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COVID-19 相关血液透析患者的临床特征、治疗及预后。

Clinical features, management, and outcome of hemodialysis patients with SARS-CoV-2.

机构信息

Department of Infectious Diseases, SBU Istanbul Training and Research Hospital, Istanbul, Turkey.

Department of Nephrology, SBU Istanbul Training and Research Hospital, Istanbul, Turkey.

出版信息

Ther Apher Dial. 2022 Feb;26(1):171-177. doi: 10.1111/1744-9987.13696. Epub 2021 Jun 9.

Abstract

The aim of the study was to evaluate the clinical features of the patients on HD with COVID-19 and determine the prognostic factors. In this single-center prospective study, a total of 58 chronic renal failure patients on HD and diagnosed COVID-19 infection were enrolled in the study. The patients were divided into two groups according to their need for intensive care unit referral. Demographic features of the patients, clinical manifestations, laboratory data, treatments, and clinical outcome were evaluated. The mean age of 58 HD patients was 63.2 ± 13.8 (30-93) years and female-male ratio was 0.34. SARS-CoV2-PCR positivity rate was 32.8%. 85.2% of patients (n = 46) had bilateral lesions and 14.8% (n = 8) had unilateral one lesion in chest CT. The most common symptoms were fatigue (in 44 patients, 80%) and dyspnea (in 31 patients, 56.4%). The most common comorbidity was HT (in 37 patients, 67.3%). The patients who need intensive care and died were older (p = 0.015). We observed lower platelet and eosinophil counts, potassium levels, higher AST, troponin and CRP levels in the group of patients who need intensive care and died than the group who survived (p = 0.043, 0.005, 0.033, 0.007, 0.001, <0.001, respectively). 15.5% of the patients (n = 9) were transferred to intensive care unit. Among them, two were discharged with cure and seven patients died. Mortality rate was 12.1%. Older age, lower platelet and eosinophil counts and higher AST, troponin and CRP levels were prognostic risk factors in our HD patients who needed intensive care.

摘要

本研究旨在评估 COVID-19 合并血液透析(HD)患者的临床特征,并确定其预后因素。在这项单中心前瞻性研究中,共纳入 58 例在血液透析过程中被诊断为 COVID-19 感染的慢性肾衰竭患者。根据是否需要转入重症监护病房(ICU),将患者分为两组。评估患者的人口统计学特征、临床表现、实验室数据、治疗和临床结局。58 例 HD 患者的平均年龄为 63.2±13.8(30-93)岁,男女比例为 0.34。SARS-CoV2-PCR 阳性率为 32.8%。胸部 CT 显示,85.2%(n=46)的患者有双侧病变,14.8%(n=8)的患者有单侧病变。最常见的症状是乏力(44 例,80%)和呼吸困难(31 例,56.4%)。最常见的合并症是高血压(37 例,67.3%)。需要转入 ICU 和死亡的患者年龄更大(p=0.015)。我们观察到,需要转入 ICU 和死亡的患者的血小板和嗜酸性粒细胞计数、钾水平较低,AST、肌钙蛋白和 CRP 水平较高(p=0.043、0.005、0.033、0.007、0.001,均<0.001)。15.5%的患者(n=9)转入 ICU。其中,2 例患者治愈出院,7 例患者死亡。死亡率为 12.1%。年龄较大、血小板和嗜酸性粒细胞计数较低以及 AST、肌钙蛋白和 CRP 水平较高是需要转入 ICU 的 HD 患者的预后危险因素。

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