Corpus overview


MeSH Disease

Human Phenotype


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    The incidence, risk factors and prognosis of acute kidney injury MESHD acute kidney injury HP in severe and critically ill patients with COVID-19 in mainland China: a retrospective study

    Authors: Ling Sang; Sibei Chen; Xia Zheng; Weijie Guan; Zhihui Zhang; Wenhua Liang; Ming Zhong; Li Jiang; Chun Pan; Wei Zhang; Jiaan Xia; Nanshan Chen; Wenjuan Wu; Hongkai Wu; Yonghao Xu; Xuesong Liu; Xiaoqing Liu; Jianxing He; Shiyue Li; Dingyu Zhang; Nanshan Zhong; Yimin Li

    doi:10.21203/ Date: 2020-07-29 Source: ResearchSquare

    Background: Since the clinical correlates, prognosis and determinants of AKI in patients with Covid-19 remain largely unclear, we perform a retrospective study to evaluate the incidence, risk factors and prognosis of AKI in severe and critically ill patients with Covid-19.Methods: We reviewed medical records of all adult TRANS patients (>18 years) with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. The clinical data, including patient demographics, clinical symptoms and signs MESHD, laboratory findings, treatment [including respiratory supports, use of medications and continuous renal replacement therapy (CRRT)] and clinical outcomes, were extracted from the electronic records, and we access the incidence of AKI and the use of CRRT, risk factors for AKI, the outcomes of renal diseases MESHD, and the impact of AKI on the clinical outcomes.Results: Among 210 subjects, 131 were males TRANS (62.4%). The median age TRANS was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) patients were classified as stage 1, 2 and 3, respectively. 54 cases (58.7%) received CRRT. Age TRANS, sepsis MESHD sepsis HP, Nephrotoxic drug, IMV and elevated baseline Scr were associated with AKI occurrence. The renal recover during hospitalization among 16 AKI patients (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure MESHD and higher P/F ratio. Of 210 patients, 93 patients deceased within 28 days of ICU admission. AKI stage 3, critical disease MESHD, greater age TRANS and minimum P/F <150mmHg independently associated with it.Conclusions: Among patients with Covid-19, the incidence of AKI was high. age TRANS , sepsis MESHD sepsis HP, nephrotoxic drug, IMV and baseline Scr were strongly associated with the development of AKI. Time from admission to AKI diagnosis, right heart failure MESHD and P/F ratio were independently associated with the potential of renal recovery. Finally, AKI KIDGO stage 3 independently predicted the risk of death within 28 days of ICU admission.

    Patient characteristics and predictors of mortality in 470 adults TRANS admitted to a district general hospital in England with Covid-19

    Authors: Joseph V Thompson; Nevan Meghani; Bethan M Powell; Ian Newell; Roanna Craven; Gemma Skilton; Lydia J Bagg; Irha Yaqoob; Michael J Dixon; Eleanor J Evans; Belina Kambele; Asif Rehman; Georges Ng Man Kwong

    doi:10.1101/2020.07.21.20153650 Date: 2020-07-27 Source: medRxiv

    Background Understanding risk factors for death MESHD in Covid 19 is key to providing good quality clinical care. Due to a paucity of robust evidence, we sought to assess the presenting characteristics of patients with Covid 19 and investigate factors associated with death MESHD. Methods Retrospective analysis of adults TRANS admitted with Covid 19 to Royal Oldham Hospital, UK. Logistic regression modelling was utilised to explore factors predicting death MESHD. Results 470 patients were admitted, of whom 169 (36%) died. The median age TRANS was 71 years (IQR 57 to 82), and 255 (54.3%) were men. The most common comorbidities were hypertension MESHD hypertension HP (n=218, 46.4%), diabetes (n=143, 30.4%) and chronic neurological disease MESHD (n=123, 26.1%). The most frequent complications were acute kidney injury MESHD acute kidney injury HP (n=157, 33.4%) and myocardial injury (n=21, 4.5%). Forty three (9.1%) patients required intubation and ventilation, and 39 (8.3%) received non-invasive ventilation Independent risk factors for death MESHD were increasing age TRANS (OR per 10 year increase above 40 years 1.87, 95% CI 1.57 to 2.27), hypertension MESHD hypertension HP (OR 1.72, 1.10 to 2.70), cancer (OR 2.20, 1.27 to 3.81), platelets <150x103/microlitre (OR 1.93, 1.13 to 3.30), C-reactive protein >100 micrograms/mL (OR 1.68, 1.05 to 2.68), >50% chest radiograph infiltrates, (OR 2.09, 1.16 to 3.77) and acute kidney injury MESHD acute kidney injury HP (OR 2.60, 1.64 to 4.13). There was no independent association between death MESHD and gender TRANS, ethnicity, deprivation level, fever MESHD fever HP, SpO2/FiO2 (oxygen saturation index), lymphopenia MESHD lymphopenia HP or other comorbidities. Conclusions We characterised the first wave of patients with Covid 19 in one of Englands highest incidence areas, determining which factors predict death MESHD. These findings will inform clinical and shared decision making, including the use of respiratory support and therapeutic agents.

