Abstract
Introduction: The determinants of COVID-19 mortality are well-characterized in the general population. Less numerous and inconsistent data are among the maintenance hemodialysis (HD) patients, who are the population most at risk of an unfavorable prognosis. Methods: In this retrospective cohort study we included all adult HD patients from the Pomeranian Voivodeship, Poland, with laboratory-confirmed SARS-CoV-2 infection hospitalized between 6 October 2020 and 28 February 2021, both those who survived, and also those who died. Demographic, clinical, treatment, and laboratory data on admission, were extracted from the electronic medical records of the dedicated hospital and patients’ dialysis unit, and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with 3-month all-cause mortality. Results: The 133 patients (53.38% males) aged 73.0 (67–79) years, with a median duration of hemodialysis of 42.0 (17–86) months, were included in this study. At diagnosis, the majority were considered to have a mild course (34 of 133 patients were asymptomatic, another 63 subjects presented mild symptoms), while 36 (27.07%) patients had low blood oxygen saturation and required oxygen supplementation. Three-month mortality was 39.08% including an in-hospital case fatality rate of 33.08%. Multivariable logistic regression showed that the frailty clinical index of 4 or greater (OR 8.36, 95%CI 1.81–38.6; p < 0.01), D-Dimer of 1500 ng/mL or greater (6.00, 1.94–18.53; p < 0.01), and CRP of >118 mg/L at admission (3.77 1.09–13.01; p = 0.04) were found to be predictive of mortality. Conclusion: Very high 3-month all-cause mortality in hospitalized HD patients was determined mainly by frailty. High CRP and D-dimer levels upon admission further confer mortality risk.
Highlights
A population with a relatively high incidence of COVID-19, and associated high inhospital mortality, is that of chronically hemodialyzed (HD) patients [1]
Frailty (CFS) appeared to be strongest sole predictor of 3-month mortality (OR = 11.7 95%CI 3.4–40.7; p < 0.001) followed by advanced age (OR = 8.0 95%CI 2.3–28.3; p = 0.001), whereas blood type 0 and chronic D-vitamin supplementation were associated with favorable prognosis (OR = 0.45, 95%CI 0.20–0.998; p = 0.49, and odds ratio (OR) = 0.45 95%CI = 0.22–0.93; p = 0.03, respectively)
In univariable but not multivariable analyses we demonstrated for the first time in HD COVID-19 patients the protective effect of blood group O, and chronic treatment with active vitamin D
Summary
A population with a relatively high incidence of COVID-19, and associated high inhospital mortality, is that of chronically hemodialyzed (HD) patients [1]. In one of our previous surveys we found the unusually high in-hospital mortality of COVID19 HD patients from the north of Poland, with a fatality rate up to 43.81% in subjects over 74 years old [3]. In another survey, we found that three months after eradication only. Cases of sudden cardiac arrest in patients after recovery from COVID-19 have been described as well [5]. It can’t be ruled out, that a similar situation occurs in HD patients with a high burden of cardiovascular disease
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