Identifying prognostic risk factors for poor outcome following COVID-19 disease among in-centre haemodialysis patients: role of inflammation and frailty

Hendra, Heidy; Vajgel, Gisele; Antonelou, Marilina; Neradová, Aegida; Manson, Bethia; Clark, Sarah Grace; Kostakis, Ioannis D.; Caplin, Ben; Salama, Alan D.

doi:10.1007/s40620-020-00960-5

Cited by 24 publications

(45 citation statements)

References 29 publications

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“…The most common health outcome reported was mortality (37 studies; 71.2%) 8,19,23,24,26,27,29,31–37,40–45,47–52,54–57,59,62–65,68,69 . The pooled odds ratio (OR) for unadjusted data associating frailty based on the CFS with mortality was 2.02 (95% confidence interval [CI] 1.62–2.51; I 2 83%; Figure S1).…”

Section: Resultsmentioning

confidence: 99%

Association of frailty with outcomes in individuals with COVID‐19: A living review and meta‐analysis

Dumitrascu

Branje

Hladkowicz

et al. 2021

J American Geriatrics Society

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Background and Objectives: Frailty leaves older adults vulnerable to adverse health outcomes. Frailty assessment is recommended by multiple COVID-19 guidelines to inform care and resource allocation. We aimed to identify, describe, and synthesize studies reporting the association of frailty with outcomes (informed by the Institute for Healthcare Improvement's Triple Aim [health, resource use, and experience]) in individuals with COVID-19.Design: Systematic review and meta-analysis. Setting: Studies reporting associations between frailty and outcomes in the setting of COVID-19 diagnosis. Participants: Adults with COVID-19.Measurements: Following review of titles, abstracts and full text, we included 52 studies that contained 118,373 participants with COVID-19. Risk of bias was assessed using the Quality in Prognostic studies tool. Our primary outcome was mortality, secondary outcomes included delirium, intensive care unit admission, need for ventilation and discharge location. Where appropriate, random-effects meta-analysis was used to pool adjusted and unadjusted effect measures by frailty instrument.Results: The Clinical Frailty Scale (CFS) was the most used frailty instrument. Mortality was reported in 37 studies. After confounder adjustment, frailty identified using the CFS was significantly associated with mortality in COVID-19 positive patients (odds ratio 1.79, 95% confidence interval [CI] 1.49-2.14; hazard ratio 1.87, 95% CI 1.33-2.61). On an unadjusted basis, frailty identified using the CFS was significantly associated with increased odds of delirium and reduced odds of intensive care unit admission. Results were generally consistent using other frailty instruments. Patient-reported, cost and experience outcomes were rarely reported. Conclusion:Frailty is associated with a substantial increase in mortality risk in COVID-19 patients, even after adjustment. Delirium risk is also increased. Frailty assessment may help to guide prognosis and individualized care

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Section: Resultsmentioning

confidence: 99%

Association of frailty with outcomes in individuals with COVID‐19: A living review and meta‐analysis

Dumitrascu

Branje

Hladkowicz

et al. 2021

J American Geriatrics Society

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“…In research articles reporting clinical manifestation and outcome of COVID-19 patients (78[54.4%]) the diagnosis of SARS-CoV-2 infection relied principally on RT-PCR (52[63.4%]) [ 11 – 20 , 32 , 61 , 62 , 69 , 93 , 94 , 100 , 108 – 111 , 113 , 115 – 124 , 126 , 129 , 132 , 134 , 135 , 138 – 151 ], serology (4[6.3%]) [ 18 , 20 , 22 – 24 , 86 , 99 ], RT-PCR and serological assay (5[6.6%])[ 29 – 31 , 85 , 127 , 152 ] or a combination of diagnostic tests including clinical evaluation [ 6 , 13 , 19 , 21 , 112 , 114 , 125 , 128 , 130 , 131 , 133 , 136 , 137 , 153 , 154 ].…”

Section: Resultsmentioning

confidence: 99%

“…All outcome measures were influenced by the sample size, the age of patients, length of follow-up and policy of healthcare delivery. Excluding studies reporting outcome of patient admitted to hospital as a preventive measure and regardless of symptoms, we found that hospitalization of HD patients varied from 35 to 88.2% [ 11 – 13 , 17 , 21 , 32 , 62 , 82 , 93 , 109 , 114 , 116 , 118 , 120 , 127 , 129 , 133 , 136 – 138 , 144 , 145 , 150 , 154 ]. with a percentage of patients requiring ICU admission of 2.6–70.5% [ 6 , 13 , 17 , 21 , 32 , 62 , 109 , 114 , 116 , 118 , 119 , 121 , 125 , 126 , 129 – 134 , 136 , 138 , 143 , 154 ].…”

