ABSTRACT
Objective@#The objective of the study is to determine the association of renal impairment (AKI or CKD) with IL-6 levels on mortality, intubation, and length of hospitalization among COVID-19 positive patients. @*Methods@#This is a retrospective cohort study involving chart review of COVID-19 patients with IL-6 levels and admitted from May 2020 to April 2021. The KDIGO criteria was used for determining renal impairment. The subsequent data processing and analysis was carried out using the statistical software, Stata 13.@*Results@#A total of 1,120 charts were included with patients classified as having AKI (33%), CKD (14%), and no renal impairment (58%). Overall mortality and need for intubation were 27% and 30%, respectively, with average length of stay at 12 days. The IL-6 values were divided into low (0 to less than 51 pg/mL), intermediate (51 to 251 pg/mL), and high (greater than 251 pg/mL) tertiles, which showed acceptable sensitivity and specificity for mortality and need for intubation. @*Conclusion@#The presence of renal impairment (CKD or AKI) with increasing IL-6 levels had an effect of increasing risk of adverse outcomes; however, within tertile groups, the presence of renal impairment did not significantly change the risk of adverse outcomes. The tertile groups have acceptable sensitivity and specificity for clinical use.
Subject(s)
Interleukin-6 , Acute Kidney Injury , Renal Insufficiency, ChronicABSTRACT
Objectives@#In the Philippines, patients on chronic hemodialysis with COVID-19 remain admitted in hospitals despite clinical recovery because most free-standing dialysis units require proof of negative conversion via Reverse Transcriptase – Polymerase Chain Reaction (RT-PCR). This study aims to determine the time to negative conversion of COVID-19 RT-PCR testing among adult patients on chronic hemodialysis with COVID-19 admitted at the Philippine General Hospital (PGH) and bring insight in using the symptom or time-based procedure as recommended by local guideline, and ultimately, to ensure delivery of adequate hemodialysis despite being infected with COVID-19, shorten isolation period, and conserve resources especially in resource-limited settings.@*Methods@#This is a retrospective cohort study on all adult patients on chronic hemodialysis who were admitted in PGH after the diagnosis of COVID-19 by RT-PCR between March 2020 and February 2021. Descriptive statistics was used in summarizing the data.@*Results@#A total of 90 patients on chronic hemodialysis who tested positive for COVID-19 via RT-PCR admitted at PGH were included in the study. Most of these patients had moderate COVID-19 at 53.3%. The median number of days from onset of symptoms to clinical recovery was 14.5 days. The median time to first negative conversion was 18 days. Most of these patients had negative conversion at the second week. The correlation coefficient between time to clinical recovery and negative conversion was 0.214. @*Conclusion@#Among adult patients on chronic hemodialysis who were admitted in PGH after the diagnosis of COVID-19, the time to negative conversion was longer compared to the time to clinical recovery with a very weak correlation between the two.
Subject(s)
COVID-19 , Renal DialysisABSTRACT
Introduction@#As of February 4, 2021, a total of 530,118 COVID-19 cases were recorded in the Philippines with a fatality rate of 2.1%. Significant morbidity from COVID-19 is caused by hyperinflammation. Hemoperfusion (HP), which adsorbs inflammatory cytokines, has been performed in the Philippine General Hospital (PGH) as an adjunct to management given to COVID-19 patients. @*Objectives@#This study aimed to describe the clinical and laboratory profile, ventilatory support, therapeutic regimens, and outcomes of COVID-19 patients who underwent hemoperfusion in PGH. @*Methods@#The COVID-19 patient electronic database (April to September 2020) of the Division of Nephrology was reviewed and we included patients with COVID-19 who underwent hemoperfusion. Demographic, clinical, and laboratory data as well as therapeutics and outcomes were described. @*Results@#Sixty-six patients with COVID-19 underwent hemoperfusion. The majority were male (59.1%) with an average age of 61.3 years (SD 15). Hypertension was the most common comorbidity (62.1%). Acute kidney injury (AKI) requiring dialysis comprised 28.8% while 33.3% had diagnosed chronic kidney disease (CKD). The majority were critical COVID-19 cases who had acute respiratory distress syndrome (ARDS) (56.1%). The mean baseline inflammatory marker levels (Il-6, CRP, LDH, ferritin) were elevated. Post-HP inflammatory markers decreased except for IL-6 among patients who died. Most patients were mechanically ventilated (54.5%). Steroids were the most common medications administered (71.2%). Mortality occurred in 62.1% of the patients. The average length of hospital stay was 20.8 days (SD 19.5), duration from admission to first HP 5.9 days (SD 5.8), and 15.3 days (SD 17.4) from first HP to death or discharge. @*Conclusion@#Our study showed the characteristics of patients with COVID-19 who underwent HP. Majority were hypertensive men in their early 60s with critical COVID-19 disease. The mean inflammatory markers were elevated with a decrease in most markers post-hemoperfusion (except for IL-6 among those who died). Despite this, mortality was still high and the average length of hospital stay was long.
Subject(s)
Hemoperfusion , Hemadsorption , COVID-19ABSTRACT
BACKGROUND: Newborn screening (NBS) detects genetic and metabolic conditions that may be present in a newborn before clinical symptoms manifest. Early detection and treatment prevents catastrophic health outcomes. It was introduced into the public health delivery system with the enactment of the Newborn Screening Act of 2004. However, there still seems to be a trend of noncompliance.OBJECTIVE: The study sought to determine the prevalence of NBS compliance in Quezon City lying-in clinics (LICs) between 2010-2015 and the factors that are associated with compliance of mothers with NBS.METHODS: An analytic cross sectional study design was utilized. Records of 710 mothers who gave birth in Quezon City LICs were randomly selected. Multiple logistic regression was used to determine if the mothers' age, civil status, PhilHealth membership, gravidity, and parity were associated with NBS compliance.RESULTS: A 6-year prevalence of NBS compliance of 36.6% was found. PhilHealth members were more likely to comply with newborn screening (AOR=4.1; 95%CI: 2.9 - 6.0). Moreover, the odds of compliance among married mothers were higher than unmarried mothers (AOR=1.6; 95%CI: 1.1 - 2.3). Finally, primiparous mothers were more likely to comply than multiparous mothers (AOR=1.5; 95%CI: 1.0 - 2.1). Age and gravidity were not found to have statistical association with NBS compliance.CONCLUSION: The higher odds of compliance among PhilHealth members was expected since they can avail of NBS for free. Ninety-five percent of primiparous mothers included in the study were primigravid; they are more likely to go to prenatal checkups when NBS information is given, according to literature.
