Presentation and Outcomes of Patients with ESKD and COVID-19
The relative immunosuppression and high prevalence of comorbidities in patients with ESKD on dialysis raise concerns that they may have an elevated risk of severe coronavirus disease 2019 (COVID-19), but outcomes for COVID-19 in such patients are unclear. To examine presentation and outcomes of COVI...
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| Vydáno v: | Journal of the American Society of Nephrology Ročník 31; číslo 7; s. 1409 |
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| Hlavní autoři: | , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
01.07.2020
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| ISSN: | 1533-3450, 1533-3450 |
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| Abstract | The relative immunosuppression and high prevalence of comorbidities in patients with ESKD on dialysis raise concerns that they may have an elevated risk of severe coronavirus disease 2019 (COVID-19), but outcomes for COVID-19 in such patients are unclear.
To examine presentation and outcomes of COVID-19 in patients with ESKD on dialysis, we retrospectively collected clinical data on 59 patients on dialysis who were hospitalized with COVID-19. We used Wilcoxon rank sum and Fischer exact tests to compare patients who died versus those still living.
Two of the study's 59 patients were on peritoneal dialysis, and 57 were on hemodialysis. Median age was 63 years, with high prevalence of hypertension (98%) and diabetes (69%). Patients who died were significantly older than those still living (median age, 75 versus 62 years) and had a higher median Charlson comorbidity index (8 versus 7). The most common presenting symptoms were fever (49%) and cough (39%); initial radiographs most commonly showed multifocal or bilateral opacities (59%). By end of follow-up, 18 patients (31%) died a median 6 days after hospitalization, including 75% of patients who required mechanical ventilation. Eleven of those who died had advanced directives against intubation. The remaining 41 patients (69%) were discharged home a median 8 days after admission. The median initial white blood cell count was significantly higher in patients who died compared with those still living (7.5 versus 5.7×10
/
l), as was C-reactive protein (163 versus 80 mg/L).
The association of COVID-19 with high mortality in patients with ESKD on dialysis reinforces the need to take appropriate infection control measures to prevent COVID-19 spread in this vulnerable population. |
|---|---|
| AbstractList | The relative immunosuppression and high prevalence of comorbidities in patients with ESKD on dialysis raise concerns that they may have an elevated risk of severe coronavirus disease 2019 (COVID-19), but outcomes for COVID-19 in such patients are unclear.
To examine presentation and outcomes of COVID-19 in patients with ESKD on dialysis, we retrospectively collected clinical data on 59 patients on dialysis who were hospitalized with COVID-19. We used Wilcoxon rank sum and Fischer exact tests to compare patients who died versus those still living.
Two of the study's 59 patients were on peritoneal dialysis, and 57 were on hemodialysis. Median age was 63 years, with high prevalence of hypertension (98%) and diabetes (69%). Patients who died were significantly older than those still living (median age, 75 versus 62 years) and had a higher median Charlson comorbidity index (8 versus 7). The most common presenting symptoms were fever (49%) and cough (39%); initial radiographs most commonly showed multifocal or bilateral opacities (59%). By end of follow-up, 18 patients (31%) died a median 6 days after hospitalization, including 75% of patients who required mechanical ventilation. Eleven of those who died had advanced directives against intubation. The remaining 41 patients (69%) were discharged home a median 8 days after admission. The median initial white blood cell count was significantly higher in patients who died compared with those still living (7.5 versus 5.7×10
/
l), as was C-reactive protein (163 versus 80 mg/L).
