scholarly journals Features of comorbid pathology spectrum and age structure of oxygen-dependent patients with severe coronavirus disease 2019 (COVID-19) depending on outcomes of the disease

2021 ◽  
Vol 23 (2) ◽  
pp. 214-219
Author(s):  
O. V. Riabokon ◽  
V. V. Cherkaskyi ◽  
T. Ye. Onishchenkо ◽  
Yu. Yu. Riabokon
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Age Structure ◽  
Statistical Data ◽  
Severe Disease ◽  
Persistent Atrial Fibrillation ◽  
Comorbid Conditions ◽  
Postinfarction Cardiosclerosis

The aim was to analyze spectrum of comorbid pathology and age structure of oxygen-dependent patients with severe coronavirus disease 2019 (COVID-19) depending on outcomes of the disease. Materials and methods. The study included 85 oxygen-dependent patients with severe COVID-19. The patients were divided into groups: I – 70 patients with recovery; II – 15 patients in whom the disease was fatal. Statistical data processing was performed in the program Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. Among the patients with fatal outcomes of the disease, elderly and senile were dominated – 93.3 % (14 of 15) versus 67.1 % (47 of 70) among patients who recovered (P < 0.05). Analysis of comorbid pathology structure in oxygen-dependent patients with severe COVID-19 showed that patients who died more often had hypertension (93.3 % vs. 30.0 %, P < 0.001), postinfarction cardiosclerosis (26.7 % vs. 2.9 %, P < 0.001), rhythm disturbance as persistent atrial fibrillation (20.0 % vs. 1.4 %, P < 0.01) as compared to those who survived. The patients of group II were more commonly diagnosed with chronic kidney disease (20.0 % vs. 4.3 %, P < 0.05) as the comorbid pathology. The presence of ischemic stroke in COVID-19 infection influenced the disease outcome (20.0 % vs. 4.3 %, P < 0.05). Fatal outcomes in the patients with COVID-19 were associated with a combination of 3 or more comorbid conditions in 46.7 % versus 17.4 % among oxygen-dependent survivors with severe disease (P < 0.01). Conclusions. Elderly and senile oxygen-dependent patients are more likely to die from severe COVID-19 (P < 0.05). Comorbid hypertension, postinfarction cardiosclerosis, arrhythmia in the form of persistent atrial fibrillation, chronic kidney disease and ischemic stroke or the combination of 3 or more comorbid conditions listed are more common among patients with COVID-19 who died (P < 0.05) as compared to survivors.

scholarly journals Prediction of unfavorable outcome in ischemic stroke patients with chronic kidney disease

2021 ◽  
pp. 53-59
Author(s):  
A. Antonenko ◽  
K. Antonenko ◽  
L. Vakulenko ◽  
Z. Dubovenko
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Prognostic Factors ◽  
Kidney Disease ◽  
Functional Outcomes ◽  
Unfavorable Outcome ◽  
Stroke Outcome ◽  
Basic Characteristics

Patients with chronic kidney disease (CKD) have significantly poorer functional outcomes and greater mortality after suffering a stroke. The present study aimed to identify the prognostic factors of an unfavorable outcome of the ischemic stroke in patients with CKD. Methods and subjects. The current study was designed retrospectively and performed with data of patients who were hospitalized due to ischemic stroke to the neurological department. A complex clinical and neuroimaging investigation was carried out in 65 patients (30 men and 35 women) aged 53 to 81 years (mean age – (67.7 ± 5.9) years) with acute stroke and CKD. Patients underwent all the necessary ancillary investigations according to guidelines. According to the clinical outcome on the 21-st day by the modified Rankin scale (mRS) all patients were divided into two groups: 1-st –favorable stroke outcome (mRS=0-3) – 34 (52.3%), 2-nd – unfavorable stroke outcome – (mRS=4-6) – 31 (47.7%). Results. During comparing the basic characteristics of both groups, it was revealed that patients with unfavorable functional outcomes were almost twice as likely to have diabetes mellitus (51.6% vs. 26.5%, p<0.037) and atrial fibrillation (41.9% vs. 17.6%, p<0.032). In age-and sex-adjusted multifactor logistic regression it was found that ischemic stroke unfavorable outcome is associated with diabetes mellitus (OR – 2.5, CI: 1.6-8.3; p=0.014), atrial fibrillation – 2.7, CI: 0.7-9.6; p=0.043), dialysis therapy (OR – 3.4, CI: 2.3-8.1; p=0.007), GFR <42 ml/min/1.73 m2 (OR – 2.7, CI: 2.1-7.8; p=0.003). Conclusions. Determining prognostic factors of unfavorable course of the ischemic stroke in patients with CKD allows to optimize the management of such patients in the acute period of ischemic stroke and improve the prognosis.

