Chronic Hemodialysis Patients Hospitalized with COVID-19: Short-term Outcomes in the Bronx, New York
Chronic Hemodialysis Patients Hospitalized with COVID-19: Short-term Outcomes in the Bronx, New York
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DOI：
10.34067/kid.0003672020
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发表时间：
2020-08-01
期刊：
影响因子：
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通讯作者：
Coco, Maria
中科院分区：
文献类型：
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作者：
Fisher, Molly;Yunes, Milagros;Coco, Maria
背景 接受长期血液透析的 ESKD 患者患有较高的合并症负担，这可能使他们在因 COVID-19 住院时面临更高的不良后果风险。然而，这一独特患者群体的数据有限。我们研究的目的是描述因 COVID-19 需要住院的慢性血液透析患者的临床特征和短期结果。方法我们对 2020 年 3 月 9 日至 4 月 8 日纽约市 SARS-CoV-2 感染激增期间在布朗克斯区两家主要医院因 COVID-19 住院的 114 名慢性血液透析患者进行了回顾性研究。对患者住院期间至2020年4月22日进行随访。对存活者和院内死亡者的临床特征和实验室数据进行比较；报告了短期结果。 结果 中位年龄为 64.5 岁，61% 为男性，89% 为黑人或西班牙裔。共有 102 名患者（90%）患有高血压，76 名患者（67%）患有糖尿病，63 名患者（55%）患有心血管疾病，30% 是疗养院居民。 13% 的患者需要入住重症监护病房 (ICU)，17% 的患者需要机械通气。 28% 的队列患者发生院内死亡，87% 需要 ICU 的患者发生院内死亡，近 100% 需要机械通气的患者发生院内死亡。观察到大量院内心脏骤停的病例。初始降钙素原、铁蛋白、乳酸脱氢酶、C反应蛋白和淋巴细胞百分比与院内死亡相关。 结论 因 COVID-19 住院的慢性血液透析患者的短期死亡率较高。需要 ICU 和机械通气的患者的结局较差，这凸显了对因严重 COVID-19 住院的 ESKD 患者进行临终讨论的重要性，以及在 COVID-19 背景下提高对急性心脏事件的认识的必要性。炎症标志物升高与因 COVID-19 住院的 ESKD 患者的院内死亡相关。
Background Patients with ESKD who are on chronic hemodialysis have a high burden of comorbidities that may place them at increased risk for adverse outcomes when hospitalized with COVID-19. However, data in this unique patient population are limited. The aim of our study is to describe the clinical characteristics and short-term outcomes in patients on chronic hemodialysis who require hospitalization for COVID-19.Methods We performed a retrospective study of 114 patients on chronic hemodialysis who were hospitalized with COVID-19 at two major hospitals in the Bronx from March 9 to April 8, 2020 during the surge of SARS-CoV-2 infections in New York City. Patients were followed during their hospitalization through April 22, 2020. Comparisons in clinical characteristics and laboratory data were made between those who survived and those who experienced in-hospital death; short-term outcomes were reported.Results Median age was 64.5 years, 61% were men, and 89% were black or Hispanic. A total of 102 (90%) patients had hypertension, 76 (67%) had diabetes mellitus, 63 (55%) had cardiovascular disease, and 30% were nursing-home residents. Intensive care unit (ICU) admission was required in 13% of patients, and 17% required mechanical ventilation. In-hospital death occurred in 28% of the cohort, 87% of those requiring ICU, and nearly 100% of those requiring mechanical ventilation. A large number of in-hospital cardiac arrests were observed. Initial procalcitonin, ferritin, lactate dehydrogenase, C-reactive protein, and lymphocyte percentage were associated with in-hospital death.Conclusions Short-term mortality in patients on chronic hemodialysis who were hospitalized with COVID-19 was high. Outcomes in those requiring ICU and mechanical ventilation were poor, underscoring the importance of end-of-life discussions in patients with ESKD who are hospitalized with severe COVID-19 and the need for heightened awareness of acute cardiac events in the setting of COVID-19. Elevated inflammatory markers were associated with in-hospital death in patients with ESKD who were hospitalized with COVID-19.