Journal Article

Clinical course and predictive risk factors for fatal outcome of SARS-CoV-2 infection in patients with chronic kidney disease

Hohenstein Bernd, Piepel Christiane, Isberner Nora, Neufang, Mark, Weidemann, Alexander, Classen Annika, Dolff Sebastian, Tometten Lukas, Borgmann, Stefan, Prasser Fabian, Keller, Ulrich, Rueddel Jessica, Ritter, Annika, Lanznaster Julia, Wettstein Matthias, Kielstein, Jan T, Roman-Ulrich, Müller, Eberwein Lukas, Rothfuss Katja, Brandenburger Timo, Guggemos Wolfgang, Rieg Siegbert, Droehmann, Daniel, Schubert Joerg, Gruener Beate, Peetz Helga, Stecher, Melanie, Stieglitz Sven, Worm Maximilian, Heigener, David, Burst Volker, Merle Uta, Vehreschild, Joerg Janne, Franke, Bernd, Pilgram, Lisa, Rüthrich, Maria, Vehreschild, Maria, Mueller-Joerger, Gabriele, Fuhrmann, Sandra, Bethge, Wolfgang, Lorenz, Walter, Fuerst, Julia, von Bergwelt-Baildon Michael, Schulze, Nick, Bals, Robert, Lablans, Martin, Hanses, Frank, Degenhardt, Christian, Hower, Martin, Hellwig Kerstin, de With Katja, Schultheis Beate, Beutel Gernot, Spinner, Christoph, Koehler, Felix C, Nattermann Jacob, Wille Kai, Raichle, Claudia, Rauschning Dominic, Jung, Norma, Prattes Juergen, Trauth Janina, Ruethrich, Maria, Friedrichs Anette, Schons Maximilian, Ja

2021

Overview

PurposeThe ongoing pandemic caused by the novel severe acute respiratory coronavirus 2 (SARS-CoV-2) has stressed health systems worldwide. Patients with chronic kidney disease (CKD) seem to be more prone to a severe course of coronavirus disease (COVID-19) due to comorbidities and an altered immune system. The study’s aim was to identify factors predicting mortality among SARS-CoV-2-infected patients with CKD.MethodsWe analyzed 2817 SARS-CoV-2-infected patients enrolled in the Lean European Open Survey on SARS-CoV-2-infected patients and identified 426 patients with pre-existing CKD. Group comparisons were performed via Chi-squared test. Using univariate and multivariable logistic regression, predictive factors for mortality were identified.ResultsComparative analyses to patients without CKD revealed a higher mortality (140/426, 32.9% versus 354/2391, 14.8%). Higher age could be confirmed as a demographic predictor for mortality in CKD patients (> 85 years compared to 15–65 years, adjusted odds ratio (aOR) 6.49, 95% CI 1.27–33.20, p = 0.025). We further identified markedly elevated lactate dehydrogenase (> 2 × upper limit of normal, aOR 23.21, 95% CI 3.66–147.11, p < 0.001), thrombocytopenia (< 120,000/µl, aOR 11.66, 95% CI 2.49–54.70, p = 0.002), anemia (Hb < 10 g/dl, aOR 3.21, 95% CI 1.17–8.82, p = 0.024), and C-reactive protein (≥ 30 mg/l, aOR 3.44, 95% CI 1.13–10.45, p = 0.029) as predictors, while renal replacement therapy was not related to mortality (aOR 1.15, 95% CI 0.68–1.93, p = 0.611).ConclusionThe identified predictors include routinely measured and universally available parameters. Their assessment might facilitate risk stratification in this highly vulnerable cohort as early as at initial medical evaluation for SARS-CoV-2.

• Publisher: Springer Nature B.V
• Subject: Anemia / C-reactive protein / Chi-square test / Chronic infection / Comparative analysis / Coronaviruses / COVID-19 / Immune system / Kidney diseases / Kidneys / L-Lactate dehydrogenase / Lactate dehydrogenase / Lactic acid / Mortality / Pandemics / Parameter identification / Patients / Risk analysis / Risk factors / Severe acute respiratory syndrome coronavirus 2 / Statistical tests / Thrombocytopenia / Viral diseases