    Neutrophil-to-Lymphocyte Ratio on Admission Predicts In-hospital Mortality in Patients with COVID-19

    Authors: Jin Hu; Jun Zhou; Fang Dong; Jie Tan; Shuntao Wang; Zhi Li; Ximeng Zhang; Huiqiong Zhang; Jie Ming; Tao Huang

    doi:10.21203/ Date: 2020-07-26 Source: ResearchSquare

    Background: A novel coronavirus caused an outbreak of acute infectious pneumonia HP pneumonia MESHD are spreading over the globe. However, studies predicting prognosis are limited. We predicted outcomes of patients with coronavirus disease MESHD 2019 (COVID-19) using the neutrophil-to-lymphocyte ratio (NLR) on admission.Methods: We retrospectively analyzed the characteristics of COVID-19 patients diagnosed from February 6 to March 1. The outcomes, including the occurrence of in-hospital mortality, acute kidney injury MESHD acute kidney injury HP (AKI), and endotracheal intubation (ETI), were recorded. The relationships of neutrophils, lymphocytes, C-reactive protein, lactate dehydrogenase, and NLR with outcomes were assessed using multivariate regression model. P-values for trends across quartiles of NLR was examined.Results: A total of 182 patients were included. 37 (20.3%) patients died during the hospitalization, 41 (22.5%) developed AKI, and 36 (19.8%) received ETI. The NLR had a superior predictive performance SERO than others. Using an NLR cutoff of 11.4, the area under the curves (AUC) were 0.766 for in-hospital mortality, 0.755 for AKI, and 0.733 for ETI. In multivariate analysis, NLR >11.4 was further identified as an independent prognostic factor. Following stratification with quartiles of NLR, a positive trend between the increasing quartiles of NLR and the three outcomes were observed (p-values for trends across quartiles were 0.043, <0.001, and 0.041, respectively). The multivariate adjusted odds ratio (OR) in the highest quartile vs. the lowest quartile were 5.738 for mortality, 25.307 for AKI, and 5.136 for ETI.Conclusions: Increasing NLR obtained on admission is a powerful predictor for inpatient mortality, AKI, and ETI in COVID-19 patients.

    A return to normal kidney function in a Caucasian male TRANS after COVID-19 induced dialysis-requiring kidney failure

    Authors: Peter Okholm MD; Jan Kampmann MD

    doi:10.21203/ Date: 2020-07-17 Source: ResearchSquare

    Background: Coronavirus disease MESHD 2019 also known as COVID-19 has been recognized by WHO as a global pandemic and has spread to most of the world. The disease MESHD has a multitude of clinical presentations, and especially the development of acute kidney injury MESHD acute kidney injury HP has been associated with increased mortality.Case Presentation: A 71-year old Caucasian male TRANS was admitted with fever MESHD fever HP and dyspnea MESHD dyspnea HP to the emergency MESHD department. His medical history included type 2 diabetes and hypertension MESHD hypertension HP. Blood SERO tests showed a normal kidney function before admission with a creatinine of 0,8 mg/dL. Clinical examination, blood SERO tests and Chest X-ray suggested COVID-19. At admission the diagnose COVID-19 was confirmed, fluid therapy was commenced and Angiotensin-converting enzyme therapy discontinued. The patients was intubated due to respiratory failures HP and transferred to the intensive care ward where he developed acute anuric kidney failure and was started in continuous renal replacement therapy. After 6 days of dialysis treatment his kidney function slowly started to improve, and he was discharged after 26 days of admission. 42 days after admission his creatinine was measured to 1.3 mg/dLConclusion: We present the rare case of a Caucasian male TRANS, who not only survived COVID-19 induced kidney failure that required continuous renal replacement therapy, but returned to almost baseline creatinine. We discuss the role of Angiotensin-converting enzyme inhibitor treatment in COVID-19 and the potential pathophysiological mechanism surrounding AKI in COVID-19 patients in literature, and connect it to our case report.

