Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Los pacientes con enfermedad renal cronica en hemodialisis tienen una respuesta inmune humoral alterada y una baja respuesta de seroconversion a vacunas. Hasta el momento, no se conoce su capacidad de generar respuesta inmune frente al coronavirus 2019 (COVID-19). Mediante este estudio analizamos la capacidad de respuesta inmunitaria frente al COVID-19 en los pacientes de una unidad de hemodialisis hospitalaria. Realizamos un estudio observacional descriptivo retrospectivo de 69 pacientes de la unidad de hemodialisis del Hospital Universitario de Guadalajara. A los 3 meses se les realizo test rapido Ac Wondfo Biotech en 62 pacientes y a los 11 meses el test serologico IgG de Abbott en 55 pacientes. Se diagnosticaron 19 casos COVID-19: 13 con PCR y 6 con test rapido. 11 de ellos sufrieron enfermedad COVID-19 grave. A los 3 meses 12 pacientes tenian Ac detectable, de los cuales 6 habian sido asintomaticos. A los 11 meses 9 pacientes tuvieron Ac IgG a nivel optimo y dos tercios de ellos habian sufrido COVID-19 grave. Todos los pacientes que sufrieron COVID-19 grave mantenian titulo de Ac IgG a los 11 meses. Por otro lado, los pacientes COVID-19 en los que no se detecto Ac IgG a los 11 meses habian sufrido la enfermedad de forma leve. En nuestra poblacion la presencia y mantenimiento de respuesta inmunitaria frente a SARS Cov2 se asocio al antecedente COVID-19 grave. Los resultados serologicos indeterminados se asociaron a casos oligosintomaticos.

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Daniel Germán Gaitán

Papers

Capacidad de respuesta inmunitaria al COVID-19 en pacientes en hemodiálisis