Section: Resultsmentioning

confidence: 99%

“…Age of confirmed COVID-19 patients on HD was largely heterogeneous since principally tends to reflect national policy of access to dialysis treatment. Median and mean age of this large cohort of patients ranged between 48 and 79.5 years [11,15,17,21,23,61,82,94,[108][109][110][111][112][113][114][115][116][117][118][119][120][121][122] and 54.1-76 years, [6,19,25,31,32,69,93,[123][124][125][126][127][128][129][130][131][132][133][134][135] respectively. The percentage of male was 37.5%-100% of the examined population [11,13,15,17,19,…”

Section: Demographic and Clinical Characteristics Of The Confirmed Covid-19 Hd Patientsmentioning

confidence: 99%

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The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

et al. 2021

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Background Patients undergoing in-centre haemodialysis (HD) are particularly exposed to the dire consequences of COVID-19. The present systematic scoping review aims to identify the extent, range, and nature of articles related to COVID-19 and maintenance HD: it reports specifically the prevalence of the COVID-19 pandemic in the HD population, implementation of strategies for the prevention, mitigation and containment of the COVID-19 pandemic in HD centres, demographic and clinical characteristics, and outcomes of the pediatric and adult HD patients. Methods A multi-step systematic search of the literature in Pubmed, Scopus, Ovid Medline, Embase and Web of Science, published between December 1, 2019, and January 30, 2021 was performed. Two authors separately screened the titles and abstracts of the documents and ruled out irrelevant articles. A report of the papers that met inclusion criteria was performed; then, a descriptive analysis of the characteristics of the included articles and a narrative synthesis of the results were performed. Results The review process ended with the inclusion of 145 articles. Most of them were based on single-centre experiences, which spontaneously developed best practices. Most studies were conducted in high-income countries (69.7%) and a part of them (9.6%) were not in English. Prevalence of COVID-19 among dialysis patients accounted for 0%-37.6%. Preventive measures were reported in 54% of the included articles, with particular emphasis on education, triage, hygiene, and containment measures. Patients experienced a heterogeneous spectrum of symptoms that led 35%-88.2% of them to hospital admission. Median and mean hospital length of stay ranged from 8 to 28.5 and 16.2 to 22 days, respectively. Admission to intensive care units varied widely across studies (from 2.6% to 70.5%) and was associated with high mortality (42.8%-100%). Overall, prognosis was poor in 0%-47% of the hospitalized patients. Conclusions This systematic scoping review provides an overview of the current knowledge on the impact of COVID-19 on the frail world of HD patients. Furthermore, it may help to implement the existing strategies of COVID-19 prevention and provide a list of unmet needs (safe transport, testing, shelter). Finally, it may be a stimulus for performing systematic reviews and meta-analyses which will form the basis for evidence-based guidelines.

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“…Hendra et al in their study assessed HD patients with the mortality rate after testing positive for the novel SARS-CoV-2 by RT-PCR and identified prognostic risk factors associated with poor outcome including age, frailty and markers of inflammation [17].…”

Section: Discussionmentioning

confidence: 99%

The frailty phenotype in hemodialysis patients and its association with biochemical markers of mineral bone disorder, inflammation and nutrition

Mutevelić-Turković

Resić

Roljić

et al. 2022

Romanian Journal of Internal Medicine

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Introduction: Frailty is a state of increased vulnerability to physical stressors. It is common in patients with end-stage renal disease (ESRD) who are on hemodialysis (HD). The aim of this study was to analyze the presence of frailty phenotype among HD patients and to evaluate their interrelationship with different biochemical markers. Methods: For the frailty assessment the Frailty Phenotype by Fried et al. was used, where frailty was reported if three of the following criteria were met: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and low physical activity. From 281 HD patients, 126 patients were frail, 58 were pre-frail (two criteria were met) and the rest of the study population were robust (97 patients). BMI was calculated for all patients and venous blood samples were taken to determine laboratory parameters for bone alkaline phosphatase (BAP), phosphate (P), potassium (K), C-reactive protein (CRP) and albumin. Results: Patients who were on HD longer than 60 months have more characters of frailty. (p=0.019). A statistically significant positive correlations between frailty score and BAP (rho = 0.189; p = 0.001), and CRP (rho = 0.233; p < 0.001) were observed, and significant negative correlations between frailty score and albumin (rho = - 0.218; p < 0.001) and K (rho = - 0.198; p = 0.001). Conclusions: The associations of frailty with markers of mineral bone disorder, inflammation and nutrition indicate the importance of these parameters in the indirect assessment of the frailty phenotype in HD patients.

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Identifying prognostic risk factors for poor outcome following COVID-19 disease among in-centre haemodialysis patients: role of inflammation and frailty

Cited by 24 publications

References 29 publications

Association of frailty with outcomes in individuals with COVID‐19: A living review and meta‐analysis

Association of frailty with outcomes in individuals with COVID‐19: A living review and meta‐analysis

The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

The frailty phenotype in hemodialysis patients and its association with biochemical markers of mineral bone disorder, inflammation and nutrition

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