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INTRODUCTION: Chronic kidney disease (CKD) is a risk factor of acute ischemic stroke (AIS). Outcomes of treatment with mechanical thrombectomy (MT) in patients with CKD seem to be poorer than in the general population. Long-term follow-up studies are lacking. OBJECTIVES: Assessing short- and long-term outcomes (up to 365 days after stroke) in MT-treated AIS patients with concomitant CKD. PATIENTS AND METHODS: The study included all AIS patients treated with MT in a Comprehensive Stroke Center from 2019 to 2021. The subjects were divided into CKD group (best glomerular filtration rate during hospitalization <60 ml/min/1.73 m2 or CKD diagnosed in patient's medical history) and controls. In-hospital, 90-day and 365-day mortality and rate of good functional outcomes (defined as modified Rankin Scale ≤2) were compared between CKD patients and controls as well as between patients with CKD stages 1-3 (GFR ≥30ml/min/1.73m2) and 4-5 (GFR <30ml/min/1.73m2). Factors associated with abovementioned outcomes were identified using univariable logistic regression analyses and then added to multivariable analyses. RESULTS: CKD patients had higher 90- and 365-day mortality and lower 90- and 365-day good functional outcome rates than controls. Patients with CKD stage 4-5 had significantly higher in-hospital, 90-day and 365-day mortality than patients with CKD stage 1-3. Neither CKD nor its late stages (4-5) were independently associated with short- and long-term mortality and functional outcomes of MT. CONCLUSIONS: Outcomes of MT-treatment in CKD patients are worse, especially in advanced stages of the disease, but CKD is not independently associated with bad prognosis. CKD alone should not be a contraindication for MT in otherwise eligible patients, although patients with impaired kidney function require more careful postprocedural monitoring.
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Antifúngicos , Aspergilose , Transplante de Rim , Humanos , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/cirurgia , Masculino , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/etiologia , Pessoa de Meia-IdadeRESUMO
Introduction: Acute kidney injury (AKI) seems to worsen the prognosis of acute ischaemic stroke (AIS) patients treated with mechanical thrombectomy (MT). At the same time, the procedure of MT increases AKI risk by iodinated contrast use. Identification of factors predisposing to AKI after MT is important for recognizing vulnerable patients and successful prevention. Aim: To identify factors associated with the occurrence of AKI during hospitalization in MT-treated AIS patients. Material and methods: The study included all AIS patients treated with MT in the University Hospital in Krakow from 2019 to 2021. The diagnosis of AKI during hospitalisation was based on serum creatinine concentration levels, according to the Kidney Disease Improving Global Outcomes guidelines. We compared patients with and without AKI in terms of age, sex, comorbidities, stroke course and laboratory test results at admission. We identified factors associated with the occurrence of AKI using univariate logistic regression analysis, with significant variables subsequently added to the multivariate analyses. Results: Among 593 MT-treated AIS patients the incidence of AKI during hospitalisation was 12.6%. AKI development was associated with diabetes, chronic kidney disease, total volume of iodinated contrast obtained during hospitalisation, posterior circulation stroke, lack of intravenous thrombolysis, and laboratory test results at admission: haemoglobin, glucose, urea, potassium, and creatinine. Total contrast volume and urea level were the most important independent risk factors associated with occurrence of AKI. Conclusions: AKI is common in MT-treated AIS patients. There is a need to establish a protocol for decreasing the risk of AKI in AIS patients undergoing MT and, in case it occurs, a procedure for its treatment.
