Back
The patients on maintenance hemodialysis (MHD) are at a high risk of COVID-19 adverse outcome. It seems relevant to identify the causes of this phenomenon.
Aim: The identification of predictors of COVID-19 adverse outcome in patients on MHD and two-year survival analysis of discharged patients.
124 patients on MHD with COVID-19 admitted to hospital from 04.15.20 to 07.15.20 were included in the study. The total observation period was 04.15.20 – 07.15.22. Data were collected from electronic medical database and outpatient records.
A total of 124 patients were included. The Mediana age was 65 y (IQR 54;73), females 40 %. In-hospital mortality – 42 (33.9 %) patients. The independent predictors of COVID-19 adverse outcome were detected using a single factor analysis (odds ratio): general comorbidity (Charlson Index, CCI) ≥ 7 points (OR 2.34; 95% CI, 1.07–5.13), fasting blood glucose (at the next day after hospitalization) ≥ 7 mmol/L (OR 17.08; 95% CI, 1.07–5.13), NEWS2-scale points at admission ≥ 5 points (OR 26.8; 95% CI, 9.57–75.05), 3–4 degree of lung damage according to chest computed tomography at admission (ОR 2.43; 95% CI, 1.12–5.28), C-reactive protein/serum albumin ratio at admission ≥ 3 (ОR 3.85; 95% CI, 1.76–8.48), lymphopenia at admission ≤ 0.8х109/л (ОR 2.99; 95% CI, 1.39–6.46), congestive heart failure (ОR 2.76; 95% CI, 1.28–5.95). The analysis of the frequency of occurrence of cardiovascular events was done: myocardial infarction (18 patients (14.4%)), acute stroke (2 (1.6 %)), pulmonary embolism (5 (4 %)), myocarditis (1 (1 %)). Septic complications were also analyzed: systemic inflammatory response syndrome (22 (17.8 %)), catheter-related bloodstream infection (9 (7.2 %)), infective endocarditis (4 (3.2 %)). A statistically significant prevalence of cardiovascular events was detected among non-survivors: 24 (57 %) (non-survivors) vs 2 (2.4 %) (survivors), p < 0.0001, and statistically significant prevalence of septic complications was detected among non-survivors 20 (48 %) (non-survivors) vs 2 (3 %) (survivors), p < 0.0001. 27 patients died after hospital discharge. The causes of death were: acute myocardial infarction (3 patients), pulmonary embolism (1), acute stroke (4), congestive heart failure (5), septic complications (6), recurrent COVID-19 (3), oncology (1), mesenteric thrombosis (1), unknown (3). Cardiovascular events were the cause of death in 48 %. The results of the two-year cumulative survival are presented at the Figure 1.
The patients on MHD are very vulnerable to adverse outcomes of COVID-19. According to the data obtained, patients of the observation cohort are characterized by high mortality rates both during hospitalization and subsequent follow-up period. There was a high incidence of cardiovascular events and septic complications among non-survivors during hospitalization. Cardiovascular events and septic complications were also the main causes of death during the follow-up period.