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Brkovic V, Nikolic G, Baralic M, Kravljaca M, Milinkovic M, Pavlovic J, Lausevic M, Radovic M. A Study on Mortality Predictors in Hemodialysis Patients Infected with COVID-19: Impact of Vaccination Status. Vaccines (Basel) 2023; 12:2. [PMID: 38276661 PMCID: PMC10819519 DOI: 10.3390/vaccines12010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 01/27/2024] Open
Abstract
The global outbreak of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted significant public health concerns. This study focuses on 442 chronic hemodialysis patients diagnosed with COVID-19, emphasizing the impact of vaccination status on clinical outcomes. The study investigates the correlation between vaccination status and laboratory findings, aiming to identify predictive factors for mortality. Results indicate that vaccination status plays a crucial role in outcomes. Full vaccination, evidenced by two or three doses, is associated with better outcomes, including reduced incidence of bilateral pneumonia and lower risks of complications such as hemorrhage and thrombosis. Laboratory analyses reveal significant differences between vaccinated and unvaccinated patients in parameters like C-reactive protein, ferritin, and white blood cell counts. Univariate and multivariate Cox proportional hazards regression analyses identify several factors influencing mortality, including comorbidities, pneumonia development, and various inflammatory markers. In conclusion among hemodialysis patients affected by COVID-19 infection, vaccination with at least three doses emerges as a protective factor against fatal outcomes. Independent predictors of mortality are CRP levels upon admission, maximum CRP values during the illness and cardiovascular comorbidities. Noteworthy lymphocytopenia during infection exhibits a notable level of specificity and sensitivity in predicting mortality.
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Affiliation(s)
- Voin Brkovic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Gorana Nikolic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Baralic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milica Kravljaca
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marija Milinkovic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Pavlovic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Mirjana Lausevic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milan Radovic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Dagnon da Silva M, Domingues SM, Oluic S, Radovanovic M, Kodela P, Nordin T, Paulson MR, Joksimović B, Adetimehin O, Singh D, Madrid C, Cardozo M, Baralic M, Dumic I. Renal Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review of 71 Cases. J Clin Med 2023; 12:4576. [PMID: 37510691 PMCID: PMC10380880 DOI: 10.3390/jcm12144576] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/26/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
Unlike other adverse drug reactions, visceral organ involvement is a prominent feature of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and correlates with mortality. The aim of this study was to systematically review cases published in PubMed-indexed, peer-reviewed journals in which patients had renal injury during the episode of DRESS syndrome (DS). We found 71 cases, of which 67 were adults and 56% were males. Female sex was associated with higher mortality. Chronic kidney disease (CKD) was present in 14% of patients who developed acute kidney injury (AKI) during DS. In 21% of cases, the kidneys were the only visceral organ involved, while 54% of patients had both liver and kidney involvement. Eosinophilia was absent in 24% of patients. The most common classes of medication associated with renal injury in DS were antibiotics in 34%, xanthine oxidase inhibitors in 15%, and anticonvulsants in 11%. Among antibiotics, vancomycin was the most common culprit in 68% of patients. AKI was the most common renal manifestation reported in 96% of cases, while isolated proteinuria or hematuria was present in only 4% of cases. In cases with AKI, 88% had isolated increase in creatinine and decrease in glomerular filtration (GFR), 27% had AKI concomitantly with proteinuria, 18% had oliguria, and 13% had concomitant AKI with hematuria. Anuria was the rarest manifestation, occurring in only 4% of patients with DS. Temporary renal replacement therapy was needed in 30% of cases, and all but one patient fully recovered renal function. Mortality of DS in this cohort was 13%, which is higher than previously reported. Medication class, latency period, or pre-existing CKD were not found to be associated with higher mortality. More research, particularly prospective studies, is needed to better recognize the risks associated with renal injury in patients with DS. The development of disease-specific biomarkers would also be useful so DS with renal involvement can be easier distinguished from other eosinophilic diseases that might affect the kidney.
