mortality

ABSTRACT Immunosuppressed kidney transplant recipients may have increased risk of causing severe disease during hospitalization of COVID-19. We conducted this review for better understanding the clinical characteristics and outcomes of this population. A literature search was undertaken to identify the studies which reported outcomes of kidney transplant recipients hospitalized with COVID-19 by searching MEDLINE, EMBASE, Web of Science and Google Scholar from January 1, 2019 to July 1, 2020. 38 studies reporting 217 KTR hospitalized with COVID-19 were included in the current study. All patients experienced fever, cough or dyspnea before hospitalization. 52.6% of recipients were classified as severe patients. The mortality of overall patients and discharged patients including those discharged alive and dead was 20.3% and 30.8%, respectively. Among discharged patients, 53.3% of those admitted to ICU, 73.3% requiring invasive ventilation and 38.5% receiving non-invasive ventilation died. 47.3% of in-hospital KTR developed AKI. Among the severe patients who developed AKI, 32.1% requiring renal replacement therapy during hospitalization. In conclusion, immunosuppressed kidney transplant recipients hospitalized with COVID-19 are at higher risk of developing severe disease (53.3%) at a relatively young age and have higher mortality (30.8%) and higher prevalence of acute kidney injury (47.3%) compared to the general population with COVDI-19. Keywords: Acute kidney injury; COVID-19; mortality; SARS-CoV-2; systematic review; transplantation

Introduction: Coagulation disturbances are one of the markers of systemic inflammation. Aim: To evaluate the role of D-dimer (DD) in predicting severity and mortality of hospitalized patients with community-acquired pneumonia. Material and Methods:143 CAP patients hospitalized in the Clinic of Pneumology and Phthisiatrics at “Saint Marina” University Hospital were retrospectively studied. D-dimer was measured on admission by latex-enhanced immunoturbidimetric method with reference value of 0,232mg/L. The severity of CAP was determined by PSI, CURB-65 and IDSA/ATS criteria. Results: Patients were on mean age 62.12±15.54 years, 59.4% - male. Elevated levels of D-dimer were found in 86.70% of the patients. The mean DD in non-survivors was significantly higher than in survivors (2.19±2.01mg/L vs. 1.28±1.46mg/L, р<0.05). DD increased significantly with increasing the severity group according to PSI, CURB-65 and IDSA/ATS criteria, but the correlation coefficients were weak (r=0.25; r=0.23; r=0.22 resp., p<0.001). DD>1mg/L increased the risk for in-hospital mortality with OR 4.25 (1.48-12.14; p<0.01). Conclusion: D-dimer is able to predict severity and outcome of CAP.

Introduction: Community-acquired pneumonia (CAP) is a common disease with frequent hospitalization and still high mortality rate. Aim: To analyze the clinical characteristics of patients who died in the hospital from CAP. Materials and Methods: 1292 patients hospitalized in the Clinic of Pneumonology and Phthisiatrics of MHAT “Saint Marina” – Varna were retrospectively studied for the period 2012 to 2015. Data were analyzed with statistical program SPSS.20. Results: 148 patients (11.5%) died during the hospital stay. The non-survivors were significantly older than the survivors (67.6±14.2 vs. 58.9±17.1 years, p<0.001). No significant difference in the mortality rate between male and female was proven (12.3 % vs. 10.3 %, р=0.15). Charlson comorbidity index was significantly higher in non-survivors compared to survivors (3.28±2.21 vs. 1.36±1.63, p<0.001). Patients with dementia, carcinoma with metastases and cerebrovascular disease as concomitant comorbidities had the highest risk of dying in the hospital (OR 6.86 (3.97-11.84); 4.33 (1.43-13.12); 4.05 (2.77-5.92) resp. p<0.05) C-reactive protein was also significantly higher in non-survivors compared to survivors (171.85±83.17mg/L vs.123.42±99.68mg/L, р<0.001). The most common complication was acute respiratory failure (89.9%). Of the deceased patients 16.9% did not meet the criteria for severe CAP according to IDSA/ATS on admission. Most of the deceased patients (52%) died within the first 3 days of the hospital stay. Conclusion: Older patients with comorbidities had higher risk of dying in the hospital. Patients with CAP need intensified monitoring especially in the first 3 days even if they do not have severe pneumonia on admission.