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INTRODUCTION: Acute kidney injury (AKI) is a serious and common complication of SARSCoV2 infection. Most risk assessment tools for AKI have been developed in the intensive care unit or in elderly populations. As the COVID19 pandemic is transitioning into an endemic phase, there is an unmet need for prognostic scores tailored to the population of patients hospitalized for this disease. OBJECTIVES: We aimed to develop a robust predictive model for the occurrence of AKI in hospitalized patients with COVID19. PATIENTS AND METHODS: Electronic medical records of all adult inpatients admitted between March 2020 and January 2022 were extracted from the database of a large, tertiary care center with a reference status in Lesser Poland. We screened 5806 patients with SARSCoV2 infection confirmed with a polymerase chain reaction test. After excluding individuals with lacking data on serum creatinine levels and those with a mild disease course (<7 days of inpatient care), a total of 4630 records were considered. Data were randomly split into training (n = 3462) and test (n = 1168) sets. A random forest model was tuned with feature engineering based on expert advice and metrics evaluated in nested crossvalidation to reduce bias. RESULTS: Nested crossvalidation yielded an area under the curve ranging between 0.793 and 0.807, and an average performance of 0.798. Model explanation techniques from a global perspective suggested that a need for respiratory support, chronic kidney disease, and procalcitonin concentration were among the most important variables in permutation tests. CONCLUSIONS: The CRACoVAKI model enables AKI risk stratification among hospitalized patients with COVID19. Machine learning-based tools may thus offer additional decisionmaking support for specialist providers.
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Injúria Renal Aguda , COVID-19 , Registros Eletrônicos de Saúde , Humanos , COVID-19/complicações , COVID-19/epidemiologia , Injúria Renal Aguda/etiologia , Masculino , Feminino , Pessoa de Meia-Idade , Polônia , Idoso , Adulto , Medição de Risco/métodos , SARS-CoV-2 , Algoritmos , Algoritmo Florestas AleatóriasRESUMO
Background: It is a well-known fact that COVID-19 affects the cardiovascular system by exacerbating heart failure in patients with preexisting conditions. However, there is a poor insight into the cardiovascular involvement and sequelae in patients without preexisting conditions. The aim of the study is to analyse the influence of COVID-19 on cardiac performance in patients without prior history of structural heart disease. The study is part of the CRACoV project, which includes a prospective design and a 12-month follow-up period. Material and methods: The study included 229 patients hospitalised with a diagnosis of COVID-19 (median age of 59 years, 81 were women). A standard clinical assessment and laboratory tests were performed in all participants. An extended echocardiographic image acquisition was performed at baseline and at a 3-, 6-, and 12-month follow-up. All analyses were performed off-line. A series of echocardiographic parameters was compared using repeated measures or Friedman analysis of variance. Results: In all subjects, the left ventricular (LV) ejection fraction at baseline was preserved [63.0%; Q1:Q3 (60.0-66.0)]. Elevated levels of high-sensitivity cardiac troponin T were detected in 21.3% of the patients, and elevated NT-proBNP levels were detected in 55.8%. At the 1-year follow-up, no significant changes were observed in the LV diameter and volume (LV 48.0 ± 5.2 vs. 47.8 ± 4.8â mm, p = 0.08), while a significant improvement of the parameters in the biventricular strain was observed (LV -19.1 ± 3.3% vs. -19.7 ± 2.5%, p = 0.01, and right ventricular -19.9 ± 4.5% vs. -23.2 ± 4.9%, p = 0.002). In addition, a decrease in the LV wall thickness was also observed (interventricular septum 10.4 ± 1.6 vs. 9.7 ± 2.0â mm, p < 0.001; LV posterior wall 9.8 ± 1.4 vs. 9.1 ± 1.5â mm, p < 0.001). Conclusions: In an acute phase of COVID-19, the elevation of cardiac biomarkers in patients with normal left ventricular ejection fraction is a frequent occurrence; however, it does not translate into clinically significant cardiac dysfunction after 1 year. The serial echocardiographic evaluations conducted in patients without preexisting structural heart disease demonstrate an overall trend towards an improved cardiac function and a reduced myocardial thickening at 1-year follow-up. This suggests that the acute cardiac consequences of COVID-19 are associated with systemic inflammation and haemodynamic stress in patients without preexisting conditions.
