Higher Mortality from Covid19 in Patients with Renal Dysfunction in A Multicultural Multi-Ethnic Population

Abstract Background Despite previous exposure to coronavirus epidemics a few years ago, limited clinical and epidemiological information is available from the United Arab Emirates (UAE). The UAE is the second most affected country amongst the Gulf Cooperation Council Countries by Covid19. Distinctly, the UAE has a population of almost 9.2 million, with fewer than 12% UAE nationals, and the rest immigrants, mainly unskilled labourers. The disparate socio-economic structure, crowded housing conditions, multi-ethnic, multicultural population offers a unique set of challenges in Covid19 disease management. Methods In order to assess patient characteristics and survival for patients infected with Covid19, electronic patient data was retrospectively abstracted from the medical records of two designated public Covid19 referral hospitals, and subjected to statistical analysis. Results From, the total of 3072 patients, less than one-fifth were females, the Asian population (71.2%), followed by Middle Eastern Arabs (23.3%) were the most infected by the virus. Mortality was low among the Asian population. Diabetes Mellitus (26.8%, p < 0.001), hypertension (25.7%, p < 0.001), and heart disease (9.6%, p < 0.01) were the most prevalent comorbidities observed and decreased survival by 2–3 fold. Kidney disease escalated mortality rate by almost eight-fold high (19.4%, p < 0.001), as compared to patients without kidney disease. Higher age of patients between 51 and 65 years, significantly decreased the odds for survival (Crude OR 14.1, p<,0.001) and (Adjusted OR 12.3, p < 0.001), and patient age beyond 66 years, further significantly decreased the odds for survival (Crude OR 36.1, p < 0.001) and (Adjusted OR 26.6,p < 0.001). Kidney disease as comorbidity significantly diminished the survival rates (Crude OR 9.6,p < 0.001) and (Adjusted OR 5.7, p < 0.001), as compared to those without kidney dysfunction. Conclusion Although Asian population was the highest infected by Covd19, their mortality rate was low (2.6%), compared to other nationalities. Older ages above 51 years decreased the odds of survival significantly. Despite other comorbidity risks, kidney dysfunction contributed to enhanced mortality by over eight-fold and reduced the odds of survival (Adjusted OR 26.6), compared to those patients without kidney dysfunction. Our findings are important in the management of the Covid19 disease in the region with similar economic, social, cultural and ethnic background.

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Assessment of mortality from COVID-19 in a multicultural multi-ethnic patient population

BMC Infectious Diseases ◽

10.1186/s12879-021-06762-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Satish Chandrasekhar Nair ◽

Huda Imam Gasmelseed ◽

Asad Afroz Khan ◽

Ibrahim Nageh Khafagy ◽

Jayadevan Sreedharan ◽

...

Keyword(s):

Kidney Disease ◽

United Arab Emirates ◽

Middle Eastern ◽

Survival Rates ◽

Asian Population ◽

Patient Characteristics ◽

Housing Conditions ◽

Chi Square ◽

Referral Hospitals ◽

Chi Square Test

Abstract Background Studies indicate that ethnicity and socioeconomic disparity are significant facilitators for COVID-19 mortality. The United Arab Emirates, distinctly has a population of almost 12% citizens and the rest, immigrants, are mainly unskilled labourers. The disparate socio-economic structure, crowded housing conditions, and multi-ethnic population offer a unique set of challenges in COVID-19 management. Methods Patient characteristics, comorbidities, and clinical outcomes data from the electronic patient medical records were retrospectively extracted from the hospital information system of the two designated public COVID-19 referral hospitals. Chi-square test, logistic regression, and odds ratio were used to analyse the variables. Results From, the total of 3072 patients, less than one-fifth were females; the Asian population (71.2%);followed by Middle Eastern Arabs (23.3%) were the most infected by the virus. Diabetes Mellitus (26.8%), hypertension (25.7%) and heart disease (9.6%) were the most prevalent comorbidities observed among COVID-19 patients. Kidney disease as comorbidity significantly diminished the survival rates (Crude OR 9.6, 95% CI (5.6–16.6), p < 0.001) and (Adjusted OR 5.7 95% CI (3.0 – 10.8), p < 0.001), as compared to those patients without kidney disease. Similarly, the higher age of patients between 51 and 65 years, significantly decreased the odds for survival (Crude OR 14.1 95% CI (3.4–58.4), p < 0.001) and (Adjusted OR 12.3 95% CI (2.9 – 52.4), p < 0.001). Patient age beyond 66 years, further significantly decreased the odds for survival (Crude OR 36.1 95% CI (8.5–154.1), p < 0.001), and (Adjusted OR 26.6 95% CI (5.7 – 123.8), p < 0.001). Conclusion Our study indicates that older ages above 51 years and kidney disease increased mortality significantly in COVID-19 patients. Ethnicity was not significantly associated with mortality in the UAE population. Our findings are important in the management of the COVID-19 disease in the region with similar economic, social, cultural, and ethnic backgrounds.

