%-28%]). Conclusions: MHD patients with COVID-19 may initially present as asymptomatic or with mild symptoms; nevertheless, in this study, these patients exhibited a higher risk for death compared with COVID-19 patients not undergoing MHD. Moreover, male sex and underlying cardiovascular and respiratory diseases increased the mortality risk.