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1.
Flavio Azevedo Figueiredo; Lucas Emanuel Ferreira Ramos; Rafael Tavares Silva; Magda Carvalho Pires; Daniela Ponce; Rafael Lima Rodrigues de Carvalho; Alexandre Vargas Schwarzbold; Amanda de Oliveira Maurilio; Ana Luiza Bahia Alves Scotton; Andresa Fontoura Garbini; Barbara Lopes Farace; Barbara Machado Garcia; Carla Thais Candida Alves Silva; Christiane Correa Rodrigues Cimini Cimini; Cintia Alcantara de Carvalho; Cristiane dos Santos Dias; Daniel Vitorio Silveira; Euler Roberto Fernandes Manenti; Evelin Paola de Almeida Cenci; Fernando Anschau; Fernando Graca Aranha; Filipe Carrilho de Aguiar; Frederico Bartolazzi; Giovanna Grunewald Vietta; Guilherme Fagundes Nascimento; Helena Carolina Noal; Helena Duani; Heloisa Reniers Vianna; Henrique Cerqueira Guimaraes; Joice Coutinho de Alvarenga; Jose Miguel Chatkin; Julia Parreiras Drumond de Moraes; Juliana Machado Rugolo; Karen Brasil Ruschel; Karina Paula Medeiros Prado Martins; Luanna Silva Monteiro Menezes; Luciana Siuves Ferreira Couto; Luis Cesar de Castro; Luiz Antonio Nasi; Maderson Alvares de Souza Cabral; Maiara Anschau Floriani; Maira Dias Souza; Maira Viana Rego Souza e Silva; Marcelo Carneiro; Mariana Frizzo de Godoy; Maria Aparecida Camargos Bicalho; Maria Clara Pontello Barbosa Lima; Matheus Carvalho Alves Nogueira; Matheus Fernandes Lopes Martins; Milton Henriques Guimaraes-Junior; Natalia da Cunha Severino Sampaio; Neimy Ramos de Oliveira; Patricia Klarmann Ziegelmann; Pedro Guido Soares Andrade; Pedro Ledic Assaf; Petronio Jose de Lima Martelli; POLIANNA DELFINO PEREIRA; Raphael Castro Martins; Rochele Mosmann Menezes; Saionara Cristina Francisco; Silvia Ferreira Araujo; Talita Fischer Oliveira; Thainara Conceicao de Oliveira; Thais Lorenna Souza Sales; Yuri Carlotto Ramires; Milena Soriano Marcolino.
Preprint in English | medRxiv | ID: ppmedrxiv-22268631

ABSTRACT

BackgroundAcute kidney injury (AKI) is frequently associated with COVID-19 and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalized COVID-19 patients. MethodsThis study is part of the multicentre cohort, the Brazilian COVID-19 Registry. A total of 5,212 adult COVID-19 patients were included between March/2020 and September/2020. We evaluated four categories of predictor variables: (1) demographic data; (2) comorbidities and conditions at admission; (3) laboratory exams within 24 h; and (4) the need for mechanical ventilation at any time during hospitalization. Variable selection was performed using generalized additive models (GAM) and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. The accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Risk groups were proposed based on predicted probabilities: non-high (up to 14.9%), high (15.0 - 49.9%), and very high risk ([≥] 50.0%). ResultsThe median age of the model-derivation cohort was 59 (IQR 47-70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalization. The validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. Thirty-two variables were tested and four important predictors of the need for KRT during hospitalization were identified using GAM: need for mechanical ventilation, male gender, higher creatinine at admission, and diabetes. The MMCD score had excellent discrimination in derivation (AUROC = 0.929; 95% CI 0.918-0.939) and validation (AUROC = 0.927; 95% CI 0.911-0.941) cohorts an good overall performance in both cohorts (Brier score: 0.057 and 0.056, respectively). The score is implemented in a freely available online risk calculator (https://www.mmcdscore.com/). ConclusionThe use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalized COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.

2.
Preprint in English | medRxiv | ID: ppmedrxiv-21261510

ABSTRACT

IntroductionChildren and adolescents with Covid-19 have been shown lower mortality less intense symptoms when compared to adults, but studies in Brazil have been based on the compulsory notifying system only. ObjectiveTo analyse clinical, laboratory, radiological characteristics and outcomes of hospitalized patients under 20 years with Covid-19. MethodsCases series of hospitalized patients with confirmed Covid-19 under 20 years, obtained from a cohort study in 37 hospitals from five states of Brazil. ResultsFrom 36 patients, 20 (55.5%) were adolescentes, 20 (55.5%) were male, 18 (50.0%) had comorbidities, 2 were pregnant and in 7 (19.4%), initial symptoms occurred during hospitalization for other causes, of whom 3 were possibly infected in the hospital. Fever (61.1%), dyspnea (33.3%) and neurological symptoms (33.0%) were the most common complaints. C-reactive protein was higher than 50mg/L in 16.7% and D-dimer was above the reference limit in 22.2%. Chest X-rays were performed in 20 (55.5%) patients, 9 had abnormalities, and chest tomography in 5. Hospital length of stay ranged from 1-40 days (median 5 [interquartile range 3-10]), 16 (44.4%) needed intensive therapy, 6 (16.7%) required mechanical ventilation and one patient (2.8%) died. ConclusionIn case series patients under 20 years from hospitals from 5 states of Brazil, comorbidities were frequent, and most common symptoms were fever, dyspnea and neurological symptoms. Forty-four percent required intensive therapy, showing that the disease was not as mild as it was expected, and one patient died.

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