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Affiliation(s)
| | | | - Stevan Oluic
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL 60402, USA
| | - Milan Radovanovic
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | | | - Terri Nordin
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Family Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Margaret R Paulson
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Bojan Joksimović
- Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, The Republic of Srpska, Bosnia and Herzegovina
| | - Omobolanle Adetimehin
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Devender Singh
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Nephrology, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Cristian Madrid
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Milena Cardozo
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Marko Baralic
- Department of Nephrology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Igor Dumic
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
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Lausevic M, Brkovic V, Kravljaca M, Milinkovic M, Baralic M, Gajic S, Naumovic R. Influence of Pretransplant Factors on Posttransplant Anemia Recovery Rate in Primary Deceased Donor Kidney Transplant Recipients. EXP CLIN TRANSPLANT 2021; 19:25-31. [PMID: 33441057 DOI: 10.6002/ect.2020.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our objective was to evaluate the influence of pretransplant risk factors on posttransplant anemia recovery. MATERIALS AND METHODS This single-center observational retrospective study included 80 deceased donor kidney transplant recipients who had been followed up to 16 months after kidney transplant. Time point of posttransplant anemia recovery was considered the time when hemoglobin of 11.0 g/dL was achieved and maintained for 3 consecutive monthly visits. We collected donor/transplant characteristics (age, sex, hypertension history, cause of death, donor kidney function, expanded criteria donor status, deceased donor score, HLA mismatch, and cold ischemia time) and recipient data (pretransplant hemoglobin, parathyroid hormone, kidney graft function, delayed graft function, acute rejection, infections, surgical bleeding, posttransplant parathyroid hormone, iron stores, and C-reactive protein and tacrolimus levels). We used univariate and multivariate Cox proportional hazards analyses and Kaplan-Meier plots to determine associations between variables and posttransplant anemia recovery rate. P < .05 was considered significant. RESULTS We identified 62 deceased donors (33 male; mean age 50 ± 15.1 years) and 80 kidney transplant recipients (52 male; mean age 47.0 ± 10.6 years). Mean pretransplant hemoglobin was 11.4 ± 1.5 g/dL. Donor age, deceased donor score, pretransplant parathyroid hormone, posttransplant transferrin saturation (all P < .05), and tacrolimus level (P < .01) were significantly related to posttransplant anemia recovery. Kaplan-Meier curve identified that recipients of deceased donors below 60 years old achieved hemoglobin of 11.0 g/dL more frequently and earlier than recipients of deceased donors above 60 years old (P < .05). CONCLUSIONS Deceased donor age, deceased donor score, pretransplant serum parathyroid hormone, posttransplant transferrin saturation, and tacrolimus level were significantly associated with posttransplant anemia recovery rate in deceased donor kidney transplant recipients. Anemia recovery was more frequent and earlier in recipients of deceased donors below 60 years than in recipients of donors 60 years old and above.
