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土耳其宗古尔达克市血液透析患者 COVID-19 的临床结局。

Clinical outcomes of COVID-19 in hemodialysis patients in the city of Zonguldak, Turkey.

机构信息

Department of Nephrology, Zonguldak Ataturk State Hospital, Nefroloji klinik, Huzur sokak, 67100, Zonguldak, Turkey.

Zonguldak Bulent Ecevit University, Zonguldak, Turkey.

出版信息

Int Urol Nephrol. 2021 Jul;53(7):1445-1452. doi: 10.1007/s11255-020-02781-8. Epub 2021 Jan 15.

Abstract

PURPOSE

Patients on maintenance hemodialysis are vulnerable to viral infections like COVID-19 because of the low chance of obedience and complying with rules besides the need for transfer to distant dialysis facilities. We investigated the impact and clinical effect of treatment of COVID-19 in dialysis patients.

METHODS

We included patients on maintenance hemodialysis at different healthcare facilities in Zonguldak city. With the diagnosis of the first infected HD case, all other patients who shared the same session were screened. Hospitalized and clinically confirmed cases were included. COVID-19 diagnosis was made based on clinical, biochemical along radiologic findings.

RESULTS

34 (F/M:19/15, mean age 62 ± 13.2 years, dialysis duration 66.9 ± 57.7 months, length of hospital stay 16.2 ± 7.9 days) were diagnosed with COVID-19 infection. The prevalence of COVID-19 was found to be 18.4% of our exposed population. 38.2% of our patients were initially diagnosed by CT screening while asymptomatic. 35.3% had a fever as the first presenting symptom. Lymphopenia was the most common laboratory finding. Except for one, all had at least one comorbidity. Out of 12 (35.3%) patients admitted to ICU 6(17.6%) died. The deceased patients were older, presented with lower serum albumin and lymphocyte count, and had higher CRP and fibrinogen levels. High CRP level on admission was the only significant predictor of mortality.

CONCLUSION

Early detection will lower mortality. In this study, with a low prevalence of COVID-19, the importance of early screening of both symptomatic and asymptomatic patients was shown to be highly important. Further studies are still needed to find out the most appropriate medical management.

摘要

目的

由于维持性血液透析患者顺从性和遵守规定的可能性较低,并且需要转移到较远的透析设施,因此他们容易感染 COVID-19 等病毒感染。我们调查了 COVID-19 治疗对透析患者的影响和临床效果。

方法

我们纳入了宗古尔达克市不同医疗机构的维持性血液透析患者。首例感染 HD 病例确诊后,对所有同场透析的患者进行筛查。包括住院和临床确诊病例。COVID-19 诊断基于临床、生化和影像学检查结果。

结果

34 例(F/M:19/15,平均年龄 62 ± 13.2 岁,透析时间 66.9 ± 57.7 个月,住院时间 16.2 ± 7.9 天)被诊断为 COVID-19 感染。我们暴露人群中 COVID-19 的患病率为 18.4%。我们最初通过 CT 筛查发现无症状患者 38.2%,发热为首发症状的占 35.3%。淋巴细胞减少是最常见的实验室发现。除 1 例外,所有患者均至少合并 1 种合并症。12 例(35.3%)患者入住 ICU,其中 6 例(17.6%)死亡。死亡患者年龄较大,血清白蛋白和淋巴细胞计数较低,C 反应蛋白和纤维蛋白原水平较高。入院时 C 反应蛋白水平升高是唯一显著的死亡预测因子。

结论

早期发现可降低死亡率。在这项研究中,COVID-19 的患病率较低,表明对有症状和无症状患者进行早期筛查非常重要。仍需要进一步研究以找到最合适的医疗管理方法。

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