Clinical course and predictive risk factors for fatal outcome of SARS-CoV-2 infection in patients with chronic kidney disease.

Autor: Pilgram L; Department of Internal Medicine, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany., Eberwein L; 4th Department of Internal Medicine, Klinikum Leverkusen gGmbH, Leverkusen, Germany., Wille K; University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Klinikum, University of Bochum, Minden, Germany., Koehler FC; Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.; Faculty of Medicine and University Hospital Cologne, CECAD, University of Cologne, Cologne, Germany.; Emergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany., Stecher M; Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany.; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany., Rieg S; Division of Infectious Diseases, Department of Medicine II, Medical Centre - University of Freiburg, Faculty of Medicine, Freiburg, Germany., Kielstein JT; Medical Clinic V, Academic Teaching Hospital Braunschweig, Brunswick, Germany., Jakob CEM; Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany.; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany., Rüthrich M; Department of Internal Medicine II, University Hospital Jena, Jena, Germany., Burst V; Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.; Emergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany., Prasser F; Charite, University Hospital Berlin, Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany.; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany., Borgmann S; Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany., Müller RU; Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.; Faculty of Medicine and University Hospital Cologne, CECAD, University of Cologne, Cologne, Germany.; Systems Biology of Ageing Cologne (Sybacol), University of Cologne, Cologne, Germany., Lanznaster J; Department of Internal Medicine 2, Klinikum Passau, Passau, Germany., Isberner N; Division of Infectious Diseases, Department of Medicine II, University of Würzburg Medical Center, Würzburg, Germany., Tometten L; Department of Gastroenterology and Infectiology, Klinikum Ernst-von-Bergmann, Potsdam, Germany., Dolff S; Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany. Sebastian.Dolff@uk-essen.de.
Jazyk: angličtina
Zdroj: Infection [Infection] 2021 Aug; Vol. 49 (4), pp. 725-737. Date of Electronic Publication: 2021 Apr 13.
DOI: 10.1007/s15010-021-01597-7
Abstrakt: Purpose: The ongoing pandemic caused by the novel severe acute respiratory coronavirus 2 (SARS-CoV-2) has stressed health systems worldwide. Patients with chronic kidney disease (CKD) seem to be more prone to a severe course of coronavirus disease (COVID-19) due to comorbidities and an altered immune system. The study's aim was to identify factors predicting mortality among SARS-CoV-2-infected patients with CKD.
Methods: We analyzed 2817 SARS-CoV-2-infected patients enrolled in the Lean European Open Survey on SARS-CoV-2-infected patients and identified 426 patients with pre-existing CKD. Group comparisons were performed via Chi-squared test. Using univariate and multivariable logistic regression, predictive factors for mortality were identified.
Results: Comparative analyses to patients without CKD revealed a higher mortality (140/426, 32.9% versus 354/2391, 14.8%). Higher age could be confirmed as a demographic predictor for mortality in CKD patients (> 85 years compared to 15-65 years, adjusted odds ratio (aOR) 6.49, 95% CI 1.27-33.20, p = 0.025). We further identified markedly elevated lactate dehydrogenase (> 2 × upper limit of normal, aOR 23.21, 95% CI 3.66-147.11, p < 0.001), thrombocytopenia (< 120,000/µl, aOR 11.66, 95% CI 2.49-54.70, p = 0.002), anemia (Hb < 10 g/dl, aOR 3.21, 95% CI 1.17-8.82, p = 0.024), and C-reactive protein (≥ 30 mg/l, aOR 3.44, 95% CI 1.13-10.45, p = 0.029) as predictors, while renal replacement therapy was not related to mortality (aOR 1.15, 95% CI 0.68-1.93, p = 0.611).
Conclusion: The identified predictors include routinely measured and universally available parameters. Their assessment might facilitate risk stratification in this highly vulnerable cohort as early as at initial medical evaluation for SARS-CoV-2.
(© 2021. The Author(s).)
Databáze: MEDLINE
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