Atrial Fibrillation and Clinical Outcomes in a Cohort of Hospitalized Patients with Sars-Cov-2 Infection and Chronic Kidney Disease

Abstract

The aim of the study was to investigate the role of chronic kidney disease (CKD) on in-hospital mortality and on incident atrial fibrillation (AF) in patients infected with SARS-CoV-2. The incidence of acute kidney injury (AKI) was also investigated. Multivariable regression models were used to assess the association between renal function groups (estimated Glomerular Filtration Rate, eGFR, >60 mL/min, 30–59 mL/min, <30 mL/min) and in-hospital all-cause mortality and incident AF and AKI. A cohort of 2816 patients admitted in one year for COVID-19 disease in two large hospitals was analyzed. The independent predictors of mortality were severe CKD [HR 1.732 (95%CI 1.264–2.373)], older age [HR 1.054 (95%CI 1.044–1.065)], cerebrovascular disease [HR 1.335 (95%CI (1.016–1.754)], lower platelet count [HR 0.997 (95%CI 0.996–0.999)], higher C-reactive protein [HR 1.047 (95%CI 1.035–1.058)], and higher plasma potassium value 1.374 (95%CI 1.139–1.658)]. When incident AKI was added to the final survival model, it was associated with higher mortality [HR 2.202 (1.728–2.807)]. Incident AF was more frequent in patients with CKD, but in the multivariable model only older age was significantly related with a higher incidence of AF [OR 1.036 (95%CI 1.022–1.050)]. Incident AF was strongly associated with the onset of AKI [HR 2.619 (95%CI 1.711–4.009)]. In this large population of COVID-19 patients, the presence of severe CKD was an independent predictor of in-hospital mortality. In addition, patients who underwent AKI during hospitalization had a doubled risk of death. Incident AF became more frequent as eGFR decreased and it was significantly associated with the onset of AKI.

The Spectrum of Acute Cerebrovascular Disease in Patients with COVID-19

“…The most common cardiovascular risk factors were hypertension, obesity, diabetes mellitus, smoking history, and history of CVD, which are known to be associated with increased severity of COVID-19 [ 7 ]. Although there are reports of increased incidence of atrial fibrillation in patients with COVID-19, our study found no difference between patients with COVID-19 and controls [ 21 ]. Our study found acute CVDs in COVID-19 had a male patient predominance and increased incidence in Black or African American patients.…”

U-shaped association between abnormal serum uric acid levels and COVID-19 severity: reports from the Japan COVID-19 Task Force

“…First, these patients were older ( O'Driscoll et al, 2021 ), smokers ( Shastri et al, 2021 ;World Health Organization, 2021 ), and obese ( Zheng et al, 2020 ). Second, their co-morbidities included hypertension ( Bailly et al, 2021 ), diabetes mellitus ( Ando et al, 2021 ;Fried et al, 2021 ), cardiovascular disease ( Nishiga et al, 2020 ), and chronic kidney disease Genovesi et al, 2021 ;Petrilli et al, 2020 ;Sullivan et al, 2022 ;Williamson et al, 2020 ). In addition, poor prognostic laboratory biomarkers were higher in these patients ( D -dimer) , CRP ( Brasen et al, 2021 ), and ferritin ( Deng et al, 2021 )).…”

The Composition and Physical Properties of Clots in COVID-19 Pathology

“…Strikingly, thromboembolism occurs in spite of the administration of anticoagulant medication (mainly (low molecular weight) heparins), which raised questions regarding the optimal management of these patients [35]. Notably, baseline cardiovascular complications associated with hypercoagulability (e.g., atrial fibrillation or kidney dysfunction) are more prevalent in COVID-19 patients with thrombotic complications which may further contribute to the worsening of hypercoagulability in COVID-19 patients [36]. The overall effect of combined pathologies on hypercoagulability and outcomes in global assays such as the ROTEM needs to be elucidated in further clinical studies.…”