High-density lipoproteins and clinical outcomes of COVID-19 in hemodialysis patients: A multicenter, propensity-score matched case-control study

LOW HIGH-DENSITY LIPOPROTEIN LEVEL ASSOCIATED WITH ENHANCED INFLAMMATORY RESPONSE AND ONE-YEAR PERSISTENCE OF LONG COVID IN PATIENTS UNDERGOING HEMODIALYSIS: A CROSS-SECTIONAL COHORT STUDY

Background: Long-term consequences of COVID-19, known as long COVID, present distinctive hurdles for patients receiving hemodialysis treatment. Reduced levels of high-density lipoprotein (HDL) (< 1.22 mmol/L) have previously been demonstrated to be associated with heightened susceptibility to COVID-19 and immediate COVID-19-related adverse outcomes in this patient population. However, the potential association between HDL levels and the persistence of long COVID has not been examined within the hemodialysis cohort. The present study aimed to explore the relationship between HDL levels and inflammatory responses one year after COVID-19 among patients undergoing hemodialysis. Methods: A total of 80 patients treated with hemodialysis, aged 55 (44-62.5) years, with a dialysis vintage of 45 (21-78.6) months and a history of COVID-19, were enrolled in this cross-sectional cohort study. Among them, 45 (56.2%) were diagnosed with long COVID, while 35 (43.8%) had fully recovered. Lipid profiles and inflammatory markers, such as serum C-reactive protein, and interleukins -6 and -17, were assessed one year post-infection. Results: Patients experiencing long COVID exhibited significantly lower HDL levels compared to fully recovered individuals: 1.19 (1.06-1.76) vs 1.66 (1.32-1.92) mmol/L (p < 0.0001). The HDL cut-off point of less than 1.22 mmol/L demonstrated a sensitivity of 84.9% and specificity of 95.3% to predict one-year long COVID persistence in our cohort. Among the patients with HDL levels < 1.22 mmol/L, elevated concentrations of C-reactive protein (р = 0.003), interleukin-6 (p = 0.005), and interleukin-17 (p < 0.0001) were evident compared to those with HDL concentrations exceeding 1.22 mmol/L. Subsequent subgroup analysis revealed a more pronounced inflammatory profile in patients concurrently experiencing long COVID and exhibiting low HDL levels. Conclusion: The obtained results suggest that a low level of HDL (< 1.22 mmol/L) may exacerbate the inflammatory response in patients undergoing hemodialysis, potentially contributing to the persistence of long COVID even a year after infection. Future research is necessary to elucidate the pathogenetic mechanisms of this relationship and explore potential strategies to improve patient outcomes.

Comparative analysis of early postoperative results of transcatheter aortic valve implantation and surgical aortic valve replacement with a biological prosthesis

OBJECTIVE

. Aim: The choice of aortic valve stenosis correction method is determined by a number of clinical and technical parameters. The task was to compare early postoperative outcomes in patients after correction of aortic valve stenosis using TAVI and surgical aortic valve replacement with a biological prosthesis.

PATIENTS AND METHODS

Materials and Methods: This retrospective study analyzed the medical records of adult patients (18 years of age and older) who had transcatheter aortic valve implantation or surgical aortic valve replacement with a biological prosthesis at the State Institution "Heart Institute of the Ministry of Health" in the period from 2018 to 2022.

RESULTS

Results: In 47 (47.5%) cases, TAVI was performed and in 52 (52.5%) cases, SAVR with a biological prosthesis was performed. Patients who underwent TAVI were significantly older (p=0.002) and had a higher EuroSCORE II operative risk score (p<0.001). In patients with TAVI, larger diameter aortic valve prostheses were significantly more often used compared with the SAVR group with biological prosthesis (27.5±2.74 vs. 22.5±1.84, p<0.001). The early postoperative period in patients with TAVI was characterized by an 11.4% (p=0.046) and 15.4% (p=0.006). The length of stay in the ICU (p=0.024), as well as the duration of hospitalization in general (p=0.005), was also significantly lower in patients with TAVI compared with patients with biological prosthesis SAVR.

CONCLUSION

Conclusions: Despite the higher surgical risk of surgery according to EuroSCORE II, TAVI was characterized by a lower incidence of postoperative complications, with shorter duration of stay in ICU and hospitalization in general in comparison with patients undergoing SAVR with a biological prosthesis.