    Effect of sex on clinical outcomes in COVID-19 patients: a population-based study

    Authors: Seok Hui Kang; Sang Won Kim; Jong Won Park; Jun Young Do; Kyu Hyang Cho

    doi:10.21203/ Date: 2020-07-16 Source: ResearchSquare

    Background Previous studies have reported the association between sex and clinical outcomes; however, the most relevant results were obtained as part of analyses evaluating other prognostic factors. This study aimed to evaluate the association between sex and clinical outcomes in patinets with COVID-19 using a population-based dataset.Methods This retrospective study utilized claims data from the Health Insurance Review & Assessment Service of Korea. Confirmed patients were included among all participants who underwent COVID-19 testing. Diseases MESHD including COVID-19 were defined using International Classification of Diseases MESHD, 10th revision (ICD-10). During follow-up, clinical outcomes except death MESHD were defined using Electronic Data Interchange or ICD-10 codes from the dataset.Results A total of 234,427 patients underwent laboratory testing for COVID-19. Finally, 7327 patients were included; of these, 2964 were men and 4363 were women. The proportions of patients with diabetes mellitus MESHD diabetes mellitus HP or hypertension MESHD hypertension HP as major comorbidities were higher among men than among women of the some age groups TRANS, but there were no significant differences in the Charlson comorbidity index score between men and women in same age group TRANS. Survival and clinical outcomes including acute kidney injury MESHD acute kidney injury HP, the use of inotropes, mechanical ventilator, and cardiac events were greater in men than women. The mortality rate was the highest for the populations aged TRANS 50–64 or ≥ 65 years. Subgroup analyses for age TRANS, diabetes mellitus MESHD diabetes mellitus HP, or hypertension MESHD hypertension HP showed favorable results for patient survival or clinical outcomes in women compared to men.Conclusion Our population-based study showed that female TRANS patients with COVID-19 were associated with favorable outcomes, including survival. The impact of sex was more evident in population aged TRANS 50–64 or ≥ 65 years.

    Risk factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19 in Wuhan, China

    Authors: Xiao-huan Ma; Fang Yin; Jie Zhang; Meng-yun Peng; Hong Guan; Ping Gong

    doi:10.21203/ Date: 2020-07-12 Source: ResearchSquare

    Methods: In this single-center, retrospective, observational study, we enrolled patients with confirmed severe COVID-19 admitted to Renmin Hospital of Wuhan university (Wuhan, China) from 1 February 2020 to 26 March 26 2020. Epidemiological, clinical, and laboratory data, and treatments and outcomes upon hospital admission, were obtained from electronic medical records. Sequential organ failure assessment (SOFA) scores were calculated.Results: Of 54 patients with severe COVID-19, HFNC was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC failure was seen more commonly in patients aged TRANS ≥60 years and in men. In addition, compared with patients successfully treated with HFNC, patients with HFNC failure had the following characteristics: higher percentage of fatigue MESHD fatigue HP and anorexia MESHD anorexia HP as well as cardiovascular disease MESHD; increased time from onset to diagnosis and SOFA scores; elevated body temperature, respiratory rate, and heart rate; more complications including ARDS, septic shock MESHD shock HP, myocardial damage, and acute kidney injury MESHD acute kidney injury HP; increased neutrophil counts and prothrombin time; and decreased HP arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (all P < 0.05). However, binary logistic regression analysis showed that only male TRANS gender TRANS and PaO2/FiO2 were independent risk factors significantly associated with HFNC failure (both, P < 0.05). Conclusion: Patients with severe COVID-19 had a high HFNC treatment failure rate. Male TRANS gender TRANS and decreased PaO2/FiO2 were independent risk factors associated with HFNC failure in severe COVID-19 patients.

