Respiratory and Gastrointestinal COVID-19 Phenotypes in Kidney Transplant Recipients
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:104 |
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| Enthalten in: |
Transplantation - 104(2020), 11 vom: 01. Nov., Seite 2225-2233 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Crespo, Marta [VerfasserIn] |
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| Links: |
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| Themen: |
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| Anmerkungen: |
Date Completed 09.11.2020 Date Revised 06.05.2021 published: Print Citation Status MEDLINE |
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| doi: |
10.1097/TP.0000000000003413 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM313793840 |
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| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Mazuecos, Auxiliadora |e verfasserin |4 aut | |
| 700 | 1 | |a Rodrigo, Emilio |e verfasserin |4 aut | |
| 700 | 1 | |a Gavela, Eva |e verfasserin |4 aut | |
| 700 | 1 | |a Villanego, Florentino |e verfasserin |4 aut | |
| 700 | 1 | |a Sánchez-Alvarez, Emilio |e verfasserin |4 aut | |
| 700 | 1 | |a González-Monte, Esther |e verfasserin |4 aut | |
| 700 | 1 | |a Jiménez-Martín, Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Melilli, Edoardo |e verfasserin |4 aut | |
| 700 | 1 | |a Diekman, Fritz |e verfasserin |4 aut | |
| 700 | 1 | |a Zárraga, Sofía |e verfasserin |4 aut | |
| 700 | 1 | |a Hernández, Domingo |e verfasserin |4 aut | |
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