COVID-19 Ntawm cov neeg mob hauv tsev kho mob nrog rau mob raum: Kev Paub Ntawm Lub Tsev Kho Mob Midwestern Academic Academic

AbstractPeb tau nrhiav tus yam ntxwv ntawm cov chaw kho mob thiab cov txiaj ntsig ntawm cov neeg mob uas muaj tus kab mob coronavirus 2019 thiab comorbid raum mob hauv tsev kho mob hauv nroog, Midwestern tertiary care tsev kho mob.

Khoom siv thiab txoj kev:Hauv qhov kev soj ntsuam ib-centre no, peb piav qhia txog 205 tus neeg mob uas mob raum raug mob (n=98), dialysis-dependent chronic kab mob raum theem 5 (n=54), lossis hloov raum (n{{6}). } }), tau lees paub thaum thawj zaug ntawm kev kis tus kabmob kis thoob ntiaj teb txij lub Peb Hlis 19 2020, txog rau Lub Xya Hli 31 2021.

NYEM QHOV NO kom tau txais CISTANCHE HERBAL SUPPLEMENTS

Cov txiaj ntsig:Cov neeg mob feem ntau yog neeg Asmeskas neeg Asmeskas (mob raum raug mob, 51%; dialysis-dependent mob raum mob theem 5, 82%; hloov raum, 62%), thiab rog tau tshwm sim (mob raum raug mob, 53%; dialysis-dependent mob raum mob theem 5, 44%; hloov raum 56%). Kev siv tshuab ua pa yuav tsum tau nyob hauv 50% ntawm lub raum raug mob, 22% ntawm kev lim ntshav-dependent mob raum theem 5, thiab 13% ntawm cov neeg tau txais kev hloov raum. Yuav luag ib nrab ntawm cov neeg mob raum raug mob hnyav (46%) tuag thiab 49% yuav tsum tau hloov kho, thaum nyob hauv tsev kho mob tuag yog 24% hauv cov neeg mob raum mob ntshav qab zib theem 5 thiab 9% ntawm cov neeg mob raum hloov pauv. Logistic regression tsom xam pom cov hnub nyoog laus thiab pab pawg neeg mob ua cov kev sib raug zoo ntawm cov neeg tuag, nrog kev pheej hmoo tuag tsawg dua hauv lub raum hloov pauv (24%; odds ratio (OR), 0.17; 95% CI 0. 06–0.47) thiab dialysis-dependent mob raum mob theem 5 (9%; LOSSIS, 0.36; 95% CI 0.16–0.78) cov neeg mob piv rau mob raum Cov neeg mob raug mob (46%). Kev rog rog tau cuam tshuam nrog 5-fold nce kev pheej hmoo tuag hauv tus kab mob coronavirus 2019 cov neeg mob uas mob raum raug mob (LOSSIS, 5.32; 95% CI 1.41–20.03) tab sis tsis yog nyob rau hauv kev siv tshuaj tua kab mob raum mob raum theem 5 thiab cov neeg mob hloov raum. .

Xaus:Thaum thawj qhov kev kis tus kabmob kis thoob ntiaj teb, cov neeg mob raum tau mus pw hauv tsev kho mob nrog COVID-19 tau ntsib kev tuag ntau, tshwj xeeb tshaj yog cov neeg mob raum raug mob, hnub nyoog laus, thiab rog rog. Kev txheeb xyuas cov neeg muaj kev pheej hmoo siab tshaj plaws rau qhov tshwm sim tsis zoo tuaj yeem coj cov tswv yim tiv thaiv nrog rau kev tawm tswv yim txog kev txhaj tshuaj.

Ntsiab lus:Mob raum raug mob; Kab mob khaus laus nas vais lav-2019; COVID-19; lim ntshav; kev tuag; rog rog; hloov pauv