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Affiliation(s)
- Mirjana Lausevic
- From the Clinic of Nephrology, Clinical Center of Serbia, Belgrade.,From the Medical Faculty, University of Belgrade, Belgrade
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Abstract
Introduction. COVID-19 is responsible for the current global pandemic. Globally, over 15 million people are currently infected, and just over 600,000 have died due to being infected. It is known that people with chronic illnesses and compromised immune systems can develop more severe clinical presentation. Tuberculosis (TB) is still one of the biggest epidemiological problems worldwide. Both of these diseases can be misdiagnosed and can manifest in a similar way. We will present a case study of a patient who was initially treated as a COVID-19 infection, with TB being diagnosed later on. The recovery began only after being treated for both diseases simultaneously. Case report. The patient is a 27-year-old male, non-smoker, with no history of any significant diseases. He presented with fever, fatigue and hemoptysis. Computed tomography pulmoangiography had shown massive consolidations and excavations, which could be caused by COVID-19. Despite being treated for COVID-19, there was no clinical improvement. On the follow-up chest X-ray, beside signs of COVID-19, there were also changes that could indicate TB. TB was detected in sputum, using PCR and Mycobacteria Growth Indicator Tube, and only after being treated for both diseases did his condition improve. Conclusion. There are a few reported cases of COVID-19 and TB coinfections, and we believe that there are many more patients with this coinfection being unrecognized
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Affiliation(s)
- Mihailo Stjepanovic
- Clinical Center of Serbia, Clinic of pulmonology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Slobodan Belic
- Clinical Center of Serbia, Clinic of pulmonology, Belgrade, Serbia
| | - Ivana Buha
- Clinical Center of Serbia, Clinic of pulmonology, Belgrade, Serbia
| | - Nikola Maric
- Clinical Center of Serbia, Clinic of pulmonology, Belgrade, Serbia
| | - Marko Baralic
- Clinical Center of Serbia, Clinic of nephrology, Belgrade, Serbia
| | - Violeta Mihailovic-Vucinic
- Clinical Center of Serbia, Clinic of pulmonology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia
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Baralic M, Bontic A, Pavlovic J, Lausevic M, Gajic S, Kravljaca M, Brkovic V, Milinkovic M, Karadzic V, Kezic A, Radovic' M. P1199THE IMPORTANCE OF DETERMINING ALPHA-2-MACROGLOBULIN CONCENTRATITON IN PATIENTS ON PERITONEAL DIALYSIS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
To determine the concentration of Alpha-2-macroglobulin (α2M) and its activity in patients treated with peritoneal dialysis (PD) and healthy subjects (H).
Method
a cross-sectional study included 50 PD and 30 H, in which the concentration of active α2M molecules was determined. The measurement is based on covalent binding of α2M and trypsin and zymography with gelatin incorporated into the electrophoretic gel.
Results
The intensity of proteolytic bands seen with native α2M was analyzed in relation to the concentration of α2M in patients with PD with less and / or more than three peritonitis. Linear dependence was only visible in the case of the upper range, which originates from the intact α2M-trypsin complex. The highest coefficient of variation is calculated for the smallest α2M concentration (4.2%). The signal intensities originating from α2M (H) were higher compared to PD, with the PD group being lower in patients with higher peritonitis, and the difference was more pronounced as concentration increased, resulting in a lower slope of dependence. The proposed method can reliably measure the amount of α2M originating in a group H, while the quantification of α2M in PD groups that may have structurally altered α2M can be seen more for condition estimation than for accurate measurements. The zymographic test in this experiment allows us to investigate the relationship of the concentration, structure and function of α2M in different pathological conditions, as well as in the presence of modifying agents that can accompany them.
Conclusion
A simple method for the determination of α2M concentration and function by zymography has been developed, which can be used to examine residual α2M activity after partial denaturation or structural modification due to disease.
