各种危险因素对COVID-19维持性血液透析患者短期和长期结局的影响分析

V. Suchkov, O. Klitsenko, K. K. Urtaeva, D. D. Avdoshina
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Quantitative variables: age, duration of hospitalization, days in the intensive care unit, laboratory blood parameters: the level of D-Dimer, Glucose, Interleukin-6, Procalcitonin, Lymphocytes and Platelets, CRP, CPK, CPK-MB, LDH, Fibrinogen, Ferritin. Qualitative indicators: gender, ventilator, ARDS, the presence of diabetes, the presence of obesity, the presence of complications: cardiovascular, gastrointestinal, septic, macrothrombotic, stage of pneumonia. To identify statistically significant predictors of the risk of an event, the odds ratio (OR) method was used.Results: average age 57.8±14 years, men – 59.5%, average bed day 17.6±10.6 days. In concomitant diseases, diabetes mellitus was indicated in 24% of patients, obesity was registered in 4.3% of patients. Hospital mortality (28-day) in the total cohort of follow-up was 16.05%, in total with out-ofhospital mortality of 22%. Mortality in intensive care reached 62.7%, on ventilator more than 86%, with ARDS 94.3%. No statistical significance was revealed by gender and the presence of diabetes mellitus (DM) in concomitant diseases. When comparing short-term outcomes, the age groups over 65 differed statistically. The following laboratory blood parameters showed a significant difference (P<0.001): D-Dimer, Glucose, IL-6 lymphocytes, Leukocytes, Neutrophils, Platelets, LDH, Ferritin. The following odds ratios (OR) were obtained: ARDS (OR 143.78; 95% CI 33.4-616.2; p=0.0001), on ventilator (OR 57.96; 95% CI 23.1-144.5; p=0.0001), the presence of septic complications (OR 26.4; 95% CI 13.8-50; p=0.0001), the course of the disease is defined as severe (OR 25; 95% CI 12.9-48.2; p=0.0001), the course of the disease is defined as complicated (OR 11.6; 95% CI 6.8-19.7; p=0.0001), the presence of gastrointestinal complications (OR 6.5; 95% CI 2.28-18.4; p=0.0007), the presence of obesity (OR 2.57; 95% CI 1.0-6.5; p=0.039). Mortality of patients receiving two main treatment regimens T-1 and T-2 did not differ (15.8% vs 15.7%). Significant differences (p=0.0001) appeared when compared with the T-0 and T-4 schemes, in which mortality was recorded at 8.8% and 85.7%, respectively. When comparing long-term outcomes, the analysis did not reveal statistical significance by gender. The statistical difference was noted by age. Among laboratory indicators, the PCT level was higher in survivors with complications. A significant difference among all survivors and deceased (P<0.001) was shown by: D-Dimer, blood glucose level, IL-6, CRP. The highest OR was calculated for the following indicators: the presence of gastrointestinal complications (OR 7.7; 95% CI 1.0-57.7; p=0.03), the initial LDH blood level of 622 units /l (OR 4.7; 95% CI 1.63-13.63; p=0.0086), the course of the disease defined as complicated (OR 4.05; 95% 1.97-8.33; p=0.003), the course of the disease is defined as severe (OR 2.4; 95% CI 1.17-5.0; p=0.03).Conclusions: gastrointestinal complications had the greatest impact on unfavorable short-term and long-term outcomes in patients on programmed hemodialysis. In relation to such laboratory markers as Ferritin, CRH, LDH, threshold values of a significant increase in the chances characteristic of dialysis patients were obtained. 