Novembre Dicembre 2021

Acute severe respiratory distress in chronic haemodialytic patients affected by SARS-CoV-2 pneumonia: prevalence and associated factors. A single-centre experience from Cardarelli Hospital in Naples (Italy)

Abstract

Background: SARS‑CoV‑2-induced severe acute respiratory syndrome is associated with high mortality in the general population; however, the data on chronic haemodialysis (HD) patients are currently scarce.
Methods: We performed a retrospective analysis to evaluate the onset of acute respiratory distress syndrome (ARDS) in patients with SARS‑CoV‑2-induced interstitial pneumonia diagnosed by PCR test and detected by high resolution computed tomography (HRCT). For each patient, we calculated a CT score between 0 and 24, based on the severity of pneumonia. The primary outcome was the onset of ARDS, detected by P/F ratio >200. We included 57/90 HD patients (age: 66.5 ±13.4 years, 61.4 % males, 42.1% diabetics, 52.6% CV disease) treated at the Cardarelli Hospital in Naples (Italy) from 1st September 2020 to 31st March 2021. All patients were treated with intermittent HD.
Results: Patients who experienced ARDS had a more severe pneumonia (CT score: 15 [C.I.95%:10-21] in ARDS patients vs 7 [C.I.95%: 1-16] in no ARDS; P=0.015). Logistic regression showed that the CT score was the main factor associated with the onset of ARDS (1.12; 95% c.i.: 1.00-1.25), independently from age, gender, diabetes, chronic obstructive pulmonary disease, and prior CV disease. Thirty-day mortality was much greater in ARDS patients (83,3%) than in no-ARDS (19.3%).
Conclusions: This retrospective analysis highlights that HD patients affected by SARS-CoV-2 pneumonia show an increased risk of developing ARDS, dependent on the severity of CT at presentation. This underlines once again the need for prevention strategies, in primis the vaccination campaign, for these frail patients.

Keywords: SARS‑CoV‑2, acute respiratory distress syndrome, chronic haemodialysis, retrospective analysis, prevalence, associated factors

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Introduzione

Alla fine del 2019 un nuovo coronavirus, identificato poi come SARS-CoV-2, è stato riconosciuto come causa di un’elevata incidenza di polmoniti interstiziali che si erano registrati nella città di Wuhan in Cina ed in seguito tutta la provincia cinese dello Hubei. Nei primi mesi del 2020 la diffusione di tale virus è diventata globale, tanto da portare, l’11 marzo, il Direttore Generale dell’Organizzazione Mondiale delle Sanità a dichiarare lo stato di pandemia [1]. La pandemia ha avuto un significativo impatto a livello mondiale, con importanti ricadute sociali ed assistenziali, coinvolgendo milioni di persone e mettendo duramente alla prova il Sistema Sanitario di tutti paesi del mondo [2].

 

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