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Out-of-hospital cardiac arrests in the Gulf Region: a scoping review

Eastern Mediterranean Health Journal ◽

10.26719/emhj.20.141 ◽

2020 ◽

Author(s):

Alan M. Batt ◽

Chelsea Lanos ◽

Shannon Delport ◽

Dalal Al Hasan ◽

Shane Knox ◽

...

Keyword(s):

United Arab Emirates ◽

Scoping Review ◽

Middle Eastern ◽

Grey Literature ◽

Survival Rates ◽

Spontaneous Circulation ◽

Community Response ◽

International Studies ◽

Service Utilisation ◽

Gulf Region

Background: Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality worldwide. Recent studies demonstrated low survival rates in Middle Eastern countries. Anecdotally there are unique demographic, cultural and logistical challenges in this region. However, there remains a paucity of data published on OHCA in the Middle East. In order to address OHCA in a meaningful manner in the region, we first need to quantify the issue. Methods: We conducted a scoping review of published and grey literature on OHCA in the Gulf Cooperative Council region that utilised Arksey and O’Malley’s framework. Electronic databases and grey literature sources were identified and searched. Subject matter experts in the region were consulted. All types of studies in English and Arabic were included. Results: A total of 24 studies were included from Saudi Arabia, the United Arab Emirates, Oman, Kuwait, and Qatar. No literature was identified from the state of Bahrain. OHCA victims in the region are younger, predominantly male, and more co-morbid than other international studies. We observed low Emergency Medical Service utilisation, low bystander cardiopulmonary resuscitation, return of spontaneous circulation, and survival to discharge rates across the region. There are differences in characteristics of OHCA among ethnic groups. Conclusion: We identified unique characteristics associated with OHCA in the region, variances in processes and outcomes, and a lack of coordinated effort to research and address OHCA. We recommend creating lead agencies responsible for coordinating and developing strategies such as community response, public education, and reporting databases.

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Confronting the practice of surgery on differentiated thyroid cancer with current guidelines in Germany

Nuklearmedizin ◽

10.1055/s-0038-1625203 ◽

2005 ◽

Vol 44 (05) ◽

pp. 185-191 ◽

Cited By ~ 4

Author(s):

H. Wieler ◽

S. Birtel ◽

E. Ostwald-Lenz ◽

K. P. Kaiser ◽

H. P. Becker ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Survival Rates ◽

Perioperative Morbidity ◽

Referral Hospitals ◽

Principles Of Treatment ◽

Current Guidelines ◽

Papillary Microcarcinomas ◽

Retrospective Multicenter Study

Summary:Aim: For the surgical therapy of differentiated thyroid cancer precise guidelines are applied by the German medical societies. In a retrospective multicenter study, we investigated the following issues: Are the current guidelines respected?. Is there a difference concerning the surgical radicalism and the outcome?. Does the perioperative morbidity increase with the higher radicalism of the procedure?. Patients, methods: Data gained from 102 patients from 17 regional referral hospitals who underwent surgery for thyroid cancer and a following radioiodine treatment (mean follow up: 42.7 [24-79] months) were analyzed. At least 71 criterias were analyzed in a SPSS file. Results: 46.1% of carcinomas were incidentally detected during goiter surgery. The thyroid cancer (papillary n = 78; follicular n = 24) occurred in 87% unilateral and in 13% bilateral. Papillary carcinomas <1 cm were detected in 25 cases; in five of these cases (20%) contralateral carcinomas <1 cm were found. There were significant differences concerning the surgical radicalism: a range from hemithyroidectomy to radical thyroidectomy with lateral neck dissection. Analysis of the histopathologic reports revealed that lymph node dissection was not performed according to guidelines in 55% of all patients. The perioperative morbidity was lower in departments with a high case load. The postoperative dysfunction of the recurrent laryngeal nerve (mean: 7.9% total / 4.9% nerves at risk) variated highly, depending on differences in radicalism and hospitals. Up to now these variations in surgical treatment have shown no differences in their outcome and survival rates, when followed by radioiodine therapy. Conclusion: Current surgical regimes did not follow the guidelines in more than 50% of all cases. This low acceptance has to be discussed. The actual discussion about principles of treatment regarding, the socalled papillary microcarcinomas (old term) has to be respected within the current guidelines.