    Clinical characteristics and outcome of critically ill COVID-19 patients with Acute Kidney Injury MESHD Acute Kidney Injury HP: A single centre cohort study

    Authors: Richard Lowe; Matteo Ferrari; Myra Nasim-Mohi; Alexander Jackson; Ryan Meacham; Kristin Veighey; Rebecca Cusack; Dominic Richardson; Michael Grocott; Denny Levett; Ahilanandan Dushianthan

    doi:10.21203/ Date: 2020-07-10 Source: ResearchSquare

    BackgroundAcute kidney injury (AKI) is a common manifestation among patients critically ill with SARS-CoV-2 infection MESHD (Coronavirus 2019) and is associated with significant morbidity and mortality. The pathophysiology of renal failure in this context is not fully understood, but likely to be multifactorial. The intensive care unit outcomes of patients following COVID-19 acute critical illness MESHD with associated AKI have not been fully explored. We conducted a cohort study to investigate the risk factors for acute kidney injury MESHD acute kidney injury HP in patients admitted to and intensive care unit with COVID-19, its incidence and associated outcomes.MethodsWe reviewed the medical records of all patients admitted to our adult intensive care unit suffering from SARS-CoV-2 infection from 3rd March 2020 until 10th May 2020. Acute kidney injury was defined using the Kidney Disease MESHD Improving Global Outcome (KDIGO) criteria. The outcome analysis was assessed up to date as 15th of June 2020.ResultsA total of 81 patients admitted during this period. All patients had acute hypoxic respiratory failure HP and needed either noninvasive or invasive mechanical ventilatory support. Thirty-six patients (44%) had evidence of AKI (Stage I-33%, Stage II-22%, Renal Replacement Therapy (RRT)-44%). All patients with AKI stage III had RRT. Age TRANS, diabetes mellitus MESHD diabetes mellitus HP, immunosuppression, lymphopenia MESHD lymphopenia HP, high D-Dimer levels, increased APACHE II and SOFA scores, mechanical ventilation and use of inotropic or vasopressor support were significantly associated with AKI. The peak AKI was at day 4 and mean duration of RRT was 9 days. The mortality was 25% for the AKI group compared to 7% in those without AKI. Among those received RRT and survived their illness, the renal function recovery is complete and back to baseline in 92% of patients. Conclusion Acute kidney injury and renal replacement therapy is common in critically ill patients presenting with COVID-19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay.

    Characteristics and outcomes of Acute Respiratory Distress HP Syndrome MESHD related to COVID-19 in Belgian and French Intensive Care Units according to antiviral strategies. The COVADIS multicenter observational study.

    Authors: David Grimaldi; Nadia Aissaoui; Gauthier Blonz; Giuseppe Carbutti; Romain Courcelle; Stephane Gaudry; Julien Higny; Geoffrey Horlait; Sami Hraiech; Laurent Lefebvre; Francois Lejeune; Andre Ly; Michael Piagnerelli; Bertrand Sauneuf; Nicolas Serck; Thibaud Soumagne; Piotr Szychowiak; Julien Textoris; Benoit Vandenbunder; Christophe Vinsonneau; Jean Baptiste Lascarrou

    doi:10.1101/2020.06.28.20141911 Date: 2020-07-07 Source: medRxiv

    Background Limited data are available for antiviral therapy efficacy especially for the most severe patients under mechanical ventilation suffering from Covid-19 related Acute Respiratory Distress HP Syndrome MESHD (ARDS). Methods Observational multicenter cohort of patients with moderate to severe Covid-19 ARDS, comparing antiviral strategies (none, hydroxychloroquine (HCQ), lopinavir/ritonavir (L/R), others (combination or remdesivir). The primary end-point was the day-28 ventilator free days (VFD), patients which died before d28 were considered as having 0 VFD. The variable was dichotomized in patients still ventilated or dead at day 28 vs patients being extubated and alive at day 28 (VFD = or > 0). Results We analyzed 376 patients (80 with standard of care (SOC), 49 treated with L/R, 197 with HCQ, and 50 others). The median number of d28-VFD was 0 (IQR 0-13) and was different across the different groups (P=0.01), the SOC patients having the highest d28-VFD. A multivariate logistic regression including antiviral strategies, showed that age TRANS (OR 0.95 CI95%:0.93-0.98), male TRANS gender TRANS (OR 0.53 CI95%:0.31-0.93), Charlson score (OR 0.85 CI95%:0.73-0.99) and plateau pressure (OR 0.94 CI95%:0.88-0.99) were associated with having 0 d28-VFD whereas P/F ratio (OR 1.005 CI95%:1.001-1.010) was associated with having > or = 1 d28-VFD (ie. being extubated and alive). Acute kidney injury MESHD Acute kidney injury HP (AKI) was frequent (64%), its incidence was different across the patients groups (P=0.01). In a post-hoc logistic multivariate regression apart from demographics characteristics and comorbidities, the use of L/R (administered to 81 of 376 patients) was associated with occurrence of AKI (OR 2.07 CI95%:1.17-3.66) and need for renal replacement therapy (RRT). Conclusion In this observational study of moderate to severe Covid-19 ARDS patients, we did not observed a benefit of treating patients with any specific antiviral treatment. We observed an association between L/R treatment and occurrence of AKI and need for RRT.

