The Effect of Nosocomial Infection on the Severity and Outcome of the Disease in Patients with Severe and Extremely Severe COVID-19

The mechanisms of development of nosocomial infectious complications in COVID-19 and the contribution of bacterial and mycotic superinfection to the formation of extremely high mortality among patients with severe and extremely severe course of this disease have not yet been fully revealed. The objective: to study epidemiology, risk factors for the development of nosocomial superinfection, and its effect on the severity and outcome of the disease in patients with COVID-19.Subjects and Methods. 383 cases of severe and extremely severe COVID-19 were retrospectively analyzed. Demographic data, the presence of concomitant diseases, community-acquired co-infection at the time of hospitalization, data on the methods used to treat new coronavirus infection, severity of the course of the disease, developed infectious complications and their etiology, and the disease outcome were studied. Risk factors for the development of secondary infectious complications and the contribution of nosocomial superinfection to the severity of COVID-19 and the disease outcome were evaluated.Results. Risk factors for the development of secondary infectious complications include age over 65 years (OR 1.04; 95% CI 1.03–1.06; p < 0.0001), concomitant cardiovascular pathology (OR 3.82; 95% CI 2.02‒7.19; p < 0.0001), chronic kidney disease, including requiring renal replacement therapy (OR 2.01; 95% CI 1.33–3.02; p = 0.0007), and glucocorticoid therapy (OR 1.62; 95% CI 1.02–2.69; p = 0.04). The development of nosocomial infectious complications in patients with COVID-19 is associated with a more severe course of the disease and unfavorable prognosis (OR 13.44; 95% CI 8.23‒21.92; p < 0.0001).Conclusion. Identification of risk factors for the development of secondary infectious complications in COVID-19 allows developing differentiated approaches to the pathogenetic treatment of patients with severe COVID-19, increasing alertness in terms of the development of nosocomial infections, ensuring their timely diagnosis and treatment.

Download Full-text

THU0300 RISK FACTORS FOR COMPLICATIONS AND REFRACTORY COURSE IN PATIENTS WITH ANCA-ASSOCIATED SYSTEMIC VASCULITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6460 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 378.2-378

Author(s):

A. Chudinov ◽

I. Belyaeva ◽

M. Pervakova ◽

V. Mazurov ◽

O. Inamova ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Induction Therapy ◽

Granulomatosis With Polyangiitis ◽

Disease Risk ◽

Systemic Vasculitis ◽

Cardiovascular Complications ◽

Infectious Complications ◽

Eosinophilic Granulomatosis With Polyangiitis

Background:ANCA-associated systemic vasculitis (AAV) is characterized by a high incidence of complications and high mortality. The most significant complications during the first 3 years of the disease are infectious and cardiovascular. Development of chronic kidney disease also impairs the prognosis of AAV. Refractory to induction therapy can significantly increase the severity of organ lesions in patients with AAV.Objectives:The aim of this study was to determine risk factors for complications and refractory course in patients with AAV.Methods:Patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA) were observed during the first 3 years of the disease and included in this study between 2010 and 2018. Most common infectious complications requiring inpatient treatment were pneumonia, mycosis, sepsis, purulent arthritis, purulent otitis media. Cardiovascular complications included pulmonary thromboembolism, myocardial infarction, ischemic stroke, venous thrombosis.Results:In total 209 (165 [79%] female and mean age 51.8 ± 13.2 years) AAV patients (94 GPA; 46 MPA; and 69 EGPA) were included in the analysis. Risk factors for infectious complications were BVAS level at the beginning of induction therapy > 25 (OR – 2.92, 95% CI (1.53;5.45) p<0.001), usage of prednisone in doses more than 60 mg / day at the induction of remission (OR – 2.76, 95% CI (1.45;5.29) p=0.003), usage of prednisone in doses ≥ 10 mg / day after 6 months of induction therapy (OR – 2.60, 95% CI (1.38;4.93) p=0.003), ANCA-PR3 positivity (OR – 2.25, 95% CI (1.13;4.46) p=0.017) and presence of diabetes mellitus in the AAV onset (OR – 1.77, 95% CI (1.14;3.45) p=0.038). Patients with AAV had following risk factors for cardiovascular complications: male (OR – 2.28, 95% CI (1.33;3.88) p=0.002), BVAS level > 25 (OR – 2.1, 95% CI (1.11;3.16) p=0.008) and presence of coronary artery disease in the AAV onset (OR – 2.2, 95% CI (1.18;4.10) p=0.015). ANCA positivity (OR – 5.62, 95% CI (2.1;14.9) p<0.001), presence of rapidly progressive glomerulonephritis in the first 3 months from onset AAV (OR – 5.02, 95% CI (3.42;7.35) p<0.001) and over 60 years of age (OR – 2.17, 95% CI (1.38;3.44) p=0.001) were risk factors of development of chronic kidney disease. Risk factors for refractory to induction therapy in patients with AAV were ANCA-PR3 positivity (OR – 3.13, 95% CI (1.63;6.02) p<0.001), BVAS level > 25 (OR – 2.63, 95% CI (1.74;4.34) p<0.001), initiation of therapy after 4 months from the onset of clinical manifestations (OR – 2.17, 95% CI (1.26;3.91) p=0.005). We additionally defined that identification of pathological phenotypes of alpha-1-antitrypsin was risk factors for refractory course in patients with GPA manifestations (OR – 2.66, 95% CI (1.12;6.33) p=0.048).Conclusion:Our study has shown that high disease activity, ANCA positivity and comorbid pathology increase risk of serious complications. Early administration of immunosuppressive therapy, adequate steroid dosing and use of risk factors for complications and refractory course in clinical practice can significantly improve the prognosis of AAV.Disclosure of Interests:None declared