Taw qhia

Tus kab mob tshiab coronavirus-2019 (COVID-19) kis thoob qhov txhia chaw uas tshwm sim los ntawm tus mob hnyav ua pa nyuaj ua pa mob coronavirus 2 (SARS-CoV-2) tau cuam tshuam rau cov zej zog thoob plaws ntiaj teb. Txawm li cas los xij, qee pawg neeg suav nrog cov neeg mob uas muaj kab mob raum ntev (CKD) thiab cov neeg tau txais kev hloov raum (KTx) tshwj xeeb yog qhov cuam tshuam rau qhov tshwm sim tsis zoo los ntawm COVID-19.1–7 tus kab mob Coronavirus-2019 tshwm sim thiab tshwm sim hauv cov pej xeem, nrog rau cov neeg mob raum mob, muaj ntau yam nyob ntawm thaj chaw, hnub nyoog, haiv neeg, thiab haiv neeg.3,8 Tus kab mob sib kis tau cuam tshuam rau qee cov pej xeem suav nrog haiv neeg thiab haiv neeg tsawg thiab cov neeg mob uas muaj qee yam kev tsis sib haum xeeb thiab kev pheej hmoo ntawm kev sib raug zoo.8 -10 Raws li cov kws kho mob nephrology saib xyuas cov neeg mob raum ntawm lub nroog, Midwestern tertiary care lub tsev kho mob, peb tau nrhiav tus yam ntxwv ntawm cov chaw kho mob thiab cov txiaj ntsig ntawm cov neeg mob nrog COVID-19 thiab mob raum mob hauv tsev kho mob ntawm peb lub chaw.

METHODS Cov ntaub ntawv qhov chaw thiab tshawb fawb pej xeem

Hauv qhov kev soj ntsuam ib-chaw soj ntsuam no, peb tau tshuaj xyuas tus yam ntxwv, kev nthuav qhia, kev kho mob, thiab cov txiaj ntsig hauv tsev kho mob ntawm cov neeg mob raum tau txais mus rau Tsev Kho Mob nrog COVID-19 thaum thawj zaug kev kis thoob qhov txhia chaw hauv zos txij lub Peb Hlis 19, 2020. , mus txog Lub Xya Hli 31, 2021. Cov neeg mob suav nrog hnub nyoog 18 xyoo lossis tshaj saud, pom tias muaj COVID-19, thiab tau pw hauv tsev kho mob hauv tsev kho mob thaum lub sijhawm soj ntsuam. Cov ntaub ntawv kho mob hluav taws xob hluav taws xob (EHR) tau raug tshuaj xyuas rau cov ntaub ntawv ntawm tus neeg mob pej xeem thiab cov yam ntxwv kho mob (hnub nyoog, poj niam txiv neej, haiv neeg, kab mob hauv lub raum, lub cev qhov hnyav (BMI), comorbid conditions, hloov kho (RT) cov qauv, hnub tim KTx thiab tus neeg pub dawb hom), kuaj pom, tshuaj, thiab cov txiaj ntsig. Kev kuaj mob ntawm COVID-19 tau lees paub los ntawm qhov txiaj ntsig zoo ntawm cov tshuaj tiv thaiv polymerase saw ntawm qhov ntswg thiab / lossis pharyngeal swab cov qauv ua hauv peb lub cev noj qab haus huv lossis los ntawm COVID-19 hauv EHR.

Cov neeg mob tau categorized rau hauvmob raum raug mob(AKI),Kev lim ntshav-dependent CKD theem 5(CKD-5D), los yog KTx pab pawg.Mob raum raug mobtau txhais raws li Kev Kho Mob Raum Txhim Kho Ntiaj Teb Cov txiaj ntsig ntawm kev nce hauv cov ntshav creatinine los ntawm 0.3 mg/dL lossis ntau dua hauv 48 teev lossis kev nce hauv cov ntshav creatinine tsawg kawg yog 1.5 npaug hauv paus hauv 7 hnub dhau los.11 Txoj kev tshawb no tau pom zoo los ntawm University Institutional Review Board (Protocol #31323). Muab qhov rov qab los thiab muaj kev pheej hmoo tsawg ntawm txoj kev tshawb fawb, kev pom zoo suav nrog kev zam ntawm kev tso cai ntawm tus kheej.

