Respiratory and Gastrointestinal COVID-19 Phenotypes in Kidney Transplant Recipients
Por:
Crespo M, Mazuecos A, Rodrigo E, Gavela E, Villanego F, Sánchez-Alvarez E, González-Monte E, Jiménez-Martín C, Melilli E, Diekman F, Zárraga S, Hernández D and Pascual J
Publicada:
1 nov 2020
Ahead of Print:
13 ago 2020
Categoría:
Transplantation
Resumen:
Background.
Coronavirus infectious disease 2019 (COVID-19) pandemic has posed at risk the kidney transplant (KT) population. We describe clinical pictures, risk factors for death, and chances to recovery in a large cohort of KT recipients with COVID-19.
Methods.
Inclusion in a Spanish prospectively filled registry was allowed for KT cases with confirmed COVID-19. Outcomes were assessed as in-hospital mortality or recovery.
Results.
The study population comprised of 414 patients. Fever, respiratory symptoms, and dyspnea were the most frequent COVID-19-related symptoms, and 81.4% of them had pneumonia. More than one-third of patients showed digestive symptoms at diagnosis, combinations of nausea, vomiting, and diarrhea. Most patients were hospitalized, 12.1% in intensive care units, and 17.6% needed ventilator support. Treatment for COVID-19 included frequently hydroxychloroquine, azithromycin, high-dose steroids, lopinavir/ritonavir, and tocilizumab. After a mean follow-up of 44 days, the fatality rate was 26.3%. Pneumonia without gastrointestinal symptoms was associated with a 36.3% mortality (respiratory phenotype), and gastrointestinal symptoms without pneumonia with a 5.3% mortality (gastrointestinal phenotype). The mixed pneumonia and gastrointestinal phenotype showed an intermediate mortality of 19.5% (mixed phenotype). Multivariate Cox regression analysis showed that age and pneumonia were independently associated with death, whereas the gastrointestinal phenotype was associated with recovery.
Conclusions.
COVID-19 is frequent among the KT population. Advanced age and pneumonia are the main clinical features associated with a high-mortality rate. Gastrointestinal disease is associated with a more benign course and lower mortality.
Filiaciones:
Crespo M:
Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain
Mazuecos A:
Department of Nephrology, Hospital Puerta del Mar, Cádiz, Spain
Rodrigo E:
Department of Nephrology, Hospital Marqués de Valdecilla, Santander, Spain
:
Department of Nephrology, Hospital Doctor Peset, Valencia, Spain
Villanego F:
Department of Nephrology, Hospital Puerta del Mar, Cádiz, Spain
Sánchez-Alvarez E:
Department of Nephrology, Hospital de Cabueñes, Gijón, Spain
González-Monte E:
Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
Jiménez-Martín C:
Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
Melilli E:
Department of Nephrology, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
Diekman F:
Department of Nephrology and Kidney Transplantation, Hospital Clinic, Barcelona, Spain
Zárraga S:
Department of Nephrology, Hospital de Cruces, Bilbao, Spain
Hernández D:
Department of Nephrology, Hospital Regional Universitario Carlos Haya, University of Málaga, IBIMA, REDinREN (RD16/0009/0006) Málaga, Spain
Pascual J:
Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain
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