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Retrospective evaluation of 85 patients with urea cycle disorders: one center experience, three new mutations

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0413 ◽

2020 ◽

Vol 33 (6) ◽

pp. 721-728

Author(s):

Özlem Saritaş Nakip ◽

Yılmaz Yıldız ◽

Ayşegül Tokatlı

Keyword(s):

Mortality Rate ◽

Urea Cycle ◽

Laboratory Data ◽

Patient Characteristics ◽

Hereditary Diseases ◽

Urea Cycle Disorders ◽

Carbamoyl Phosphate ◽

Term Survival ◽

Genetic Features ◽

Cycle Disorders

AbstractObjectivesUrea cycle disorders (UCDs) are rare hereditary diseases. This study was conducted to help identify the characteristics of UCDs in Turkey.MethodsThe primary outcome was to determine patient characteristics. Investigating the relationships between the patient outcomes and ammonia levels were the secondary outcomes. Eighty five patients from 79 families, diagnosed with UCD at a single metabolic referral center between 1979 and 2017, were included. Clinical and laboratory data were retrieved retrospectively from hospital records.ResultsClassical citrullinemia was the most common type of UCD; citrin deficiency and carbamoyl phosphate synthase 1 deficiency (CPS1D) were the rarest. One thirty one hyperammonemic episodes were recorded. The peak ammonia levels were found to be significantly associated with polycythemia and hypocalcemia at presentation. The median peak ammonia values of the patients who died were higher than those of the survivors. The highest mortality rate was in the classical citrullinemia group. The mortality rate of the first hyperammonemic crisis was 28.6%, while it was 6.7% in subsequent episodes with an odds ratio of 4.28 (95% CI: 1.67–11.0) (p=0.001). Forty-four patients underwent genetic analysis and genetic variants were detected in 42 patients (95%). Three of the detected variants have not been previously reported.ConclusionsThis is the largest UCD series in Turkey and may serve as a guide to clinical, biochemical and genetic features of UCDs in our country. Prevention of hyperammonemia may be the most influential measure to improve long term survival.

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Total numbers and in-hospital mortality of patients with myocardial infarction in Germany during the FIFA soccer world cup 2014

Scientific Reports ◽

10.1038/s41598-021-90582-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Karsten Keller ◽

Lukas Hobohm ◽

Volker H. Schmitt ◽

Martin Engelhardt ◽

Philip Wenzel ◽

...

Keyword(s):

Myocardial Infarction ◽

Mortality Rate ◽

Hospital Mortality ◽

Environmental Stress ◽

Nationwide Inpatient Sample ◽

Hospital Admissions ◽

Patient Characteristics ◽

World Cup ◽

National Team ◽

Comparison Period

AbstractEnvironmental stress like important soccer events can induce excitation, stress and anger. We aimed to investigate (i) whether the FIFA soccer world cup (WC) 2014 and (ii) whether the soccer games of the German national team had an impact on total numbers and in-hospital mortality of patients with myocardial infarction (MI) in Germany. We analyzed data of MI inpatients of the German nationwide inpatient sample (2013–2015). Patients admitted due to MI during FIFA WC 2014 (12th June–13th July2014) were compared to those during the same period 2013 and 2015 (12th June–13th July). Total number of MI patients was higher during WC 2014 than in the comparison-period 2013 (18,479 vs.18,089, P < 0.001) and 2015 (18,479 vs.17,794, P < 0.001). WC was independently associated with higher MI numbers (2014 vs. 2013: OR 1.04 [95% CI 1.01–1.07]; 2014 vs. 2015: OR 1.07 [95% CI 1.04–1.10], P < 0.001). Patient characteristics and in-hospital mortality rate (8.3% vs. 8.3% vs. 8.4%) were similar during periods. In-hospital mortality rate was not affected by games of the German national team (8.9% vs. 8.1%, P = 0.110). However, we observed an increase regarding in-hospital mortality from 7.9 to 9.3% before to 12.0% at final-match-day. Number of hospital admissions due to MI in Germany was 3.7% higher during WC 2014 than during the same 31-day period 2015. While in-hospital mortality was not affected by the WC, the in-hospital mortality was highest at WC final.

