The risk factors associated with COVID-19-Related death among patients with end-stage renal disease.

BACKGROUND: The extent to which patients with End-stage renal disease (ESRD) are at a higher risk of COVID-19-related death is still unclear. Therefore, the aim of this study was to identify the ESRD patients at increased risk of COVID-19 -related death and its associated factors. METHODS: This retrospective cohort study was conducted on 74 patients with ESRD and 446 patients without ESRD hospitalized for COVID-19 in Alborz province, Iran, from Feb 20 2020 to Apr 26 2020. Data on demographic factors, medical history, Covid-19- related symptoms, and blood tests were obtained from the medical records of patients with confirmed COVID-19. We fitted univariable and multivariable Cox regression models to assess the association of underlying condition ESRD with the COVID-19 in-hospital mortality. Results were presented as crude and adjusted Hazard Ratios (HRs) and 95% confidence intervals (CIs). In the ESRD subgroup, demographic factors, medical history, symptoms, and blood parameters on the admission of survivors were compared with non-survivors to identify factors that might predict a high risk of mortality. RESULTS: COVID-19 patients with ESRD had in-hospital mortality of 37.8% compared to 11.9% for those without ESRD (P value < 0.001). After adjusting for confounding factors, age, sex, and comorbidities, ESRD patients were more likely to experience in-hospital mortality compared to non-ESRD patients (Adjusted HR (95% CI): 2.59 (1.55-4.32)). The Log-rank test revealed that there was a significant difference between the ESRD and non-ESRD groups in terms of the survival distribution (χ2 (1) = 21.18, P-value < 0.001). In the ESRD subgroup, compared to survivors, non-survivors were older, and more likely to present with lack of consciousness or O2 saturation less than 93%; they also had lower lymphocyte but higher neutrophil counts and AST concentration at the presentation (all p -values < 0.05). CONCLUSIONS: Our findings suggested that the presence of ESRD would be regarded as an important risk factor for mortality in COVID-19 patients, especially in those who are older than age 65 years and presented with a lack of consciousness or O2 saturation less than 93%.

Psychological problems and reduced health-related quality of life in the COVID-19 survivors.

BACKGROUND: COVID-19 survivors are predicted to experience the long-term consequences, including pulmonary, neurologic, cardiovascular, and mental health sequelae. This systematic review and meta-analysis was performed on studies assessing the health-related quality of life (HRQoL) and psychiatric problems in COVID-19 survivors. METHODS: A systematic search was performed on PubMed, Embase, and Google scholar databases using key terms COVID-19, PTSD, depression, anxiety, HRQoL, survivors. Pooled estimates were calculated using the random-effects models. RESULTS: A total of 21 eligible articles were included. The pooled prevalence of PTSD, depression, and anxiety among COVID-19 survivors were 18% (95% CI: 13 to 23%, I2=88.23%), 12% (8 to 17%, I2=91.84%), and 17% (12 to 22%, I2=97.07%), respectively. COVID-19 survivors compared to pre-COVID-19 time and controls showed reduced HRQoL and a lower score in Social Functioning (SF) and Role Physical (RP), and Role Emotional (RE) health. Females compared to males had a higher risk of experiencing mental health problems. Also, patients with severe disease had a higher prevalence of depression and anxiety, but not PTSD. LIMITATIONS: Regarding HRQoL, we were not able to perform a subgroup analysis due to a lack of data. Also, the included studies mainly used a self-rating scale to detect psychological problems in their study population. CONCLUSION: A significant number of patients who survived from COVID-19 might suffer from PTSD, depression, and anxiety beyond one month. Our systematic review also found evidence of reduced HQOL and limited social role in these survivors.

Factors associated with the poor outcomes in diabetic patients with COVID-19.

PURPOSE: Diabetic's patients are supposed to experience higher rates of COVID-19 related poor outcomes. We aimed to determine factors predicting poor outcomes in hospitalized diabetic patients with COVID-19. METHODS: This retrospective cohort study included all adult diabetic patients with radiological or laboratory confirmed COVID-19 who hospitalized between 20 February 2020 and 27 April 2020 in Alborz province, Iran. Data on demographic, medical history, and laboratory test at presentation were obtained from electronic medical records. Diagnosis of diabetes mellitus was self-reported. Comorbidities including cancer, rheumatism, immunodeficiency, or chronic diseases of respiratory, liver, and blood were classified as "other comorbidities" due to low frequency. The assessed poor outcomes were in-hospital mortality, need to ICU care, and receiving invasive mechanical ventilation. Self-reported. Multivariate logistic regression models were fitted to quantify the predictors of in-hospital mortality from COVID-19 in patients with DM. RESULTS: Of 455 included patients, 98(21.5%) received ICU care, 65(14.3%) required invasive mechanical ventilation, and 79 (17.4%) dead. In the multivariate model, significant predictors of "death of COVID-19" were age 65 years or older (OR (95% CI): 2.0 (1.16-3.44), chronic kidney disease (CKD) (2.05 (1.16-3.62), presence of "other comorbidities" (2.20 (1.04-4.63)), neutrophil count ≥8.0 × 109/L)6.62 (3.73-11.7 ((, Hb level < 12.5 g/dl (2.05 (1.13-3.72) (, and creatinine level ≥ 1.36 mg/dl (3.10 (1.38-6.98)). (All p -values <0.05). Some of these factors were also associated with other assessed poor outcomes, e.g., need to ICU care or invasive mechanical ventilation. CONCLUSION: Diabetic patients with age 65 years or older, comorbidity CKD, "other comorbidities", as well as neutrophil count ≥8.0 × 109/L, Hb level < 12.5 g/dl, and creatinine level ≥ 1.36 mg/dl, were more likely to dead after COVID-19. Presence of hypertension and cardiovascular disease were associated with none of the poor outcomes.