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Affiliation(s)
- Marko Baralic
- Belgrade, Clinical centre of Serbia, Nephrology, Belgrade, Serbia
| | - Ana Bontic
- Belgrade, Belgrade, Clinical centre of Serbia Nephrology, Belgrade, Serbia
| | - Jelena Pavlovic
- Belgrade, Belgrade, Clinical centre of Serbia Nephrology, Belgrade, Serbia
| | - Mirjana Lausevic
- Belgrade, Belgrade, Clinical centre of Serbia Nephrology, Belgrade, Serbia
| | - Selena Gajic
- Belgrade, Belgrade, Clinical centre of Serbia Nephrology, Belgrade, Serbia
| | - Milica Kravljaca
- Belgrade, Belgrade, Clinical centre of Serbia Nephrology, Belgrade, Serbia
| | - Voin Brkovic
- Belgrade, Belgrade, Clinical centre of Serbia Nephrology, Belgrade, Serbia
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Radinovic K, Markovic Denic L, Milan Z, Cirkovic A, Baralic M, Bumbasirevic V. Impact of intraoperative blood pressure, blood pressure fluctuation, and pulse pressure on postoperative delirium in elderly patients with hip fracture: A prospective cohort study. Injury 2019; 50:1558-1564. [PMID: 31279476 DOI: 10.1016/j.injury.2019.06.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 05/18/2019] [Accepted: 06/24/2019] [Indexed: 02/02/2023]
Abstract
AIM Postoperative delirium (PD) is a frequent complication of hip fracture surgery, but its pathophysiology remains poorly understood. We investigated the impact of a single episode of intraoperative hyper/hypotension, blood pressure (BP) fluctuation (ΔMAP), and pulse pressure (PP) on hyper/hypoactive PD in elderly patients undergoing surgery for hip fracture. We also assessed the effect of PD on clinical outcomes. METHODS This was a prospective 1-year follow-up study of patients over 60 years of age with a primary diagnosis of acute low-energy hip fracture. Perioperative delirium was assessed using the Confusion Assessment Method (CAM); the development of PD and the type, hyperactive or hypoactive PD, were recorded. Cognitive assessment was evaluated using the Short Portable Mental Status Questionnaire (SPMSQ). The lowest and highest BP values were extracted from the patients' anaesthesia charts. Postoperative complications, reinterventions and 1-month mortality were recorded. RESULTS PD occurred in 148 (53%) patients during the first postoperative week, with 75% of the cases diagnosed as hypoactive PD. Patients developing PD of any type were older, had a lower body mass index, higher SPMSQ and Charlson scores, more severe systemic diseases, a lower lowest intraoperative BP, a higher ΔMAP, a lower PP, and a higher postoperative pain score. They also took more drugs and received more blood transfusion intraoperatively. Multivariate logistic regression analyses showed that a higher MAP min had a protective effect on the occurrence of any type of PD, as well as hypoactive and hyperactive. PD had negative effect on outcomes. CONCLUSION Our results provide evidence of an association between maximal hypotension, the lowest intraoperative mean blood pressure (MAP), ΔMAP, PP, and PD. A progressive decrease in MAP during surgery was associated with the increased odds of developing either type of PD.
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Affiliation(s)
| | - Ljiljana Markovic Denic
- Institute of Epidemiology, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Andja Cirkovic
- Institute of Medical Statistics and Medical Informatics, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Baralic
- Clinic for Nephrology, Clinical Center of Serbia, Belgrade, Serbia
| | - Vesna Bumbasirevic
- Clinic of Anesthesiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Petrovic M, Baralic M, Arsenovic A, Brkovic V, Stojanov V, Stankovic S, Jankovic A, Stanisavljevic D, Radivojevic N, Maric I, Pejanovic S, Lezaic V. SP694SIGNIFICANCE OF abPWV VALUES ON HEMODIALYSIS PATIENTS SURVIVAL. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ivko Maric
- Special Hospital for Endemic Nephropathy, Lazarevac, Serbia
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Kezic A, Stojanovic J, Stisovic K, Baralic M, Jovanovic D. SP494PHOSPHATE HANDLING IN PERITONEAL DIALYSIS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aleksandra Kezic
- Clinic for Nephrology, Clinical Center of Serbia, Belgrade
- Internal Medicine, Nephrology, School of Medicine, University of Belgrade, Belgrade
| | - Jelena Stojanovic
- Internal Medicine, Nephrology, School of Medicine, University of Belgrade, Belgrade
| | - Kosana Stisovic
- Internal Medicine, Nephrology, School of Medicine, University of Belgrade, Belgrade
| | - Marko Baralic
- Clinic for Nephrology, Clinical Center of Serbia, Belgrade
| | - Dijana Jovanovic
- Clinic for Nephrology, Clinical Center of Serbia, Belgrade
- Internal Medicine, Nephrology, School of Medicine, University of Belgrade, Belgrade
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