Download Full-text

Early screening of chronic kidney disease patients among the asymptomatic adult population in Bangladesh

Journal of Preventive Epidemiology ◽

10.34172/jpe.2020.10 ◽

2020 ◽

Vol 5 (1) ◽

pp. e10-e10

Author(s):

Zebunnesa Zeba ◽

Kaniz Fatema ◽

Ahmed Faisal Sumit ◽

Rahelee Zinnat ◽

Liaquat Ali

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Large Scale ◽

Screening Program ◽

Kidney Diseases ◽

Demographic Data ◽

Adult Population ◽

Control Group ◽

Asymptomatic Adult

Introduction: Early identification of chronic kidney disease (CKD) provides valuable opportunities for effective interventions that reduce the risk of outcomes, particularly renal failure. Objectives: This study aimed to screen the Bangladeshi asymptomatic adult population for CKD to identify potential risk factors for its development. Patients and Methods: The screening program was carried out among the 400 subjects in the Thakurgaon district of Bangladesh to identify people with the risk of CKD. All the subjects were asymptomatic and previously been never diagnosed with kidney diseases. Demographic data were collected by a structured questionnaire. Urinary protein was tested by dipstick method, and serum creatinine was measured by an auto-analyzer. Estimated glomerular filtration rate (eGFR) was calculated by using standard formula. CKD was diagnosed and classified according to the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines. Results: A total of 18.2% respondents were found to have likely CKD to whom 82% were in stage 1 and 18% were in stage 2. The majority of the likely CKD respondents (30.1%) were in age >60 years. The prevalence of proteinuria was significantly (P=0.0001) higher among previously documented CKD patients compared to the control group. Logistic analysis revealed that after adjustments, CKD showed a significant association with diabetes mellitus (ORs: 7.46, P=0.00), smoking (ORs: 2.36, P=0.02), obesity (ORs: 3.98, P=0.00) and hypertension (ORs: 1.16, P=0.66) compared to control. Conclusion: A substantial number of adults were found to be unaware of the existence of CKD hence, large-scale prevention programs should be undertaken to reduce the classical risk factors of these disorders.

Download Full-text

Peritonites in peritoneal dialysis patients

Revista dos Trabalhos de Iniciação Científica da UNICAMP ◽

10.20396/revpibic262018382 ◽

2018 ◽

Author(s):

Emanuelle Barbara Dias Tomaz ◽

Plínio Trabasso ◽

Gabriela Jorge Trigo Alves ◽

Rodrigo Bueno de Oliveira

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Kidney Disease ◽

Replacement Therapy ◽

Dialysis Patients ◽

Fungal Peritonitis ◽

Bacteria And Fungi ◽

Etiological Agents

Peritonitis is one of the most common complications of the population with chronic kidney disease on peritoneal dialysis. The most frequent etiological agents are bacteria and fungi, the latter being responsible for 2 to 5% of the total cases of this type of infection. Fungal peritonitis is severe and its occurrence requires immediate removal of the catheter and transfer of renal replacement therapy for hemodialysis. The present study aimed to retrospectively study the risk factors and clinical outcomes of patients at the Centro Integrado de Nefrologia (CIN) of the Hospital das Clínicas da UNICAMP, who presented bacterial or fungal peritonitis, comparing them to peritoneal dialysis patients who did not present peritonitis.

Download Full-text

Prevention and drug therapy in chronic kidney disease

ESC CardioMed ◽

10.1093/med/9780198784906.003.0239 ◽

2018 ◽

pp. 993-999

Author(s):

Stephan Segerer ◽

Harald Seeger

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Renal Function ◽

Heart Disease ◽

Drug Therapy ◽

Renal Replacement Therapy ◽

Kidney Disease ◽

Replacement Therapy ◽

Vascular Risk Factors ◽

Function Loss

Three major goals need to be addressed in the treatment of patients with chronic kidney disease: (1) progression of renal function loss needs to be inhibited by treatment of risk factors, (2) co-morbidities and vascular risk factors have to be treated, and (3) the patient must be educated about and prepared for renal replacement therapy. During the progressive loss of renal function, the treatment necessities and medication doses need to be adjusted. Therefore, the treatment of heart disease differs between patients with normal and decreased renal function.

