Published online Mar 25, 2022. doi: 10.5527/wjn.v11.i2.58
Peer-review started: October 29, 2021
First decision: December 27, 2021
Revised: January 9, 2022
Accepted: March 23, 2022
Article in press: March 23, 2022
Published online: March 25, 2022
Processing time: 147 Days and 1.9 Hours
Coronavirus disease 2019 (COVID-19) pandemic runs as mild upper respiratory infection or being asymptomatic in 80% of infected patients, 15% develop severe lung disease, and 5% progress to respiratory failure or septic shock. Mortality ranges from 2%-50%.
Τo analyze our experience with patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (MHD) with COVID-19 before the era of vaccination.
To identify predictors of worst outcome in patients with ESKD on MHD with COVID-19 in the era prior to vaccination, and to study all the range of clinical pictures of COVID-19 in this group of patients, including asymptomatic to severe cases all from a single center.
This was a retrospective cohort study from a single referral center from April to February 2021. We examined the kinetics of laboratory evolution of certain parameters linked to COVID-19 pathophysiology, as potential prognostication markers of adverse outcome. Patients were scored according to the WHO severity system for COVID-19 and frailty index, besides classic demographics, and co-morbidities. A new simplified scoring system of severity (Covid Visual Assessment score, CoVAsc) was used.
Thirty-two hospitalized MHD patients with COVID-19 were studied, from admission to outcome. Although initial presentation was mild on admission regarding WHO severity (16 with mild disease, 13 with moderate, and 3 with severe) and CoVAsc score (24 patients had 0-10% lung infiltrates), the outcome was quite adverse. Approximately 40.6% of patients progressed to severe disease and 15.5% died. “Progressors” tended to have a more “inflamed” laboratory profile at the time of admission and statistically significant higher neutrophils to lymphocytes ratio during the first 10 d of hospitalization. The deceased differed from “survivors” with statistical significance as having a worse WHO severity score, frailty index, and CoVASc score and regarding the first 10-d kinetics of lactate dehydrogenase (increase), D-dimers (increase), and albumin (decrease).
Traditional risk factors for adverse COVID-19 outcome including male gender and comorbidities do not seem to apply in MHD patients. Potential new clinical indicators of adverse outcome, according to our findings, include the WHO severity score, frailty index, CoVASc score, and the 10-d kinetics of certain laboratory parameters.
A larger number of dialysis patients might be studied especially after vaccination and the evolving various mutations of SARS-CoV-2.