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INTRODUCTION: The clinical presentation of COVID19 may range from asymptomatic infection to severe disease. Previous studies reported a relationship between the course of COVID19 and a history of cardiovascular (CV) disease (CVD). OBJECTIVES: We aimed to analyze the influence of CV risk factors, established CVD, and treatment with CV drugs on short- and longterm survival in patients hospitalized for COVID19. PATIENTS AND METHODS: We retrospectively analyzed data of patients hospitalized in 13 COVID19 hospitals in Poland (between March and October 2020). Individual deaths during the followup were recorded until March 2021. RESULTS: Overall, 2346 patients with COVID19 were included (mean age, 61 years; 50.2% women). A total of 341 patients (14.5%) died during the hospitalization, and 95 (4.7%) died during the followup. Independent predictors of inhospital death were older age, a history of established CVD, heart failure, and chronic kidney disease (CKD), while treatment with reninangiotensinaldosterone system blockers or statins was associated with a lower risk of death during hospitalization. Factors that independently predicted death during the followup were older age, a history of established CVD, CKD, and a history of cancer. The presence of CV risk factors did not increase the odds of death either in the hospital or during the followup. Of note, higher systolic blood pressure and oxygen blood saturation on admission were associated with better short- and longterm prognosis. CONCLUSION: Established CVD and CKD were the main predictors of mortality during both the hospitalization and the followup in the patients hospitalized for COVID19, while the use of CV drugs during the hospitalization was associated with better prognosis. The presence of CV risk factors did not increase the odds of inhospital and postdischarge death.
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COVID-19 , Doenças Cardiovasculares , Insuficiência Renal Crônica , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Doenças Cardiovasculares/epidemiologia , COVID-19/complicações , Estudos Retrospectivos , Mortalidade Hospitalar , Assistência ao Convalescente , Fatores de Risco , Alta do Paciente , Fatores de Risco de Doenças CardíacasRESUMO
BACKGROUND: Cardiovascular diseases including arterial hypertension are common comorbidities among patients hospitalized due to COVID-19. We assessed the influence of preexisting hypertension and its pharmacological treatment on in-hospital mortality in patients hospitalized with COVID-19. METHODS: We studied all consecutive patients who were admitted to the University Hospital in Krakow, Poland, due to COVID-19 between March 2020 and May 2021. Data of 5191 patients (mean age 61.9±16.7 years, 45.2% female) were analyzed. RESULTS: The median hospitalization time was 14 days, and the mortality rate was 18.4%. About a quarter of patients had an established cardiovascular disease including coronary artery disease (16.6%) or stroke (7.6%). Patients with hypertension (58.3%) were older and had more comorbidities than patients without hypertension. In multivariable logistic regression analysis, age above median (64 years), male gender, history of heart failure or chronic kidney disease, and higher C-reactive protein level, but not preexisting hypertension, were independent risk factors for in-hospital death in the whole study group. Patients with hypertension already treated (n=1723) with any first-line antihypertensive drug (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, or thiazide/thiazide-like diuretics) had a significantly lower risk of in-hospital death (odds ratio, 0.25 [95% CI, 0.2-0.3]; P<0.001) compared to nontreated hypertensives (n=1305). CONCLUSIONS: Although the diagnosis of preexisting hypertension per se had no significant impact on in-hospital mortality among patients with COVID-19, treatment with any first-line blood pressure-lowering drug had a profound beneficial effect on survival in patients with hypertension. These data support the need for antihypertensive pharmacological treatment during the COVID-19 pandemic.