The association of COVID-19 with high mortality in patients with ESKD on dialysis reinforces the need to take appropriate infection control measures to prevent COVID-19 spread in this vulnerable population. The relative immunosuppression and high prevalence of comorbidities in patients with ESKD on dialysis raise concerns that they may have an elevated risk of severe coronavirus disease 2019 (COVID-19), but outcomes for COVID-19 in such patients are unclear.BACKGROUNDThe relative immunosuppression and high prevalence of comorbidities in patients with ESKD on dialysis raise concerns that they may have an elevated risk of severe coronavirus disease 2019 (COVID-19), but outcomes for COVID-19 in such patients are unclear.To examine presentation and outcomes of COVID-19 in patients with ESKD on dialysis, we retrospectively collected clinical data on 59 patients on dialysis who were hospitalized with COVID-19. We used Wilcoxon rank sum and Fischer exact tests to compare patients who died versus those still living.METHODSTo examine presentation and outcomes of COVID-19 in patients with ESKD on dialysis, we retrospectively collected clinical data on 59 patients on dialysis who were hospitalized with COVID-19. We used Wilcoxon rank sum and Fischer exact tests to compare patients who died versus those still living.Two of the study's 59 patients were on peritoneal dialysis, and 57 were on hemodialysis. Median age was 63 years, with high prevalence of hypertension (98%) and diabetes (69%). Patients who died were significantly older than those still living (median age, 75 versus 62 years) and had a higher median Charlson comorbidity index (8 versus 7). The most common presenting symptoms were fever (49%) and cough (39%); initial radiographs most commonly showed multifocal or bilateral opacities (59%). By end of follow-up, 18 patients (31%) died a median 6 days after hospitalization, including 75% of patients who required mechanical ventilation. Eleven of those who died had advanced directives against intubation. The remaining 41 patients (69%) were discharged home a median 8 days after admission. The median initial white blood cell count was significantly higher in patients who died compared with those still living (7.5 versus 5.7×103/μl), as was C-reactive protein (163 versus 80 mg/L).RESULTSTwo of the study's 59 patients were on peritoneal dialysis, and 57 were on hemodialysis. Median age was 63 years, with high prevalence of hypertension (98%) and diabetes (69%). Patients who died were significantly older than those still living (median age, 75 versus 62 years) and had a higher median Charlson comorbidity index (8 versus 7). The most common presenting symptoms were fever (49%) and cough (39%); initial radiographs most commonly showed multifocal or bilateral opacities (59%). By end of follow-up, 18 patients (31%) died a median 6 days after hospitalization, including 75% of patients who required mechanical ventilation. Eleven of those who died had advanced directives against intubation. The remaining 41 patients (69%) were discharged home a median 8 days after admission. The median initial white blood cell count was significantly higher in patients who died compared with those still living (7.5 versus 5.7×103/μl), as was C-reactive protein (163 versus 80 mg/L).The association of COVID-19 with high mortality in patients with ESKD on dialysis reinforces the need to take appropriate infection control measures to prevent COVID-19 spread in this vulnerable population.CONCLUSIONSThe association of COVID-19 with high mortality in patients with ESKD on dialysis reinforces the need to take appropriate infection control measures to prevent COVID-19 spread in this vulnerable population. |
| Author | Valeri, Anthony M Husain, S Ali Robbins-Juarez, Shelief Y Radhakrishnan, Jai Rao, Maya K Gharavi, Ali G Mohan, Sumit Stevens, Jacob S Ahn, Wooin |
| Author_xml | – sequence: 1 givenname: Anthony M surname: Valeri fullname: Valeri, Anthony M organization: Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York – sequence: 2 givenname: Shelief Y surname: Robbins-Juarez fullname: Robbins-Juarez, Shelief Y organization: Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York – sequence: 3 givenname: Jacob S surname: Stevens fullname: Stevens, Jacob S organization: The Columbia University Renal Epidemiology Group, New York, New York – sequence: 4 givenname: Wooin surname: Ahn fullname: Ahn, Wooin organization: Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York – sequence: 5 givenname: Maya K surname: Rao fullname: Rao, Maya K organization: Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York – sequence: 6 givenname: Jai surname: Radhakrishnan fullname: Radhakrishnan, Jai organization: Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York – sequence: 7 givenname: Ali G surname: Gharavi fullname: Gharavi, Ali G organization: Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York – sequence: 8 givenname: Sumit orcidid: 0000-0002-5305-9685 surname: Mohan fullname: Mohan, Sumit organization: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York – sequence: 9 givenname: S Ali surname: Husain fullname: Husain, S Ali email: SAH2134@cumc.columbia.edu organization: The Columbia University Renal Epidemiology Group, New York, New York |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32467113$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Adult Age Factors Aged Cause of Death Cohort Studies Comorbidity Coronavirus Infections - diagnosis Coronavirus Infections - epidemiology Coronavirus Infections - therapy COVID-19 Female Hospital Mortality - trends Hospitalization - statistics & numerical data Hospitals, University Humans Infection Control - organization & administration Intensive Care Units - organization & administration Kidney Failure, Chronic - diagnosis Kidney Failure, Chronic - epidemiology Kidney Failure, Chronic - therapy Male Middle Aged New York City Outcome Assessment, Health Care Pandemics Pneumonia, Viral - diagnosis Pneumonia, Viral - epidemiology Pneumonia, Viral - therapy Prevalence Renal Dialysis - methods Renal Dialysis - mortality Retrospective Studies Risk Assessment Severity of Illness Index Sex Factors Statistics, Nonparametric Survival Analysis Vulnerable Populations - statistics & numerical data |
| Title | Presentation and Outcomes of Patients with ESKD and COVID-19 |
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