Prognostic Role of Anemia in COVID-19 Patients: A Meta-Analysis
Infectious disease reports. 2021;13(4):930-937
INTRODUCTION The prevalence and prognostic implications of anemia in patients infected by the SARS-CoV-2 remains unclear. We performed a systematic review and meta-analysis to assess the prevalence and mortality risk in COVID-19 patients with anemia. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to 1 September 2021, reporting data on the adjusted OR (aOR) for mortality among COVID-19 patients with anemia. The pooled prevalence of anemia among COVID-19 patients was calculated using a random effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random effects models with odds ratio (aOR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I(2) statistic. RESULTS Five studies, enrolling 9.623 COVID-19 patients [3.707 males (38.5%)], met the inclusion criteria and were included in the final analysis. The pooled prevalence of anemia was 25.6% of cases (95% CI: 8.3-56.5%), with high heterogeneity (I(2) = 98.9%). Meta-regression showed that the anemia prevalence was influenced by a direct correlation with age (p = 0.007) and chronic kidney disease (p = 0.004) as moderating variables. Conversely, an inverse relationship was observed with male gender (p < 0.0001). Anemia was significantly associated with higher risk of short-term mortality (aOR: 1.69, 95% CI: 1.28-2.24, p < 0.001), with low heterogeneity (I(2) = 0%). CONCLUSIONS Anemia represents a major comorbidity in about 25% of COVID-19 patients and it is associated with about 70% higher risk of short-term mortality.
Anemia management for home dialysis including the new US public policy initiative
Kidney International Supplements. 2021;11(1):59-69
Patients with end-stage kidney disease (ESKD) requiring kidney replacement therapy are often treated in conventional dialysis centers at substantial cost and patient inconvenience The recent United States Executive Order on Advancing American Kidney Health, in addition to focusing on ESKD prevention and reforming the kidney transplantation system, focuses on providing financial incentives to promote a shift toward home dialysis In accordance with this order, a goal was set to have 80% of incident dialysis patients receiving home dialysis or a kidney transplant by 2025 Compared with conventional in-center therapy, home dialysis modalities, including both home hemodialysis and peritoneal dialysis, appear to offer equivalent or improved mortality, clinical outcomes, hospitalization rates, and quality of life in patients with ESKD in addition to greater convenience, flexibility, and cost-effectiveness Treatment of anemia, a common complication of chronic kidney disease, may be easier to manage at home with a new class of agents, hypoxia-inducible factor-prolyl hydroxylase inhibitors, which are orally administered in contrast to the current standard of care of i v iron and/or erythropoiesis-stimulating agents This review evaluates the clinical, quality-of-life, economic, and social aspects of dialysis modalities in patients with ESKD, including during the coronavirus disease 2019 pandemic;explores new therapeutics for the management of anemia in chronic kidney disease;and highlights how the proposed changes in Advancing American Kidney Health provide an opportunity to improve kidney health in the United States © 2021 International Society of Nephrology
Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis
European Journal of Epidemiology. 2020;:1-11
Iron metabolism and anemia may play an important role in multiple organ dysfunction syndrome in Coronavirus disease 2019 (COVID-19). We conducted a systematic review and meta-analysis to evaluate biomarkers of anemia and iron metabolism (hemoglobin, ferritin, transferrin, soluble transferrin receptor, hepcidin, haptoglobin, unsaturated iron-binding capacity, erythropoietin, free erythrocyte protoporphyrine, and erythrocyte indices) in patients diagnosed with COVID-19, and explored their prognostic value. Six bibliographic databases were searched up to August 3rd 2020. We included 189 unique studies, with data from 57,563 COVID-19 patients. Pooled mean hemoglobin and ferritin levels in COVID-19 patients across all ages were 129.7 g/L (95% Confidence Interval (CI), 128.51; 130.88) and 777.33 ng/mL (95% CI, 701.33; 852.77), respectively. Hemoglobin levels were lower with older age, higher percentage of subjects with diabetes, hypertension and overall comorbidities, and admitted to intensive care. Ferritin level increased with older age, increasing proportion of hypertensive study participants, and increasing proportion of mortality. Compared to moderate cases, severe COVID-19 cases had lower hemoglobin [weighted mean difference (WMD), - 4.08 g/L (95% CI - 5.12; - 3.05)] and red blood cell count [WMD, - 0.16 × 10(12) /L (95% CI - 0.31; - 0.014)], and higher ferritin [WMD, - 473.25 ng/mL (95% CI 382.52; 563.98)] and red cell distribution width [WMD, 1.82% (95% CI 0.10; 3.55)]. A significant difference in mean ferritin levels of 606.37 ng/mL (95% CI 461.86; 750.88) was found between survivors and non-survivors, but not in hemoglobin levels. Future studies should explore the impact of iron metabolism and anemia in the pathophysiology, prognosis, and treatment of COVID-19.
Microangiopathic anemia and multisystem inflammatory syndrome associated to covid-19 in a cuban pediatric patient
Revista Cubana de Pediatria. 2020;92:1-12
Introduction: Clinical manifestations of the infection by SARS-CoV-2 are less frequent and severe in children than in adults;however, recent publications suggest the possibility of a severe clinical scenario secondary to the infection by this coronavirus called multisystem inflammatory syndrome in children (MIS-C) This syndrome has a post-infection nature and its physiopathology is probably the result of an abnormally organized activation of the immune system in a genetic context of predispostion, and actived by the particular biology of SARS-CoV-2 Objective: To describe the first Cuban case with criterion of multisystemic syndrome associated to COVID-19 Case presentation: 2 years old male patient, previously healthy, with clinical and laboratory evidences of microangiopathic anemia, systemic hyperinflammation and organs and systems´ multiple dysfunction, associated with serologic evidences of previous infection by SARS-CoV-2 Conclusions: The proper approach to cases as the above mentioned in this work requires to keep a high level of clinical alert, with a clear definition of suspicious cases, multidisciplinary participation and the early establishment of and adequate therapeutic strategy that will be significant in the reduction of systems and organs damage´s extension;as well as increasing the chance to improve the dysfunction © 2020, Editorial Ciencias Medicas All rights reserved