Naaraayan Ashutossh, Nimkar Abhishek, Hasan Amrah, Pant Sushil, Durdevic Momcilo, Elenius Henrik, Nava Suarez Corina, Basak Prasanta, Lakshmi Kameswari, Mandel Michael, Jesmajian Stephen
Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA.
Internal Medicine, Montefiore New Rochelle Hospital, New Rochelle, USA.
Cureus. 2020 Sep 11;12(9):e10373. doi: 10.7759/cureus.10373.
Introduction Several comorbid conditions have been identified as risk factors in patients with coronavirus disease 2019 (COVID-19). However, there is a dearth of data describing the impact of COVID-19 infection in patients with end-stage renal disease on hemodialysis (ESRD-HD). Methods This retrospective case series analyzed 362 adult patients consecutively hospitalized with confirmed COVID-19 illness between March 12, 2020, and May 13, 2020, at a teaching hospital in the New York City metropolitan area. The primary outcome was severe pneumonia as defined by the World Health Organization. Secondary outcomes were the (1) the Combined Outcome of Acute respiratory distress syndrome or in-hospital Death (COAD), and (2) need for high levels of oxygen supplementation (HiO). Results Patients with ESRD-HD had lower odds for poor outcomes including severe pneumonia [odds ratio (OR) 0.4, confidence interval (CI) 0.2-0.9, p=.04], HiO [OR 0.3, CI (0.1-0.8), p=.02] and COAD [OR 0.4, CI (0.2-1.05), p=.06], when compared to patients without ESRD. In contrast, higher odds for severe pneumonia, COAD and HiO were seen with advancing age. African Americans were over-represented in the hospitalized patient cohort, when compared to their representation in the community (35% vs 18%). Hispanics had higher odds for severe illness and HiO when compared to Caucasians. Conclusions Patients with ESRD-HD had a milder course of illness with a lower likelihood of severe pneumonia and a lesser need for aggressive oxygen supplementation when compared to patients not on chronic dialysis. The lower odds of severe illness in ESRD-HD patients might have a pathophysiologic basis and need to be further explored.
引言 几种合并症已被确定为2019冠状病毒病（COVID-19）患者的风险因素。然而，关于终末期肾病接受血液透析（ESRD-HD）患者感染COVID-19的影响的数据却很匮乏。方法 本回顾性病例系列分析了2020年3月12日至2020年5月13日期间在纽约市大都市地区一家教学医院连续住院的362例确诊COVID-19疾病的成年患者。主要结局是世界卫生组织定义的重症肺炎。次要结局是（1）急性呼吸窘迫综合征或住院死亡的综合结局（COAD），以及（2）高流量吸氧需求（HiO）。结果 与非ESRD患者相比，ESRD-HD患者出现不良结局的几率较低，包括重症肺炎[比值比（OR）0.4，置信区间（CI）0.2-0.9，p = 0.04]、HiO[OR 0.3，CI（0.1-0.8），p = 0.02]和COAD[OR 0.4，CI（0.2-1.05），p = 0.06]。相比之下，随着年龄增长，出现重症肺炎、COAD和HiO的几率更高。与社区中的比例相比，非裔美国人在住院患者队列中的占比过高（35%对18%）。与白种人相比，西班牙裔患重症疾病和HiO的几率更高。结论 与未接受慢性透析的患者相比，ESRD-HD患者的病程较轻，重症肺炎的可能性较低，积极吸氧的需求也较小。ESRD-HD患者重症疾病几率较低可能有病理生理基础，有待进一步探索。