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Quantitative variables: age, duration of hospitalization, days in the intensive care unit, laboratory blood parameters: the level of D-Dimer, Glucose, Interleukin-6, Procalcitonin, Lymphocytes and Platelets, CRP, CPK, CPK-MB, LDH, Fibrinogen, Ferritin. Qualitative indicators: gender, ventilator, ARDS, the presence of diabetes, the presence of obesity, the presence of complications: cardiovascular, gastrointestinal, septic, macrothrombotic, stage of pneumonia. To identify statistically significant predictors of the risk of an event, the odds ratio (OR) method was used.Results: average age 57.8±14 years, men – 59.5%, average bed day 17.6±10.6 days. In concomitant diseases, diabetes mellitus was indicated in 24% of patients, obesity was registered in 4.3% of patients. Hospital mortality (28-day) in the total cohort of follow-up was 16.05%, in total with out-ofhospital mortality of 22%. Mortality in intensive care reached 62.7%, on ventilator more than 86%, with ARDS 94.3%. 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Mortality of patients receiving two main treatment regimens T-1 and T-2 did not differ (15.8% vs 15.7%). Significant differences (p=0.0001) appeared when compared with the T-0 and T-4 schemes, in which mortality was recorded at 8.8% and 85.7%, respectively. When comparing long-term outcomes, the analysis did not reveal statistical significance by gender. The statistical difference was noted by age. Among laboratory indicators, the PCT level was higher in survivors with complications. A significant difference among all survivors and deceased (P<0.001) was shown by: D-Dimer, blood glucose level, IL-6, CRP. 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引用次数: 0

摘要

接受维持性血液透析(MHD)形式的肾脏替代治疗(RRT)的患者属于感染和病程特别高的人群。新型冠状病毒感染对长期结果也有很大影响。材料和方法:一项回顾性观察性研究纳入了510例MHD患者,这些患者于2020年4月1日至2021年4月1日住院。住院结局被选为研究的主要终点:出院或28天死亡率。出院后6个月内的死亡以及在此期间与COVID-19相关的并发症的发生被视为次要终点。通过分析电子病历和档案病历进行数据收集。定量变量:年龄、住院时间、重症监护天数、血液学参数:d -二聚体、葡萄糖、白细胞介素-6、降钙素原、淋巴细胞和血小板、CRP、CPK、CPK- mb、LDH、纤维蛋白原、铁蛋白水平。定性指标:性别,呼吸机,急性呼吸窘迫综合征,有无糖尿病,有无肥胖,有无并发症:心血管,胃肠道,化脓性,大血栓形成,肺炎分期。为了确定具有统计学意义的事件风险预测因子,采用比值比(OR)方法。结果:平均年龄57.8±14岁,男性占59.5%,平均卧床时间17.6±10.6天。在合并疾病中,24%的患者有糖尿病,4.3%的患者有肥胖症。随访总队列的住院死亡率(28天)为16.05%,院外死亡率为22%。重症监护死亡率为62.7%,呼吸机死亡率超过86%,ARDS死亡率为94.3%。性别和合并疾病中是否存在糖尿病(DM)的差异无统计学意义。在比较短期结果时,65岁以上的年龄组在统计上存在差异。实验室血液指标:d -二聚体、葡萄糖、IL-6淋巴细胞、白细胞、中性粒细胞、血小板、乳酸脱氢酶、铁蛋白差异有统计学意义(P<0.001)。获得以下比值比(OR): ARDS (OR 143.78;95% ci 33.4-616.2;p=0.0001),呼吸机(OR 57.96;95% ci 23.1-144.5;p=0.0001),脓毒性并发症的存在(OR 26.4;95% ci 13.8-50;p=0.0001),病程定义为严重(OR 25;95% ci 12.9-48.2;p=0.0001),病程定义为复杂(OR 11.6;95% ci 6.8-19.7;p=0.0001),胃肠道并发症的存在(OR 6.5;95% ci 2.28-18.4;p=0.0007),肥胖的存在(OR 2.57;95% ci 1.0-6.5;p = 0.039)。接受两种主要治疗方案T-1和T-2的患者死亡率没有差异(15.8% vs 15.7%)。与T-0和T-4方案相比,出现了显著差异(p=0.0001), T-0和T-4方案的死亡率分别为8.8%和85.7%。当比较长期结果时,分析没有显示性别的统计学意义。统计差异是按年龄划分的。在实验室指标中,有并发症的幸存者的PCT水平较高。d -二聚体、血糖水平、IL-6、CRP在所有幸存者和死者之间存在显著差异(P<0.001)。以下指标的OR最高:存在胃肠道并发症(OR 7.7;95% ci 1.0-57.7;p=0.03),初始LDH血药浓度为622单位/l (OR 4.7;95% ci 1.63-13.63;p=0.0086),病程定义为复杂(OR 4.05;95% 1.97 - -8.33;p=0.003),病程定义为严重(OR 2.4;95% ci 1.17-5.0;p = 0.03)。结论:胃肠道并发症对程序性血液透析患者的短期和长期不良预后影响最大。对于铁蛋白、CRH、LDH等实验室标志物,获得了透析患者机会特征显著增加的阈值。在疫情的第一年,治疗主要是支持性的,旨在预防并发症,主要的隔离治疗方案对COVID-19结局的影响没有显着差异。
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Analysis of the impact of various risk factors on short-term and long-term outcomes in patients with COVID-19 on maintenance hemodialysis
Patients receiving renal replacement therapy (RRT) in the form of maintenance hemodialysis (MHD) belong to a group of particularly high risk of infection and the course of COVID-19. The new coronavirus infection also has a great impact on long-term outcomes.Materials and methods: A retrospective observational study included 510 patients on MHD, hospitalized from April 1, 2020 to April 01, 2021. The outcome of hospitalization was chosen as the primary endpoint of the study: discharge or 28day mortality. Death within 6 months after discharge and the