    Clinical, laboratory, and radiologic findings associated with mortality in COVID-19: A systematic review and meta-analysis

    Authors: Hoo Jung Rhim; Jin Hyun Park; Yuna Lee; Seung Chan Kwon; Min Gyu Yu; Hunju Lee; Solam Lee; Yeon-Soon Ahn

    doi:10.21203/ Date: 2020-07-01 Source: ResearchSquare

    Although there has been a surge in reports on coronavirus disease MESHD 2019 (COVID-19), the clinical signs and findings associated with fatal outcomes have rarely been studied. This systematic review and meta-analysis aimed to investigate the clinical, laboratory, and radiologic features associated with mortality in COVID-19. A comprehensive search was performed using PubMed, Embase, Web of Science, and other databases including government sources, for articles and reports published until May 1, 2020. We extracted the number of events (mortality and non-mortality) from case series and case-control and cross-sectional studies. Hazard ratios (HR) of each finding were extracted from studies with time-to-outcome analysis. In total, 23 studies met the inclusion criteria. Of them, 18 studies were case-control, cross-sectional, and case series study. Whereas, only 5 studies included time-to-outcome analysis. Male TRANS sex, age TRANS over 80 years, dyspnea, cardiovascular disease MESHD disease, chronic kidney HP kidney disease MESHD, increased troponin I level, acute respiratory distress HP syndrome MESHD, acute kidney injury MESHD acute kidney injury HP, and need of invasive mechanical ventilation were significantly associated with mortality. The identification of patients at higher risk of mortality has an utmost importance to achieve better treatment outcomes. The findings from our study may aid the prioritization in times of severe shortages of medical resources. Further studies analyzing diverse demographic and geographic populations are needed to generalize the findings from this study. 

    Superior anticoagulation strategies for renal replacement therapy in critically ill patients with COVID-19: a cohort study

    Authors: Frederic Arnold; Lukas Westermann; Siegbert Rieg; Elke Neumann-Haefelin; Paul Biever; Gerd Walz; Johannes Kalbhenn; Yakup Tanriver

    doi:10.1101/2020.06.26.20140699 Date: 2020-07-01 Source: medRxiv

    Background Coronavirus disease MESHD 2019 (COVID-19) patients who are admitted to intensive care units (ICU) have a high risk of requiring renal replacement therapy (RRT) due to acute kidney injury MESHD acute kidney injury HP (AKI). Concomitantly, COVID-19 patients exhibit a state of hypercoagulability HP that can affect circuit lifespan. An optimal anticoagulation strategy is therefore needed in order to maintain circuit patency and therapeutic efficiency of RRT. Methods Retrospective single-centre cohort study on 71 critically ill COVID-19 patients at the University of Freiburg Medical Center. Included were all patients aged TRANS 18 years and older with confirmed severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) infection MESHD that were admitted to ICU between February 26 and May 21, 2020. We collected data on the COVID-19 disease MESHD course, AKI, RRT, thromboembolic events and anticoagulation. Primary outcome of the study was the effect of different anticoagulation strategies during RRT on extracorporeal circuit lifespans. Results Anticoagulation during continuous veno-venous haemodialysis (CVVHD) was performed with unfractionated heparin (UFH) or citrate. Mean treatment time in the UFH group was 21.3h (SEM: {+/-}5.6h). Mean treatment time in the citrate group was 45.6h (SEM: {+/-}2.7h). Citrate anticoagulation prolonged treatment duration significantly by 24.4h (p=0.0014). Anticoagulation during sustained low-efficiency daily dialysis (SLEDD) was performed with UFH, argatroban or low molecular weight heparin (LMWH). Mean dialysis time with UFH was 8.1h (SEM: {+/-}1.3h), argatroban 8.0h (SEM: {+/-}0.9h) and LMWH 11.8h (SEM: {+/-}0.5h). Compared to UFH and argatroban, LMWH significantly prolonged treatment times by 3.7h (p=0.0082) and 3.8h (p=0.0024), respectively. Conclusions UFH fails to prevent early clotting events in dialysis circuits. For patients, who do not require an effective systemic anticoagulation, regional citrate dialysis is the most effective strategy in our cohort. For patients, who require an effective systemic anticoagulation treatment, the usage of LMWH results in the longest circuit life spans.

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MeSH Disease
Human Phenotype

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