Haemolytic anaemia: a consequence of COVID-19

A man in his early 50s presented with jaundice, mild shortness of breath on exertion and dark urine. He had had coryzal symptoms 2 weeks prior to admission. Medical history included obstructive sleep apnoea and hypertension. His initial blood tests showed a mild hyperbilirubinaemia and acute kidney injury stage 1. Chest X-ray and CT pulmonary angiogram were negative for features suggestive of COVID-19. He later developed a drop in haemoglobin and repeat bloods showed markedly raised lactate dehydrogenase and positive direct antiglobulin test. These results were felt to be consistent with a haemolytic anaemia. A nasopharyngeal swab came back positive for COVID-19. We suspect the cause of his symptoms was an autoimmune haemolytic anaemia secondary to COVID-19 which has recently been described in European cohorts.

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Implementation of a computer-guided consultation in the assessment of suspected obstructive sleep apnoea syndrome

ERJ Open Research ◽

10.1183/23120541.00362-2019 ◽

2020 ◽

Vol 6 (3) ◽

pp. 00362-2019

Author(s):

Biswajit Chakrabarti ◽

Nadia Lewis-Burke ◽

Mike Pearson ◽

Sonya Craig ◽

Lisa Davies ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Clinical Decision ◽

Final Diagnosis ◽

Sleep Apnoea ◽

Obstructive Sleep Apnoea Syndrome ◽

Sleep Apnoea Syndrome ◽

System A ◽

Specialist Referral ◽

Obstructive Sleep ◽

Stage 1

BackgroundWe describe implementation of a clinical decision support system, a computer-guided consultation (CGC), in the assessment of subjects referred with suspected obstructive sleep apnoea syndrome (OSAS).MethodsTwo cohorts of patients were assessed. The first 100 cases had data collected with the CGC by a specialist sleep physician (stage1). A further 100 cases were assessed by a nonspecialist using the CGC (stage 2). For each case, the diagnosis suggested by the CGC was compared with the final diagnosis made by a second specialist sleep physician blinded to the CGC diagnosis.ResultsStage 1: of 100 people evaluated, a final diagnosis of OSAS was made by both the sleep specialist and CGC in 88% of cases. In 7 of the remaining 12 cases, both agreed there was “No evidence of OSAS”; in 5 cases the CGC did not reach a final diagnosis instead prompting specialist referral. Stage 2: 100 people were evaluated; 95% were evaluable. Both CGC and the sleep specialist made a diagnosis of OSAS in 83 cases (87%), in 5 cases both agreed there was no OSAS, whereas in 7 cases the CGC prompted a specialist review due to unexplained symptoms. The CGC was concordant with the final diagnosis in 95% and 93% of cases in the two cohorts, respectively and where there was doubt, prompted for clinical review. No OSAS cases were overlooked by the CGC.ConclusionAn intelligent CGC program creates opportunities in sleep medicine management pathways to safely yet effectively utilise nonspecialists working under specialist supervision.

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Reduction in acute kidney injury stage predicts survival in patients with type-1 hepatorenal syndrome

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz048 ◽

2019 ◽

Vol 35 (9) ◽

pp. 1554-1561 ◽

Cited By ~ 2

Author(s):

Florence Wong ◽

Thomas D Boyer ◽

Arun J Sanyal ◽

Stephen C Pappas ◽

Shannon Escalante ◽

...

Keyword(s):

Overall Survival ◽

Acute Kidney Injury ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Double Blind Study ◽

Baseline Serum ◽

Acute Kidney Injury Stage ◽

Stage 1 ◽

The Impact

Abstract Background Hepatorenal syndrome type 1 (HRS-1), a form of acute kidney injury (AKI) in cirrhosis, has a median survival of days to weeks if untreated. The impact of reduction in AKI stage on overall survival in cirrhosis, independent of HRS reversal, is unclear. Methods The Randomized, placEbo-controlled, double-blind study to confirm the reVERSal of HRS-1 with terlipressin study assessed terlipressin versus placebo, both with albumin, as treatment for HRS-1 for ≤14 days. Renal dysfunction severity was categorized by AKI stage at enrollment. Baseline patient characteristics were evaluated as predictors of AKI improvement using a multivariate model; the association between AKI stage reduction and 90-day survival was assessed using linear regression. Results A total of 184 patients (terlipressin: n = 91; placebo: n = 93) with similar numbers in AKI Stages 1–3 (terlipressin/placebo, Stage 1: n = 25/26; Stage 2: n = 35/33; Stage 3: n = 31/34) were included. Predictors of AKI improvement were absence of alcoholic hepatitis, baseline serum creatinine and male gender. Overall survival was not significantly different across AKI stages (range 53–65%). In patients with no AKI worsening, 90-day survival was consistently better when AKI improved independent of HRS reversal, regardless of the initial AKI stage, with patients with Stage 1 at initial diagnosis achieving the greatest clinical benefit. A significant association was observed between AKI reduction and overall 90-day survival (P = 0.0022). Conclusions A reduction in AKI stage, independent of HRS reversal, was sufficient to improve overall survival in patients with HRS-1. The goal for HRS-1 treatment should be less stringent than absolute HRS reversal.

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Disparate outcomes observed within Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury stage 1

Kidney International ◽

10.1016/j.kint.2018.11.030 ◽

2019 ◽

Vol 95 (4) ◽

pp. 905-913 ◽

Cited By ~ 8

Author(s):

Harlan G. Sparrow ◽

Joshua T. Swan ◽

Linda W. Moore ◽

A. Osama Gaber ◽

Wadi N. Suki

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Acute Kidney Injury Stage ◽

Stage 1

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Clinical Aspects and Prognosis Evaluation of Cirrhotic Patients Hospitalized with Acute Kidney Injury

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/6567850 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Célio Geraldo de Oliveira Gomes ◽

Marcus Vinicius Melo de Andrade ◽

Ludmila Resende Guedes ◽

Henrique Carvalho Rocha ◽

Roberto Gardone Guimarães ◽

...

Keyword(s):

Acute Kidney Injury ◽

Volume Expansion ◽

Laboratory Data ◽

Kidney Injury ◽

Clinical Aspects ◽

Advanced Cirrhosis ◽

Acute Kidney Injury Stage ◽

Tertiary Center ◽

Cirrhotic Patients ◽

Stage 1

Background. Acute kidney injury occurs in approximately 20% of hospitalized cirrhotic patients. Mortality is estimated at 60% within a month and 65% within a year. Aims. To evaluate survival in 30 days and in 3 months of cirrhotic patients hospitalized with acute kidney injury, identifying factors associated with mortality. Methods. 52 patients with cirrhosis admitted to an academic tertiary center who presented acute kidney injury according to the International Club of Ascites criteria were evaluated. Clinical and laboratory data was collected at diagnosis between 2011 and 2015. Results. Average age was 54.6 (±10.7) years and 69.2% were male. The average MELD, MELD-Na, and Child-Pugh scores were 21.9 (±7.0), 24.5 (±6.7), and 10.1 (±2.2), respectively. Thirty patients (57.7%) were in acute kidney injury stage 1, 16 (30.8%) in stage 2, and six (11.6%) in stage 3. Mortality was 28.6% in 30 days and 44.9% in three months. In multivariate analysis, variables that were associated independently to mortality were lack of response to expansion treatment and Child-Pugh score. Mortality was 93.3% in three months among nonresponders compared to 28.6% among those who responded to volume expansion (p<0.0001). Conclusion. Acute kidney injury in cirrhosis has dire prognosis, particularly in patients with advanced cirrhosis and in nonresponders to volume expansion.

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