Department of Internal Medicine, Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Department of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey.
Int J Clin Pract. 2021 Sep;75(9):e14428. doi: 10.1111/ijcp.14428. Epub 2021 Jun 17.
Older adults with co-morbidities have been reported to be at higher risk for adverse outcomes of coronavirus disease 2019 (COVID-19). The characteristics of COVID-19 in older patients and its clinical outcomes in different kidney disease groups are not well known.
Data were retrieved from a national multicentric database supported by Turkish Society of Nephrology, which consists of retrospectively collected data between 17 April 2020 and 31 December 2020. Hospitalised patients aged 18 years or older with confirmed COVID-19 diagnosis suffering from stage 3-5 chronic kidney disease (CKD) or on maintenance haemodialysis (HD) treatment were included in the database. Non-uraemic hospitalised patients with COVID-19 were also included as the control group.
We included 879 patients [388 (44.1%) female, median age: 63 (IQR: 50-73) years]. The percentage of older patients in the CKD group was 68.8% (n = 188/273), in the HD group was 49.0% (n = 150/306) and in the control group was 30.4% (n = 70/300). Co-morbidities were higher in the CKD and HD groups. The rate of presentation with severe-critical disease was higher in the older CKD and HD groups (43.6%, 55.3% and 16.1%, respectively). Among older patients, the intensive care unit (ICU) admission rate was significantly higher in the CKD and HD groups than in the control group (38.8%, 37.3% and 15.7%, respectively). In-hospital mortality or death and/or ICU admission rates in the older group were significantly higher in the CKD (29.3% and 39.4%) and HD groups (26.7% and 30.1%) compared with the control group (8.6% and 17.1%). In the multivariate analysis, in-hospital mortality rates in CKD and HD groups were higher than control group [hazard ratio (HR): 4.33 (95% confidence interval [CI]: 1.53-12.26) and HR: 3.09 (95% CI: 1.04-9.17), respectively].
Among older COVID-19 patients, in-hospital mortality is significantly higher in those with stage 3-5 CKD and on maintenance HD than older patients without CKD regardless of demographic characteristics, co-morbidities, clinical and laboratory data on admission.
有报道称，合并症的老年患者患 2019 年冠状病毒病（COVID-19）不良结局的风险更高。年龄较大的 COVID-19 患者的特征及其在不同肾病组中的临床结局尚不清楚。
数据来自土耳其肾脏病学会支持的全国多中心数据库，该数据库由 2020 年 4 月 17 日至 2020 年 12 月 31 日期间回顾性收集的数据组成。该数据库纳入了年龄在 18 岁或以上、患有 3-5 期慢性肾脏病（CKD）或维持性血液透析（HD）治疗的确诊 COVID-19 且患有 COVID-19 的住院患者。非尿毒症性 COVID-19 住院患者也被纳入对照组。
我们纳入了 879 名患者[388 名（44.1%）女性，中位年龄：63（IQR：50-73）岁]。CKD 组老年患者的比例为 68.8%（n=188/273），HD 组为 49.0%（n=150/306），对照组为 30.4%（n=70/300）。CKD 和 HD 组合并症更多。CKD 和 HD 组老年患者出现严重-危重症的比例更高（分别为 43.6%、55.3%和 16.1%）。在老年患者中，CKD 和 HD 组入住重症监护病房（ICU）的比例明显高于对照组（分别为 38.8%、37.3%和 15.7%）。老年组的院内死亡率或死亡/入住 ICU 率在 CKD 组（29.3%和 39.4%）和 HD 组（26.7%和 30.1%）明显高于对照组（8.6%和 17.1%）。多因素分析显示，CKD 和 HD 组的院内死亡率均高于对照组[风险比（HR）：4.33（95%置信区间[CI]：1.53-12.26）和 HR：3.09（95%CI：1.04-9.17）]。
在 COVID-19 老年患者中，无论人口统计学特征、合并症、入院时的临床和实验室数据如何，与无 CKD 的老年患者相比，患有 3-5 期 CKD 和维持性 HD 的患者的院内死亡率显著更高。