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An Update on Hepatocellular Carcinoma in Chronic Kidney Disease

Cancers ◽

10.3390/cancers13143617 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3617

Author(s):

Fabrizio Fabrizi ◽

Roberta Cerutti ◽

Carlo M. Alfieri ◽

Ezequiel Ridruejo

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Early Stage ◽

Survival Rates ◽

International Study ◽

Public Health Issue ◽

Advanced Chronic Kidney Disease ◽

Ablative Techniques ◽

Risk Of Cancer

Chronic kidney disease is a major public health issue globally and the risk of cancer (including HCC) is greater in patients on long-term dialysis and kidney transplant compared with the general population. According to an international study on 831,804 patients on long-term dialysis, the standardized incidence ratio for liver cancer was 1.2 (95% CI, 1.0–1.4) and 1.5 (95% CI, 1.3–1.7) in European and USA cohorts, respectively. It appears that important predictors of HCC in dialysis population are hepatotropic viruses (HBV and HCV) and cirrhosis. 1-, 3-, and 5-year survival rates are lower in HCC patients on long-term dialysis than those with HCC and intact kidneys. NAFLD is a metabolic disease with increasing prevalence worldwide and recent evidence shows that it is an important cause of liver-related and extra liver-related diseases (including HCC and CKD, respectively). Some longitudinal studies have shown that patients with chronic hepatitis B are aging and the frequency of comorbidities (such as HCC and CKD) is increasing over time in these patients; it has been suggested to connect these patients to an appropriate care earlier. Antiviral therapy of HBV and HCV plays a pivotal role in the management of HCC in CKD and some combinations of DAAs (elbasvir/grazoprevir, glecaprevir/pibrentasvir, sofosbuvir-based regimens) are now available for HCV positive patients and advanced chronic kidney disease. The interventional management of HCC includes liver resection. Some ablative techniques have been suggested for HCC in CKD patients who are not appropriate candidates to surgery. Transcatheter arterial chemoembolization has been proposed for HCC in patients who are not candidates to liver surgery due to comorbidities. The gold standard for early-stage HCC in patients with chronic liver disease and/or cirrhosis is still liver transplant.

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Lifetime risk of stroke stratified by chronic kidney disease and hypertension in the general Asian population: the Ohasama study

Hypertension Research ◽

10.1038/s41440-021-00635-z ◽

2021 ◽

Author(s):

Shingo Nakayama ◽

Michihiro Satoh ◽

Hirohito Metoki ◽

Takahisa Murakami ◽

Kei Asayama ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Asian Population ◽

Lifetime Risk

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Osteoprotegerin is a marker of cardiovascular mortality in patients with chronic kidney disease stages 3–5

Scientific Reports ◽

10.1038/s41598-021-82072-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Gustavo Lenci Marques ◽

Shirley Hayashi ◽

Anna Bjällmark ◽

Matilda Larsson ◽

Miguel Riella ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Multivariate Analysis ◽