scholarly journals The association of anticoagulation, ischemic stroke, and hemorrhage in elderly adults with chronic kidney disease and atrial fibrillation

2017 ◽  
Vol 91 (4) ◽  
pp. 928-936 ◽  
Author(s):  
Vaibhav Keskar ◽  
Eric McArthur ◽  
Ron Wald ◽  
Ziv Harel ◽  
Deborah Zimmerman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Elderly Adults

The Problem of Atrial Fibrillation in Patients with Chronic Kidney Disease

2016 ◽  
Vol 14 (3) ◽  
pp. 260-265 ◽  
Author(s):  
Beata Franczyk ◽  
Anna Gluba-Brzózka ◽  
Aleksandra Cia|kowska-Rysz ◽  
Maciej Banach ◽  
Jacek Rysz
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease

scholarly journals Impact of antithrombotic therapy in the prognosis of atrial fibrillation patients with advanced chronic kidney disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.M Andreu Cayuelas ◽  
S Raposeiras-Roubin ◽  
E Fortuny Frau ◽  
A Garcia Del Egido ◽  
J Seller-Moya ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antithrombotic Therapy ◽  
Anticoagulation Therapy ◽  
Bleeding Event ◽  
Funding Source ◽  
Newly Diagnosed ◽  
Bleeding Events ◽  
Cox Regression Analysis

Abstract Introduction Chronic kidney disease (CKD) is associated with an elevated thromboembolic and bleeding risk in atrial fibrillation (AF) patients, so the decision of antithrombotic therapy is a challenge. Purpose To analyze mortality, embolic and bleeding events in patients with advanced CKD and AF. Methods Multicentric retrospective registry on patients with AF and advanced CKD (CKD-EPI &lt;30 mL/min/1.73 m2). For death, multivariable Cox regression analysis was developed. For embolic and bleeding events, competing-risks regression based on Fine and Gray's proportional subhazards model was performed, being death the competing event Results We analysed 405 patients with advanced CKD and newly diagnosed AF. 57 patients were not treated with antithrombotic therapy (14.1%), 80 only with antiplatelet/s (19.8%), 211 only with anticoagulation (52.1%), and 57 with anticoagulant plus antiplatelet/s (14.1%). During a follow-up of 4.6±2.5 years, 205 died (50.6%), 34 had embolic events (8.4%) and 85 had bleeding outcomes (21.0%). Bleeding event rate was significantly lower in patients without antithrombotic therapy (Figure). After multivariate analysis, anticoagulant treatment was associated with higher bleeding rates, without differences in mortality or embolic events (Table). Conclusion Anticoagulation therapy was associated with a significant increase in bleeding events in patients with advanced CKD and newly diagnosed AF. None of the antithrombotic therapy regimens resulted in lower embolic events rate neither benefit in mortality. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by an unconditional grant from BMS-Pfizer

scholarly journals Plasma natriuretic peptide level is an independent determinant of major clinical outcomes in atrial fibrillation patients without heart failure: the Fushimi AF Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Hamatani ◽  
M Iguchi ◽  
Y Aono ◽  
K Ishigami ◽  
S Ikeda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Prognostic Marker ◽  
Oral Anticoagulants ◽  
Systemic Embolism ◽  
The Mean

