COVID-19 in Kidney Transplant Patients From a Large UK Transplant Center: Exploring Risk Factors for Disease Severity

Sran, Kiran; Olsburgh, Jonathon; Kasimatis, Theo; Clark, Kal; Gökmen, Refik; Hilton, Rachel; Shah, Sapna; Shaw, Catriona; Farmer, Chris; Kilbride, Hannah; Asgari, Elham

doi:10.1016/j.transproceed.2020.11.007

Cited by 9 publications

(4 citation statements)

References 15 publications

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“…In addition, raised CRP and low GFR were associated with a more severe disease outcome with 18% deaths recorded in a renal transplant cohort in keeping with the severe disease course predicted in this group of immunocompromised patients. 34 Our model identified raised urea and CRP in addition to transplant status as predictors of greater mortality risk which may lower threshold for admission or earlier referral for intensive care support. However, our algorithm could not specify the direction or size of this interaction which is a limitation of such models.…”

Section: Discussionmentioning

confidence: 85%

Increased risk of COVID-19-related admissions in patients with active solid organ cancer in the West Midlands region of the UK: a retrospective cohort study

et al. 2021

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Objective Susceptibility of patients with cancer to COVID-19 pneumonitis has been variable. We aim to quantify the risk of hospitalisation in patients with active cancer and use a machine learning algorithm (MLA) and traditional statistics to predict clinical outcomes and mortality. Design Retrospective cohort study. Setting A single UK district general hospital. Participants Data on total hospital admissions between March 2018 and June 2020, all active cancer diagnoses between March 2019 and June 2020 and clinical parameters of COVID-19-positive admissions between March 2020 and June 2020 were collected. 526 COVID-19 admissions without an active cancer diagnosis were compared with 87 COVID-19 admissions with an active cancer diagnosis. Primary and secondary outcome measures 30-day and 90-day post-COVID-19 survival. Results In total, 613 patients were enrolled with male to female ratio of 1:6 and median age of 77 years. The estimated infection rate of COVID-19 was 87 of 22 729 (0.4%) in the patients with cancer and 526 of 404 379 (0.1%) in the population without cancer (OR of being hospitalised with COVID-19 if having cancer is 2.942671 (95% CI: 2.344522 to 3.693425); p<0.001). Survival was reduced in patients with cancer with COVID-19 at 90 days. R-Studio software determined the association between cancer status, COVID-19 and 90-day survival against variables using MLA. Multivariate analysis showed increases in age (OR 1.039 (95% CI: 1.020 to 1.057), p<0.001), urea (OR 1.005 (95% CI: 1.002 to 1.007), p<0.001) and C reactive protein (CRP) (OR 1.065 (95% CI: 1.016 to 1.116), p<0.008) are associated with greater 30-day and 90-day mortality. The MLA model examined the contribution of predictive variables for 90-day survival (area under the curve: 0.749); with transplant patients, age, male gender and diabetes mellitus being predictors of greater mortality. Conclusions Active cancer diagnosis has a threefold increase in risk of hospitalisation with COVID-19. Increased age, urea and CRP predict mortality in patients with cancer. MLA complements traditional statistical analysis in identifying prognostic variables for outcomes of COVID-19 infection in patients with cancer. This study provides proof of concept for MLA in risk prediction for COVID-19 in patients with cancer and should inform a redesign of cancer services to ensure safe delivery of cancer care.

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Section: Discussionmentioning

confidence: 85%

Increased risk of COVID-19-related admissions in patients with active solid organ cancer in the West Midlands region of the UK: a retrospective cohort study

et al. 2021

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“…Unfortunately, other assessment methods may not be sufficiently specific and sensitive, particularly in regions where the community prevalence of COVID-19 infections may be high. As a result, the universal swabbing of inpatients for COVID-19 is advocated because COVID-19 can be diagnosed in 1.6% to 15.4% of unsuspected patients who were admitted and swabbed [13][14][15][16]. Filtering out unsuspected COVID-19 infections by universal swabbing could reduce hospital-acquired COVID-19 infections, which occurred in 6.9% of the ASTREGO cohort.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics, outcomes, and management of COVID-19 in kidney transplant recipients across Asia: an ASTREGO report

Kee

Jeong

Rashid

et al. 2021

Korean J Transplant

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Background: Asia is the global epicenter of the coronavirus disease 2019 (COVID-19) pandemic; however, COVID-19-related mortality in Asia remains lower than in other parts of the world. It is uncertain whether the mortality of COVID-19-infected kidney transplant recipients (KTXs) from Asia follows the lower mortality trends of the younger Asian population. Methods: Specific transplant centers from countries in the Asian Society of Transplantation were invited to participate in a study to examine the epidemiology, clinical features, natural history, and outcomes of COVID-19 infections in KTXs. Data were analyzed and compared with those of large cohort studies from other countries. Results: The study population was 87 KTXs from nine hospitals in seven Asian countries. Within the study population, 9% were aged 60 years and older, and 79% had at least one comorbidity. The majority of patients (69%) presented with mild-to-moderate COVID-19 severity. Disease progression was more frequently encountered among those with moderate or severe infection (23%) and non-survivors (55%). The mortality rate was 23% (n=20) and differed according to the level of care: 12% (n=1/8), 15% (n=10/67), and 100% (n=9/9) of patients managed as outpatients, in the general ward, and in the intensive care unit, respectively. Disease severity at the time of presentation was an independent predictor of mortality. Compared with the mortality rates in other studies worldwide, mortality rates in the current study were comparable. Conclusions: Mortality in Asian KTXs who were infected with COVID-19 remains high and could be related to comorbidity burden and the constraints of the general healthcare system when the COVID-19 caseload is high.

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“…Systemic inflammation and bacterial sepsis affect erythrocyte membrane composition, predisposing patients to anaemia due to accelerated clearance of erythrocytes [ 11 , 25 ]. Lower haemoglobin levels at baseline in kidney transplant patients predicted severe COVID-19 infection in a UK study [ 26 ], whereas Chinese studies did not find differences in haemoglobin levels of severe vs. non-severe COVID-19 disease patients [ 2 , 6 , 17 ]. Moreover, the RDW index can be abnormal in severe COVID-19 due to haemolysis, with increases in lactate dehydrogenase and ferritin [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Anaemia and enhancement of coagulation are associated with severe COVID-19 infection

Helin

Lemponen

Lahtiharju

et al. 2021

Scandinavian Journal of Clinical and Laboratory Investigation

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COVID-19 in Kidney Transplant Patients From a Large UK Transplant Center: Exploring Risk Factors for Disease Severity

Cited by 9 publications

References 15 publications

Increased risk of COVID-19-related admissions in patients with active solid organ cancer in the West Midlands region of the UK: a retrospective cohort study

Increased risk of COVID-19-related admissions in patients with active solid organ cancer in the West Midlands region of the UK: a retrospective cohort study

Clinical characteristics, outcomes, and management of COVID-19 in kidney transplant recipients across Asia: an ASTREGO report

Anaemia and enhancement of coagulation are associated with severe COVID-19 infection

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