Arterial oxygen saturation and hypoxemia in hemodialysis patients with COVID-19.
Arterial oxygen saturation and hypoxemia in hemodialysis patients with COVID-19.
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DOI：
10.1093/ckj/sfab019
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发表时间：
2021-04
影响因子：
4.6
通讯作者：
Kotanko P
中科院分区：
文献类型：
--
作者：
Preciado P;Tapia Silva LM;Ye X;Zhang H;Wang Y;Waguespack P;Kooman JP;Kotanko P
维持性血液透析（MHD）患者特别容易感染2019冠状病毒病（COVID-19），这是一种可能导致间质性肺炎、肺泡气体交换受损和低氧血症的病毒性疾病。我们确定了MHD患者在COVID-19诊断前4周至诊断后一周的分析动脉氧饱和度（SaO2）的时间过程。我们对来自11个透析机构的确诊COVID-19中心MHD患者进行了质量改进项目。在有动静脉通道的患者中，在透析期间使用critical - line监测仪（Fresenius Medical Care, Waltham， MA， USA）测量1x /min的SaO2。我们从患者的电子健康记录中提取了人口统计、临床、治疗和实验室数据以及与covid -19相关的症状。52例患者（男性29例，平均±标准差年龄66.5±15.7岁）可获得溶栓性SaO2，参与了338例HD治疗。从COVID-19症状的出现到诊断的平均时间为1.1天（中位数0；范围0 - 9）。在COVID-19诊断之前，HD治疗伴低氧血症（定义为治疗水平平均SaO2 <90%）的比例从2.8%（诊断前2-4周）增加到12.2%（1周）和20.7%（诊断前3天）。诊断后血氧补充急剧增加。11名患者在5周内死于COVID-19。与COVID-19康复患者相比，死亡患者在COVID-19诊断前SaO2下降更为明显。在HD患者中，低氧血症可能先于临床症状的出现和COVID-19的诊断。SaO2的急剧下降与患者预后不良有关。SaO2的测量可能有助于COVID-19患者的症状前识别。
Maintenance hemodialysis (MHD) patients are particularly vulnerable to coronavirus disease 2019 (COVID-19), a viral disease that may cause interstitial pneumonia, impaired alveolar gas exchange and hypoxemia. We ascertained the time course of intradialytic arterial oxygen saturation (SaO2) in MHD patients between 4 weeks pre-diagnosis and the week post-diagnosis of COVID-19. We conducted a quality improvement project in confirmed COVID-19 in-center MHD patients from 11 dialysis facilities. In patients with an arterio-venous access, SaO2 was measured 1×/min during dialysis using the Crit-Line monitor (Fresenius Medical Care, Waltham, MA, USA). We extracted demographic, clinical, treatment and laboratory data, and COVID-19-related symptoms from the patients’ electronic health records. Intradialytic SaO2 was available in 52 patients (29 males; mean ± standard deviation age 66.5 ± 15.7 years) contributing 338 HD treatments. Mean time between onset of symptoms indicative of COVID-19 and diagnosis was 1.1 days (median 0; range 0–9). Prior to COVID-19 diagnosis the rate of HD treatments with hypoxemia, defined as treatment-level average SaO2 <90%, increased from 2.8% (2–4 weeks pre-diagnosis) to 12.2% (1 week) and 20.7% (3 days pre-diagnosis). Intradialytic O2 supplementation increased sharply post-diagnosis. Eleven patients died from COVID-19 within 5 weeks. Compared with patients who recovered from COVID-19, demised patients showed a more pronounced decline in SaO2 prior to COVID-19 diagnosis. In HD patients, hypoxemia may precede the onset of clinical symptoms and the diagnosis of COVID-19. A steep decline of SaO2 is associated with poor patient outcomes. Measurements of SaO2 may aid the pre-symptomatic identification of patients with COVID-19.
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