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COVID-19 , Doenças Cardiovasculares , Hipertensão , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Anti-Hipertensivos/uso terapêutico , COVID-19/complicações , Pandemias , Mortalidade Hospitalar , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipertensão/induzido quimicamente , Bloqueadores dos Canais de Cálcio/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Tiazidas/uso terapêutico , Doenças Cardiovasculares/epidemiologia , HospitalizaçãoRESUMO
INTRODUCTION: The course of consecutive COVID19 waves was influenced by medical and organizational factors. OBJECTIVES: We aimed to assess the outcomes of patients hospitalized for COVID19 during the first 3 waves of the pandemic. PATIENTS AND METHODS: We performed a retrospective analysis of medical records of all COVID19 patients admitted to the University Hospital in Kraków, Poland, a designated COVID19 hospital in Malopolska province, between March 1, 2020 and May 31, 2021. The waves were defined as 1, 2, and 3, and covered the periods of March 2020 to July 2020, August 2020 to January 2021, and February 2021 to May 2021, respectively. Patients' characteristics and outcomes for waves 1 through 3 were compared. RESULTS: Data analyses included 5191 patients with COVID19. We found differences in age (mean [SD], 60.2 [17.3] years vs 62.4 [16.8] years vs 61.9 [16.1] years, respectively, for waves 1, 2, and 3; P = 0.003), sex distribution (proportion of women, 51.4% vs 44.2% vs 43.6%; P = 0.003), as well as concentrations of inflammatory markers and oxygen saturation (the lowest and the highest for wave 1, respectively; P <0.001). Hospital death rates in subsequent waves were 10.4%, 19.8%, and 20.3% (P <0.001). Despite similarities in patients' characteristics, the length of hospital and intensive care unit stay was shorter for wave 3 than for wave 2. The risk factors for inhospital death were: advanced age, male sex, cardiovascular or chronic kidney disease, higher Creactive protein level, and hospitalization during the second or third wave. CONCLUSIONS: We identified differences in patients' clinical characteristics and outcomes between consecutive pandemic waves, which probably reflect changes in terms of COVID19 isolation policy, hospitalization and treatment indications, and treatment strategies.
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COVID-19 , Pandemias , Feminino , Humanos , Masculino , Proteína C-Reativa , COVID-19/epidemiologia , Mortalidade Hospitalar , Hospitais Universitários , Pandemias/estatística & dados numéricos , Estudos Retrospectivos , Polônia/epidemiologia , Adulto , Pessoa de Meia-Idade , IdosoRESUMO
Background and objectives: Anemia is common in multiple myeloma (MM) and is caused by a complex pathomechanism, including impaired iron homeostasis. Our aim is to evaluate the biomarkers of iron turnover: serum soluble transferrin receptor (sTfR) and hepcidin-25 in patients at various stages of MM in relation with markers of anemia, iron status, inflammation, renal impairment and burden of the disease and as predictors of mortality. Materials and methods: Seventy-three MM patients (six with smoldering and 67 with symptomatic disease) were recruited and observed for up to 27 months. Control group included 21 healthy individuals. Serum sTfR and hepcidin were measured with immunoenzymatic assays. Results: MM patients with and without anemia had higher sTFR compared to controls, while only anemic patients had higher hepcidin-25. Both hepcidin-25 and sTfR were higher in anemic than non-anemic patients. Higher hepcidin-25 (but not sTfR) was associated with increasing MM advancement (from smoldering to International Staging System stage III disease) and with poor response to MM treatment, which was accompanied by lower blood hemoglobin and increased anisocytosis. Neither serum hepcidin-25 nor sTfR were correlated with markers of renal impairment. Hepcidin-25 predicted blood hemoglobin in MM patients independently of other predictors, including markers of renal impairment, inflammation and MM burden. Moreover, both blood hemoglobin and serum hepcidin-25 were independently associated with patients' 2-year survival. Conclusions: Our results suggest that hepcidin-25 is involved in anemia in MM and its concentrations are not affected by kidney impairment. Moreover, serum hepcidin-25 may be an early predictor of survival in this disease, independent of hemoglobin concentration. It should be further evaluated whether including hepcidin improves the early diagnosis of anemia in MM.
