Abstract
BackgroundHemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients.MethodsThis is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients’ medical records. A binary logistic regression analysis was performed to assess risk factors for mortality.ResultsA total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83).ConclusionsThis national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.
Highlights
Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population
Adjusted regression analysis showed a higher risk for death among older patients, patients with heart failure, coronary artery disease, multimorbidities, fever, C-Reactive Protein (CRP) above 100 mg/L, and pneumonia
Symptomatic patients presenting with fever and/or diarrhea and/or respiratory symptoms were isolated during their dialysis session and tested with a nasal swab for realtime reverse transcriptase-polymerase chain reaction
Summary
Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. On January 7, 2020, a new virus, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was identified in China, and on February 11, 2020, the World Health Organization (WHO) named the disease Coronavirus Disease 2019 (COVID-19) [1]. In Lebanon, a country of 6 million inhabitants with 80 dialysis facilities and 4300 hemodialysis patients [11], healthcare providers and patients received information regarding infection control and prevention, hand hygiene and use of personal protective equipment (PPE). Dialysis units were advised to treat SARS-CoV-2 positive patients isolated in an additional shift at the end of the day
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