TSEEM CEEB CEEB TOOM thiab yam ntxwv

Peb tau txheeb xyuas 205 tus neeg mob AKI (n=98), CKD-5D (n=54), lossis KTx (n=53) tau txais thaum lub sijhawm thawj zaug ntawm tus kab mob sib kis hauv zos (Table 1). Cov neeg mob pw hauv tsev kho mob txhua hli ntawm COVID-19 hauv cov neeg mob raum ntawm peb lub chaw muaj txij li 6 thaum pib muaj tus kabmob kis mus rau qhov siab tshaj ntawm 35 tus neeg mob thaum Lub Kaum Ob Hlis 2020, thiab tom qab ntawd pib poob qis thaum kawg ntawm thawj surge (Daim duab 1A). Qhov nruab nrab hnub nyoog nyob rau hauv pawg AKI, CKD-5D, thiab KTx yog 63.3 ± 14.2, 62.6 ± 13.9, thiab 54.1 ± 13.0 xyoo, feem. Cov poj niam muaj 37% ntawm AKI cov neeg mob, 44% ntawm CKD-5D mob, thiab 42% ntawm cov neeg tau txais kev cuam tshuam KTx. Feem ntau ntawm cov neeg mob (62%) yog neeg Asmeskas Asmeskas (51% hauv AKI, 82% hauv CKD-5D, thiab 62% hauv KTx pab pawg). Qhov ntsuas BMI yog 32.0 ± 9, 29.1 ± 7.1, thiab 31.9 ± 6.4 kg / m2, thiab rog (BMI ntau dua lossis sib npaug li 30 kg / m2) muaj nyob hauv 53%, 44% thiab 58% ntawm AKI, CKD{ {50}}D, thiab KTx pab pawg, feem.

Txhua tus neeg mob raum hauv pawg neeg muaj tsawg kawg yog ib qho mob ntxiv, suav nrog ntshav siab (78.9%), ntshav qab zib (50.7%), mob plawv tsis ua haujlwm (25.4%), mob ntsws hauv qab (22.9%), lossis kab mob plawv (18%). . Ntawm cov neeg mob AKI, 31% muaj CKD hauv qab, feem ntau vim yog mob ntshav qab zib nephropathy thiab kub siab, thiab ntshav qab zib nephropathy kuj yog qhov ua rau mob raum tsis ua haujlwm (61%) hauv cov neeg mob CKD-5D.

Kev nthuav qhia thiab kev kho mob

Cov tsos mob tshwm sim feem ntau suav nrog ua tsis taus pa hauv 67% ntawm AKI thiab 46% ntawm cov neeg mob CKD-5D, thiab hnoos hauv 49% ntawm cov neeg tau txais KTx (Table 2). Ntawm cov neeg tau txais kev hloov hauv lub raum, kev tiv thaiv kab mob hauv kev nthuav qhia suav nrog steroids hauv 91%, calcineurin inhibitors hauv 96%, thiab mycophenolic acid (MPA) hauv 53%. Kev kho mob COVID-19 feem ntau yog dexamethasone, muab rau 58% ntawm cov neeg mob AKI, 41% nrog CKD-5D, thiab 38% ntawm cov neeg mob KTx. Remdesivir tau siv hauv 20%, 4%, thiab 13% ntawm cov neeg mob AKI, CKD-5D, thiab KTx, feem.

Cov txiaj ntsig

The mean length of hospital stay was 20+15, 13+15, and 8+13 days in the AKI, CKD-5D, and KTx patients, including intensive care requirements in 67%, 28%, and 17%, respectively. Approximately half of the AKI patients required RRT and 8% were treated with extracorporeal membrane oxygenation (ECMO) (Table 3). Twelve percent of KTx recipients received intermittent or continuous dialysis. Mechanical ventilation was required in 50% of the AKI, 22% of the CKD-5D, and 13% of the KTx recipients (Figure 1B). Nearly half of the AKI group (46%) died, while in-hospital mortality was 24% in the CKD-5D patients and 9% in the KTx recipients (Table 3). Logistic regression analysis identified older age (OR per decade, 1.57; 95% CI 1.18–2.07; p=0.002) and patient group as significant correlates of mortality in hospitalized kidney patients with COVID-19 mortality, with lower death risk in the KTx (OR, 0.17; 95% CI 0.06–0.47; P=0.0007) and CKD-5D (OR, 0.36; 95% CI 0.16–0.78; P=0.01) compared to AKI patients. Obesity defined as BMI >30 kg/m2 (vs BMI 18.5 rau<25) was associated with mortality risk in COVID-19 patients with AKI (OR, 5.32; 95% CI 1.41–20.03; P=0.01) but not in CKD-5D (OR, 0.40; 95% CI 0.08–2.11) KTx patients (OR, 1.21; 95% CI 0.10–14.09). 

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