Abstract Background Atrial fibrillation (AF) increases the risk of death, stroke/systemic embolism and heart failure (HF). Plasma natriuretic peptide (NP) level is an important prognostic marker in HF patients. However, little is known regarding the prognostic significance of plasma NP level in AF patients without HF. Purpose The aim of this study is to investigate the relationship between plasma NP level and clinical outcomes such as all-cause death, stroke/systemic embolism and HF hospitalization during follow-up period in AF patients without HF. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in our city. The inclusion criterion of the registry is the documentation of AF at 12-lead electrocardiogram or Holter monitoring at any time, and there are no exclusion criteria. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. From the registry, we excluded 1,220 patients without a pre-existing HF (defined as having one of the following; prior hospitalization for HF, New York Heart Association class ≥2, or left ventricular ejection fraction &lt;40%). Among 3,246 AF patients without HF, we investigated 1,189 patients with the data of plasma BNP (n=401) or N-terminal pro-BNP (n=788) level at the enrollment. We divided the patients according to the quartile of each plasma BNP or NT-pro BNP level and compared the backgrounds and outcomes between these 4 groups stratified by plasma NP level. Results Of 1,189 patients, the mean age was 72.1±10.2 years, 454 (38%) were female and 684 (58%) were paroxysmal AF. The mean CHADS2 and CHA2DS2-VASc score were 1.6±1.1 and 2.9±1.5, respectively. Oral anticoagulants were prescribed in 671 (56%) at baseline. The median (interquartile range) BNP and N-terminal pro-BNP level were 84 (38, 176) and 500 (155, 984) pg/ml, respectively. Patients with high plasma NP level were older, and demonstrated lower prevalence of paroxysmal AF, higher CHADS2 and CHA2DS2-VASc scores and higher prevalence of chronic kidney disease and oral anticoagulants prescription (all P&lt;0.01). A total of 165 all-cause death, 114 stroke/systemic embolism and 103 HF hospitalization occurred during the median follow-up period of 5.0 years. Kaplan-Meier curves demonstrated that higher plasma NP level was significantly associated with the incidences of all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF (Figure 1A). Multivariable Cox regression analysis revealed that plasma NP level could stratify the risk of clinical outcomes even after adjustment by type of AF, CHA2DS2-VASc score, chronic kidney disease and oral anticoagulant prescription (Figure 1B). Conclusion Plasma NP level is a significant prognostic marker for all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF, suggesting the importance of measuring plasma NP level in AF patients even without HF. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Oral anticoagulation in chronic kidney disease with atrial fibrillation

2021 ◽  
Author(s):  
Pablo Gomez -Fernández ◽  
Antonio Martín Santana ◽  
Juan de Dios Arjona Barrionuevo
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Oral Anticoagulation

Association of Dyskalemias with Ischemic Stroke in Advanced Chronic Kidney Disease Patients Transitioning to Dialysis

2021 ◽  
pp. 1-9
Author(s):  
Ankur A. Dashputre ◽  
Keiichi Sumida ◽  
Fridtjof Thomas ◽  
Justin Gatwood ◽  
Oguz Akbilgic ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Lower Risk ◽  
Chronic Exposure ◽  
Cox Regression ◽  
Acute Exposure ◽  
Continuous Exposure ◽  
Advanced Chronic Kidney Disease

<b><i>Introduction:</i></b> Hypo- and hyperkalemia are associated with a higher risk of ischemic stroke. However, this association has not been examined in an advanced chronic kidney disease (CKD) population. <b><i>Methods:</i></b> From among 102,477 US veterans transitioning to dialysis between 2007 and 2015, 21,357 patients with 2 pre-dialysis outpatient estimated glomerular filtration rates &#x3c;30 mL/min/1.73 m<sup>2</sup> 90–365 days apart and at least 1 potassium (K) each in the baseline and follow-up period were identified. We separately examined the association of both baseline time-averaged K (chronic exposure) and time-updated K (acute exposure) treated as categorized (hypokalemia [K &#x3c;3.5 mEq/L] and hyperkalemia [K &#x3e;5.5 mEq/L] vs. referent [3.5–5.5 mEq/L]) and continuous exposure with time to the first ischemic stroke event prior to dialysis initiation using multivariable-adjusted Cox regression models. <b><i>Results:</i></b> A total of 2,638 (12.4%) ischemic stroke events (crude event rate 41.9 per 1,000 patient years; 95% confidence interval [CI] 40.4–43.6) over a median (Q<sub>1</sub>–Q<sub>3</sub>) follow-up time of 2.56 (1.59–3.89) years were observed. The baseline time-averaged K category of hypokalemia (adjusted hazard ratio [aHR], 95% CI: 1.35, 1.01–1.81) was marginally associated with a significantly higher risk of ischemic stroke. However, time-updated hyperkalemia was associated with a significantly lower risk of ischemic stroke (aHR, 95% CI: 0.82, 0.68–0.98). The exposure-outcome relationship remained consistent when using continuous K levels for both the exposures. <b><i>Discussion/Conclusion:</i></b> In patients with advanced CKD, hypokalemia (chronic exposure) was associated with a higher risk of ischemic stroke, whereas hyperkalemia (acute exposure) was associated with a lower risk of ischemic stroke. Further studies in this population are needed to explore the mechanisms underlying these associations.

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