Download Full-text

КОРЕКЦІЯ ПОТЕНЦІЙНО МОДИФІКОВАНИХ ФАКТОРІВ РИЗИКУ ПРИ ЛІКУВАННІ МЕТОДОМ ГЕМОДІАЛІЗУ: СТАНДАРТИ ЛІКУВАННЯ І ІНДИВІДУАЛЬНІ ДІАЛІЗНІ ПРОГРАМИ

Medical Informatics and Engineering ◽

10.11603/mie.1996-1960.2014.2.3839 ◽

2015 ◽

Author(s):

I. L. Kuchma

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Renal Replacement Therapy ◽

Kidney Disease ◽

Arterial Hypertension ◽

Mathematical Models ◽

Chronic Kidney Disease Stage ◽

Disease Stage ◽

Treatment Standards ◽

Death Risk

<p>In the effect prognosis of dialysis a possible adjustment of the modified potential death risk factors of patients who are on renal replacement therapy by hemodialysis techniques are discussed. The conclusions about the possibility of modern dialysis techniques to effectively influence on arterial hypertension of patients with chronic kidney disease stage 5 - D and the need for further study in order to develop treatment standards using mathematical models for individualised dialysis programs.</p>

Download Full-text

Analysis of Prognostic Significance of Risk Factors for Development of Chronic Kidney Disease

Bulletin of Science and Practice ◽

10.33619/2414-2948/58/15 ◽

2020 ◽

Vol 6 (9) ◽

pp. 167-173

Author(s):

F. Babayev

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Renal Replacement Therapy ◽

Kidney Disease ◽

Replacement Therapy ◽

Prognostic Significance ◽

Point Of View ◽

Deficiency Anemia ◽

Positive Trend ◽

The Republic

Currently, more than two million people receive renal replacement therapy worldwide, but it is estimated that this is only 10% of patients in need. From this point of view, it is extremely important to increase caution about identifying risk factors and causes of chronic kidney disease in order to prevent it in a timely manner at the primary level. In Azerbaijan, an increase in patients on hemodialysis in dynamics was revealed. At the same time, both the number of hemodialysis centers and devices for hemodialysis increases. The number of dialysis machines from 2014 to 2019 tended to increase by +15.8% in 2015, +16.9% in 2016, +13.0% in 2017, +1.7% in 2018, +3.3% in 2019. The provision of patients with hemodialysis devices increased from 0.4 in 2014 to 0.7 per 10 thousand of the population in 2019. The positive trend in dialysis sessions received by patients in the republic was +16.7% in 2017, +12.1% in 2016, +5.4% in 2015, +1.3% in 2018, +0.3% in 2019. In the Javad-zade Republican Clinical Urological Hospital, an increase in dialysis sessions was noted in 2016 (+9.4%), 2016 (+9.4%) and 2017 (+5.2%). Identification of possible effects of risk factors for chronic kidney disease showed that in men, polycystic kidney disease had a statistically significant effect (RR=1.470, 95% CI 1.007–2.146), and in women, obesity (RR=3.366, 95% CI 2.286–4.954), iron deficiency anemia (RR=2.859, 95% CI 2,516–3,249). It is necessary to guarantee state financial support for renal replacement therapy for patients with chronic kidney disease, as well as state support for the development of dialysis centers.

Download Full-text

Patients with CKD-5D and COVID infection. Individual organizational and clinical issues of therapy

Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) ◽

10.20340/vmirvz.2021.2.covid.1 ◽

2021 ◽

Author(s):

P. V. Morinets ◽

А. S. Navasardyan ◽

Е. А. Strebkova ◽

P. Е. Коmarov ◽

S. I. Popova ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Replacement Therapy ◽

Kidney Disease ◽

Replacement Therapy ◽

Social Problem ◽

Underlying Disease ◽

Regional Center ◽

Dosage Regimens ◽

Coronavirus Infection ◽

Special Risk

New coronavirus infection (COVID-19) – a serious medical and social problem. Despite the achievement of certain successes in the treatment of patients with COVID-19, there is a need to develop special clinical and organizational approaches in patients with CKD who are on renal replacement therapy and are at special risk due to the course of the underlying disease and concomitant pathology. The article presents the experience of the Samara Regional Center of Nephrology and Dialysis of the Samara Regional Clinical Hospital named after V.D. Seredavin during the pandemic, as well as the features of the management of patients with stage 5 chronic kidney disease undergoing renal replacement therapy in the infectious department to provide MP to patients with COVID-19. Patients with CKD require increased attention, treatment of coronavirus infection (both specific and concomitant) should be carried out in full, while observing the regimens and dosage regimens of drugs and their combinations.

Download Full-text