Presentation and Outcomes of Patients with ESKD and COVID-19
Presentation and Outcomes of Patients with ESKD and COVID-19
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DOI：
10.1681/asn.2020040470
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发表时间：
2020-07-01
影响因子：
13.6
通讯作者：
Husain, S. Ali
中科院分区：
文献类型：
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作者：
Valeri, Anthony M.;Robbins-Juarez, Shelief Y.;Husain, S. Ali
免疫抑制和透析ESKD患者中合并症的高患病率引起了人们的担忧，即此类患者患2019年严重冠状病毒病（COVID-19）的风险可能会升高。然而，COVID-19在该患者人群中的结局尚不清楚。在他们对59名在纽约市医疗中心接受透析的ESKD和COVID-19患者的研究中，作者发现，尽管接受COVID-19透析的患者的表现与普通人群相似，但这些患者的结局很差，包括31%的总体死亡率和75%的需要机械通气的患者死亡率。此外，较高水平的炎症标志物与严重疾病相关。这些信息将有助于为患有COVID-19的透析患者提供护理信息，并加强在治疗这一脆弱人群时感染控制措施的重要性。背景ESKD透析患者的相对免疫抑制和合并症的高患病率引起了人们的担忧，即他们患严重冠状病毒病的风险可能会增加2019方法回顾性收集59例因COVID-19住院的ESKD透析患者的临床资料，分析ESKD透析患者的COVID-19表现和转归。我们使用Wilcoxon秩和检验和Fischer精确检验来比较死亡患者与仍然活着的患者。腹膜透析59例，血液透析57例。中位年龄为63岁，高血压（98%）和糖尿病（69%）的患病率较高。死亡患者的年龄明显大于存活患者（中位年龄75岁对62岁），中位Charlson合并症指数更高（8对7）。最常见的症状是发热（49%）和咳嗽（39%）;最初的X线片最常见的表现为多灶性或双侧混浊（59%）。随访结束时，18例患者（31%）在住院后中位数6天内死亡，包括75%需要机械通气的患者。其中11名死亡者有反对插管的预先指示。其余41例患者（69%）在入院后中位数8天出院回家。死亡患者的初始白色血细胞计数中位数显著高于存活患者（7.5 vs 5.7？10（3）/？结论COVID-19与ESKD透析患者的高死亡率相关，加强了采取适当感染控制措施以防止COVID-19在该弱势人群中传播的必要性。
Significance Statement Immunosuppression and a high prevalence of comorbidities among patients with ESKD on dialysis raise concerns that such patients may have an elevated risk of severe coronavirus disease 2019 (COVID-19). However, the outcomes for COVID-19 in this patient population are not clear. In their study of 59 patients with ESKD and COVID-19 receiving dialysis at a New York City medical center, the authors found that although the presentation of patients on dialysis with COVID-19 was similar to that of the general population, these patients have poor outcomes, including 31% overall mortality and 75% mortality among those requiring mechanical ventilation. In addition, higher levels of inflammatory markers associated with severe disease. This information will help inform care of patients on dialysis who develop COVID-19 and reinforces the importance of infection control measures when treating this vulnerable population.Background 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.Methods 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.Results 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(3)/?l), as was C-reactive protein (163 versus 80 mg/L).Conclusions 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.