Introduction While there is evidence of the presence of the coronavirus in the kidneys and resultant acute kidney injury (AKI), information on the effect of chronic kidney disease (CKD) on COVID-19 outcomes and its pathogenesis is currently lacking. Methods This retrospective, observational study evaluated the outcomes of all consecutive patients hospitalized during COVID-19 outbreaks in Meir Medical Center. Serum creatinine level was assessed before hospitalization (“baseline serum creatinine”) and at admission, as well as minimum and maximum serum creatinine levels during hospitalization. Results Among 658 patients, 152 had eGFR < 60 ml/min (termed the CKD group), 506 patients served as controls. Patients in the CKD group were older, with higher prevalence of hypertension, diabetes mellitus and atherosclerosis. Disease severity and clinical presentation of CKD group were comparable to that of control group. Odds ratio for AKI was 5.8 (95%CI 3.8–8.7; p < 0.001) in CKD group vs. control group and 3.4 (95%CI 1.1–10.8) for renal replacement therapy ( p < 0.026). Among the CKD group, 32.2% died after COVID-19 infection versus 14.8% of the controls ( p < 0.001). Mortality increased as CKD stage increased (14.8% in controls, 29.6% in CKD stage 3, and 39.3% in CKD stages 4 and 5, p < 0.001). Conclusion Despite comparable disease severity at presentation, patients with CKD had significantly more AKI events and required more renal replacement therapy during hospitalization than control patients did. Mortality increased as CKD stage increased.
The CHA 2 DS 2 -VASc score incorporates several comorbidities which have prognostic implications in COVID-19. We assessed whether a modified score (M-R 2 CHA 2 DS 2 -VASc), which includes pre-admission kidney function and male sex, could be used to classify mortality risk among people hospitalized with COVID-19. This retrospective study included adults admitted for COVID-19 between March and December 2020. Pre-admission glomerular filtration rate (GFR) was calculated based on serum creatinine and used for scoring M-R 2 CHA 2 DS 2 -VASc. Participants were categorized according to the M-R 2 CHA 2 DS 2 -VASc categories as 0–1 (low), 2–3 (intermediate), or ≥ 4 (high), and according to initial COVID-19 severity score. The primary outcome was 30-day mortality rates. Secondary outcomes were mortality rates over time, and rates of mechanical ventilation, hemodynamic support, and renal replacement therapy. Eight hundred hospitalizations met the study criteria. Participants were 55% males, average age was 65.2 ± 17 years. There were similar proportions of subjects across the M-R 2 CHA 2 DS 2 -VASc categories. 30-day mortality was higher in those in higher M-R 2 CHA 2 DS 2 -VASc category and with severe or critical COVID-19 at admission. Subjects in the low, intermediate, and high M-R 2 CHA 2 DS 2 -VASc categories had 30-day mortality rates of 4.7%, 17% and 31%, respectively ( p < 0.001). Higher category was also associated with increased need for mechanical ventilation and renal replacement therapy. All-cause 90-day mortality remained significantly associated with M-R 2 CHA 2 DS 2 -VASc. The M-R 2 CHA 2 DS 2 -VASc score is associated with 30-day mortality rates among patients hospitalized with COVID-19, and adds predictive value when combined with initial COVID-19 severity.
Background Hyponatremia is the most common electrolyte abnormality observed in clinical practice. Among patients with acute coronary syndrome (ACS), serum sodium levels are inversely associated with mortality risk. We assessed associations of serum sodium level with ACS and mortality in patients with chest pain. Methods This retrospective cohort study used clinical data from a large, academic hospital. All adults admitted with chest pain and without hypernatremia and discharged after ACS rule-out from January 2010 through June 2016 were included. The primary endpoint was the composite of 30-day ACS and mortality. Secondary endpoints were a hospital admission due to ACS and mortality in the first year following discharge. Results Included were 12 315 patients (mean age 58.2 ± 13 years, 60% male). Patients were classified according to the serum sodium (Na) level: hyponatremia, defined as less than 135 mEq/L (n = 289, 2.3%); 140 > Na ≥ 135 mEq/L (n = 8066, 65.5%), and 145 > Na ≥ 140 mEq/L (n = 3960, 32.2%). Patients with serum sodium more than 145 mEq/L were excluded. Among patients with hyponatremia, low-normal, and high-normal levels, rates of the composite outcome of unadjusted 30-day all-cause mortality and ACS admission were 4.5, 1.0, and 0.7%, respectively (P < 0.001). Unadjusted one-year ACS rates were 3.8, 1.5, and 1.4%, respectively (P < 0.01). Conclusion Hyponatremia is associated with higher mortality and ACS risk among patients with chest pain who were discharged from internal medicine wards following ACS-rule-out. Sodium level may be included in the risk stratification of patients with chest pain.
Purpose: Central serous chorioretinopathy (CSCR) patients are often referred to Photodynamic Therapy (PDT) with very long-term disease because of concerns about the potential negative effects of PDT on the retina and on the visual acuity. The purpose of this study was to analyze the results of PDT in CSCR eyes with long standing disease.Methods: The medical records of the patients that underwent PDT for CSCR between 2009 and 2019 were reviewed. Cases were divided into two groups based on the duration of disease before PDT treatment: early treatment (3 to 6 months), delayed treatment (longer than 6 months). The treatment was defined as successful when the subfoveal fluid was absorbed during follow up.Results: The PDT treatment was successful in 76% and 77% of eyes in the early and delayed treatment groups respectively. Both groups showed significant improvement in central retina measurements at the 3-months follow up which persisted to the last follow-up visit. The visual acuity (VA) at baseline was significantly worse in the delayed treatment group (0.5±0.26 vs 0.3±0.24, P=0.042) and improved in both groups but remained low in the delayed treatment group during the study.Conclusion: PDT is not associated with loss of vision in eyes with chronic CSCR, and can be safely used in eyes with relatively good VA. We suggest that if CSCR is not spontaneously improving over 3 months the patient should be offered PDT, to prevent VA loss from the long-term presence of subretinal fluid in the macula.
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