Kidney Disease ◽

Cardiovascular Mortality ◽

Osteoclast Differentiation ◽

Survival Rates ◽

Elevated Serum ◽

High Sensitivity ◽

Intima Media Thickness

AbstractCardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). Osteoprotegerin (OPG), known to regulate bone mass by inhibiting osteoclast differentiation and activation, might also play a role in vascular calcification. Increased circulating OPG levels in patients with CKD are associated with aortic calcification and increased mortality. We assessed the predictive role of OPG for all-cause and cardiovascular mortality in patients with CKD stages 3–5 over a 5-year follow-up period. We evaluated the relationship between OPG and all-cause and cardiovascular mortality in 145 CKD patients (stages 3–5) in a prospective observational follow-up study. Inflammation markers, including high-sensitivity C-reactive protein, standard echocardiography, and estimation of intima-media thickness in the common carotid artery, were assessed at baseline, and correlations with OPG levels were determined. The cutoff values for OPG were defined using ROC curves for cardiovascular mortality. Survival was assessed during follow up lasting for up to 5.5 years using Fine and Gray model. A total of 145 (89 men; age 58.9 ± 15.0 years) were followed up. The cutoff value for OPG determined using ROC was 10 pmol/L for general causes mortality and 10.08 pmol/L for CV causes mortality. Patients with higher serum OPG levels presented with higher mortality rates compared to patients with lower levels. Aalen–Johansen cumulative incidence curve analysis demonstrated significantly worse survival rates in individuals with higher baseline OPG levels for all-cause and cardiovascular mortality (p < 0.001). In multivariate analysis, OPG was a marker of general and cardiovascular mortality independent of sex, age, CVD, diabetes, and CRP levels. When CKD stages were included in the multivariate analysis, OPG was an independent marker of all-cause mortality but not cardiovascular mortality. Elevated serum OPG levels were associated with higher all-cause and cardiovascular mortality risk, independent of age, CVD, diabetes, and inflammatory markers, in patients with CKD.

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P0031AURINE METABOLOMICS: AN EMERGING TOOL FOR DISSECTING BIOLOGICAL ABERRATIONS UNDERLYING RENAL DYSFUNCTION IN BARDET-BIEDL SYNDROME

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0031a ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Miriam Zacchia ◽

Emanuela Marchese ◽

Marianna Caterino ◽

Margherita Ruoppolo ◽

Giovambattista Capasso

Keyword(s):

Lactic Acid ◽

Kidney Disease ◽

Renal Disease ◽

Renal Dysfunction ◽

Metabolic Pathways ◽

Healthy Subjects ◽

Hexadecenoic Acid ◽

Kidney Dysfunction ◽

Bardet Biedl Syndrome ◽

Wide Range

Abstract Background and Aims Bardet Biedl Syndrome (BBS) is a rare genetic disorder characterized by a wide range of organ dysfunction, including kidney disease. The severity of renal dysfunction is highly variable in this setting, ranging from tubular defects to the end stage renal disease, with poor genotype-phenotype correlation. Proteomics and metabolomics are powerful tools able to contribute to the better understanding of molecular basis of disease conditions. Our previous studies demonstrated that the urinary proteomic pattern of BBS patients differed from that of healthy subjects, with a set of deregulated proteins including cell adhesion and extracellular matrix organization proteins (1). The present study aims to characterize urine metabolomic profile of BBS patients, in order to identify both 1) potential disease biomarkers and 2) aberrant metabolic pathways underlying renal disease Method To this end, in the pilot study urine samples have been collected from 14 adult BBS patients and have been compared with healthy volunteers, using an untargeted strategy. In the confirmation study, 24 BBS patients with wide range of kidney dysfunction have been enrolled, and additional control groups, besides healthy subjects, were included: 1) age-gender-matched chronic kidney disease patients by other causes and 2) obese individuals. Results Several metabolites were de-regulated in BBS patients compared with normal subjects (lactic acid, glycolic acid,3-Hydroxypropionic acid, pyruvic acid, 3-hydroxyisobutyric acid, 2-ethyl-3-hydroxy-propionic acid, succinic acid, fumaric acid, erythropentonic acid, 2-hydroxyglutaric acid, 4-hydroxyphenyllactic acid, 3,4-pyridinedicarboxylic acid, retinoic acid, 4-hydroxyphenylacetic acid, palmitic acid, 9-Hexadecenoic acid, oleic acid and 9-Octadecenoic acid). The clusterization performed by MetaboAnalyst tool, revealed a possible deregulation of different metabolic pathways, including glycolysis, TCA cycle, pyruvate metabolism, lipids biosynthesis and glutamate metabolism (p-value <0.01) (figure 1); some of these pathways were described as de-regulated in other ciliopathies (2). In the confirmation study (on-going studies) some metabolites, including lactic acid and intermediates of Krebs cycle, correlated with kidney dysfunction only in the BBS group. Conclusion These findings suggest that urine metabolomic fingerprint of BBS patients is different from that of healthy subjects and indicate a possible deregulation of several metabolic pathways; some urinary molecules correlated with kidney dysfunction only in BBS patients, suggesting the specificity of these results.

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