Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis
Por:
Mitra, S, Jayanti, A, Vart, P, Coca, A, Gallieni, M, Ovrehus, MA, Midtvedt, K, Abd ElHafeez, S, Gandolfini, I, Buttner, S, Franssen, CFM, Hemmelder, MH, Canal C., Facundo C., ERACODA Collaborators
Publicada:
1 dic 2021
Ahead of Print:
1 jun 2021
Resumen:
Background. Patients on kidney replacement therapy (KRT) are at very high risk of coronavirus disease 2019 (COVID-19). The triage pathway for KRT patients presenting to hospitals with varying severity of COVID-19 illness remains ill-defined. We studied the clinical characteristics of patients at initial and subsequent hospital presentations and the impact on patient outcomes.
Methods. The European Renal Association COVID-19 Database (ERACODA) was analysed for clinical and laboratory features of 1423 KRT patients with COVID-19 either hospitalized or nonhospitalized at initial triage and those re-presenting a second time. Predictors of outcomes (hospitalization, 28-day mortality) were then determined for all those not hospitalized at initial triage.
Results. Among 1423 KRT patients with COVID-19 [haemodialysis (HD), n = 1017; transplant, n = 406), 25% (n = 355) were not hospitalized at first presentation due to mild illness (30% HD, 13% transplant). Of the non-hospitalized patients, only 10% (n = 36) re-presented a second time, with a 5-day median interval between the two presentations (interquartile range 2-7 days). Patients who re-presented had worsening respiratory symptoms, a decrease in oxygen saturation (97% versus 90%) and an increase in C-reactive protein (26 versus 73 mg/L) and were older (72 vs 63 years) compared with those who did not return a second time. The 28-day mortality between early admission (at first presentation) and deferred admission (at second presentation) was not significantly different (29% versus 25%; P = 0.6). Older age, prior smoking history, higher clinical frailty score and self-reported shortness of breath at first presentation were identified as risk predictors of mortality when representing after discharge at initial triage.
Conclusions. This study provides evidence that KRT patients with COVID-19 and mild illness can be managed effectively with supported outpatient care and with vigilance of respiratory symptoms, especially in those with risk factors for poor outcomes. Our findings support a risk-stratified clinical approach to admissions and discharges of KRT patients presenting with COVID-19 to aid clinical triage and optimize resource utilization during the ongoing pandemic.
Filiaciones:
Mitra, S:
Manchester Univ Hosp, Manchester Acad Hlth Sci Ctr, Dept Renal Med, Manchester, Lancs, England
Jayanti, A:
Manchester Univ Hosp, Manchester Acad Hlth Sci Ctr, Dept Renal Med, Manchester, Lancs, England
Vart, P:
Univ Groningen, Univ Med Ctr Groningen, Dept Internal Med, Groningen, Netherlands
Univ Groningen, Univ Med Ctr Groningen, Dept Clin Pharm & Pharmacol, Groningen, Netherlands
Coca, A:
Univ Clin Hosp Valladolid, Dept Nephrol, Valladolid, Spain
Gallieni, M:
Univ Milan, ASST Fatebenefratelli Sacco, Milan, Italy
Ovrehus, MA:
Trondheim Reg & Univ Hosp, Dept Renal Med, St Olavs Hosp, Trondheim, Norway
Midtvedt, K:
Oslo Univ Hosp, Rikshosp, Dept Transplantat Med, Oslo, Norway
Abd ElHafeez, S:
Alexandria Univ, High Inst Publ Hlth, Epidemiol Dept, Alexandria, Egypt
Gandolfini, I:
Univ Hosp Parma, Parma, Italy
Buttner, S:
Klinikum Aschaffenburg Alzenau, Aschaffenburg, Germany
Franssen, CFM:
Univ Groningen, Univ Med Ctr Groningen, Dept Clin Pharm & Pharmacol, Groningen, Netherlands
Hemmelder, MH:
Maastricht Univ Med Ctr, Dept Internal Med, Div Nephrol, Maastricht, Netherlands
Maastricht Univ, CARIM Sch Cardiovasc Dis, Maastricht, Netherlands
Canal C.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Facundo C.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Green Published, Bronze
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