development of complications related to COVID-19 during this period were considered as secondary endpoints. Data collection was carried out by analyzing electronic and archival medical records. Quantitative variables: age, duration of hospitalization, days in the intensive care unit, laboratory blood parameters: the level of D-Dimer, Glucose, Interleukin-6, Procalcitonin, Lymphocytes and Platelets, CRP, CPK, CPK-MB, LDH, Fibrinogen, Ferritin. Qualitative indicators: gender, ventilator, ARDS, the presence of diabetes, the presence of obesity, the presence of complications: cardiovascular, gastrointestinal, septic, macrothrombotic, stage of pneumonia. To identify statistically significant predictors of the risk of an event, the odds ratio (OR) method was used.Results: average age 57.8±14 years, men – 59.5%, average bed day 17.6±10.6 days. In concomitant diseases, diabetes mellitus was indicated in 24% of patients, obesity was registered in 4.3% of patients. Hospital mortality (28-day) in the total cohort of follow-up was 16.05%, in total with out-ofhospital mortality of 22%. Mortality in intensive care reached 62.7%, on ventilator more than 86%, with ARDS 94.3%. No statistical significance was revealed by gender and the presence of diabetes mellitus (DM) in concomitant diseases. When comparing short-term outcomes, the age groups over 65 differed statistically. The following laboratory blood parameters showed a significant difference (P<0.001): D-Dimer, Glucose, IL-6 lymphocytes, Leukocytes, Neutrophils, Platelets, LDH, Ferritin. The following odds ratios (OR) were obtained: ARDS (OR 143.78; 95% CI 33.4-616.2; p=0.0001), on ventilator (OR 57.96; 95% CI 23.1-144.5; p=0.0001), the presence of septic complications (OR 26.4; 95% CI 13.8-50; p=0.0001), the course of the disease is defined as severe (OR 25; 95% CI 12.9-48.2; p=0.0001), the course of the disease is defined as complicated (OR 11.6; 95% CI 6.8-19.7; p=0.0001), the presence of gastrointestinal complications (OR 6.5; 95% CI 2.28-18.4; p=0.0007), the presence of obesity (OR 2.57; 95% CI 1.0-6.5; p=0.039). Mortality of patients receiving two main treatment regimens T-1 and T-2 did not differ (15.8% vs 15.7%). Significant differences (p=0.0001) appeared when compared with the T-0 and T-4 schemes, in which mortality was recorded at 8.8% and 85.7%, respectively. When comparing long-term outcomes, the analysis did not reveal statistical significance by gender. The statistical difference was noted by age. Among laboratory indicators, the PCT level was higher in survivors with complications. A significant difference among all survivors and deceased (P<0.001) was shown by: D-Dimer, blood glucose level, IL-6, CRP. The highest OR was calculated for the following indicators: the presence of gastrointestinal complications (OR 7.7; 95% CI 1.0-57.7; p=0.03), the initial LDH blood level of 622 units /l (OR 4.7; 95% CI 1.63-13.63; p=0.0086), the course of the disease defined as complicated (OR 4.05; 95% 1.97-8.33; p=0.003), the course of the disease is defined as severe (OR 2.4; 95% CI 1.17-5.0; p=0.03).Conclusions: gastrointestinal complications had the greatest impact on unfavorable short-term and long-term outcomes in patients on programmed hemodialysis. In relation to such laboratory markers as Ferritin, CRH, LDH, threshold values of a significant increase in the chances characteristic of dialysis patients were obtained. During the first year of the epidemic, therapy remained largely supportive and aimed at preventing complications, the main isolated treatment regimens showed no significant differences in the impact on the outcomes of COVID-19.
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