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Anemia , Hepcidinas , Nefropatias/complicações , Mieloma Múltiplo , Anemia/complicações , Hemoglobinas , Hepcidinas/sangue , Humanos , Mieloma Múltiplo/complicações , Receptores da Transferrina/sangueRESUMO
Background and Objectives: Urine insulin-like growth factor-binding protein 7 (IGFBP-7), tissue inhibitor of matrix metalloproteinase 2 (TIMP-2), and neutrophil gelatinase-associated lipocalin (NGAL) monomer are novel tubular kidney injury biomarkers. In multiple myeloma (MM), immunoglobulin free light chains (FLCs) play an integral role in renal impairment. This study aimed to investigate the correlation between new biomarkers and acclaimed parameters of renal failure, MM stage, and prognosis. Materials and Methods: The examined parameters included: urinary and serum cystatin-C, IGFBP-7, and TIMP-2, and urinary NGAL monomer in 124 enrolled patients. Results: Urinary and serum IGFBP-7 and urinary NGAL were higher among patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, and positively correlated with urine light chains. Serum and urine IGFBP-7 and urine NGAL were greater among patients with a higher disease stage. In the whole study group, urinary concentrations of the studied markers were positively correlated with each other. In multiple linear regression, urinary IGFBP-7 and NGAL were associated with lower eGFR, independently of other urinary markers. Conclusions: Urinary IGFBP-7 and NGAL monomer may be useful markers of tubular renal damage in patients with MM. Biomarker-based diagnostics may contribute to earlier treatment that may improve renal outcomes and life expectancy in MM.
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Proteínas de Ligação a Fator de Crescimento Semelhante a Insulina/genética , Lipocalina-2/genética , Mieloma Múltiplo , Insuficiência Renal , Proteínas de Fase Aguda , Biomarcadores , Taxa de Filtração Glomerular , Humanos , Mieloma Múltiplo/diagnóstico , Proteínas Proto-Oncogênicas , Insuficiência Renal/etiologia , Inibidor Tecidual de Metaloproteinase-2RESUMO
BACKGROUND: The coronavirus disease 19 (COVID-19) recently became one of the leading causes of death worldwide, similar to cardiovascular disease (CVD). Coexisting CVD may influence the prognosis of patients with COVID-19. AIMS: We analyzed the impact of CVD and the use of cardiovascular drugs on the in-hospital course and mortality of patients with COVID-19. METHODS: We retrospectively studied data for consecutive patients admitted to our hospital, with COVID-19 between March 6th and October 15th, 2020. RESULTS: 1729 patients (median interquartile range age 63 [50-75] years; women 48.8%) were included. Overall, in-hospital mortality was 12.9%. The most prevalent CVD was arterial hypertension (56.1%), followed by hyperlipidemia (27.4%), diabetes mellitus (DM) (25.7%), coronary artery disease (16.8%), heart failure (HF) (10.3%), atrial fibrillation (13.5%), and stroke (8%). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) were used in 25.0% of patients, ß-blockers in 40.7%, statins in 15.6%, and antiplatelet therapy in 19.9%. Age over 65 years (odds ratio [OR], 6.4; 95% CI, 4.3-9.6), male sex (OR, 1.4; 95% CI, 1.1-2.0), pre-existing DM (OR, 1.5; 95% CI, 1.1-2.1), and HF (OR, 2.3; 95% CI, 1.5-3.5) were independent predictors of in-hospital death, whereas treatment with ACEIs/ARBs (OR, 0.4; 95% CI, 0.3-0.6), ß-blockers (OR, 0.6; 95% CI, 0.4-0.9), statins (OR, 0.5; 95% CI, 0.3-0.8), or antiplatelet therapy (OR, 0.6; 95% CI: 0.4-0.9) was associated with lower risk of death. CONCLUSIONS: Among cardiovascular risk factors and diseases, HF and DM appeared to increase in-hospital COVID-19 mortality, whereas the use of cardiovascular drugs was associated with lower mortality.