Are High Urea Values before Intravenous Immunoglobulin Replacement a Risk Factor for COVID-19 Related Mortality?

Year 2022, , 110 - 115, 30.08.2022

Emel Atayık , Gökhan Aytekin

https://doi.org/10.18678/dtfd.1066937

Abstract

Aim: This study aimed to examine the data of the coronavirus disease 2019 (COVID-19) patients treated with intravenous immunoglobulin (IVIG) treatment and to investigate the effects of the patients' clinical, laboratory, and treatment characteristics and risk factors for mortality.
Material and Methods: The study evaluated 81 adult COVID-19 patients who were hospitalized for the treatment of COVID-19 between April 2020 and September 2020 and were followed up, treated, and consulted in the immunology clinic for IVIG treatment, in a retrospective manner.
Results: The univariate analyses revealed that the duration of hospitalization in service, being intubated, duration of IVIG treatment, and the urea value before IVIG treatment were related to mortality in COVID-19 patients treated with IVIG treatment. As a result of multivariate analysis, being intubated and urea value before IVIG treatment were found to be independent risk factors for mortality (p=0.001 and p=0.009, respectively). It was found that for the 60 mg/dL level of urea value before IVIG treatment to predict mortality, the sensitivity was 46.2%, and the specificity was 35.5%. The area under the curve was found as 0.647; 95% confidence interval 0.518-0.776 (p=0.029).
Conclusion: The study found that urea values before IVIG treatment were a risk factor for mortality in patients who received IVIG treatment for COVID-19. This is important as it indicates that urea values should be closely monitored in patients given IVIG treatment for COVID-19. It also suggests that when resources are limited and risk stratification is required in COVID-19 patients, urea values can be helpful.

Keywords

SARS-CoV-2, immunoglobulin, mortality, blood urea nitrogen, COVID-19

İntravenöz İmmünoglobulin Replasmanı Öncesi Yüksek Üre Değerleri COVID-19’a Bağlı Mortalite için Bir Risk Faktörü müdür?

Abstract

Amaç: Bu çalışmanın amacı, intravenöz immünoglobulin (IVIG) tedavisi ile tedavi edilen koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) hastalarının verilerini incelemek ve hastaların klinik, laboratuvar ve tedavi özellikleri ile mortalite için risk faktörlerinin etkilerini araştırmaktır.
Gereç ve Yöntemler: Çalışmada, Nisan 2020 ile Eylül 2020 tarihleri arasında COVID-19 tedavisi için hastaneye yatırılan ve IVIG tedavisi için immünoloji kliniğinde takip, tedavi ve konsülte edilen 81 erişkin COVID-19 hastası geriye dönük olarak değerlendirilmiştir.
Bulgular: Tek değişkenli analizler, IVIG tedavisi ile tedavi edilen COVID-19 hastalarında hastanede yatış süresi, entübe olma, IVIG tedavi süresi ve IVIG tedavisi öncesi üre değerinin mortalite ile ilişkili olduğunu gösterdi. Çok değişkenli analiz sonucunda, entübe olma ve IVIG tedavisi öncesi üre değeri mortalite için bağımsız risk faktörleri olarak bulundu (sırasıyla, p=0,001 ve p=0,009). Mortaliteyi öngörmek için IVIG tedavisi öncesi 60 mg/dL üre değeri için duyarlılık %46,2 ve özgüllük ise %35,5 olduğu bulundu. Eğri altında kalan alan 0,647; %95 güven aralığı ise 0,518-0,776 olarak bulundu (p=0,029).
Sonuç: Çalışmada, COVID-19 nedeniyle IVIG tedavisi alan hastalarda IVIG tedavisi öncesi üre değerlerinin mortalite için bir risk faktörü olduğu bulundu. Bu, COVID-19 için IVIG tedavisi verilen hastalarda üre değerlerinin yakından izlenmesi gerektiğini göstermesi açısından önemlidir. Ayrıca, COVID-19 hastalarında kaynaklar sınırlı olduğunda ve risk sınıflandırması gerektiği durumlarda, üre değerlerinin yardımcı olabileceğini göstermektedir.

Keywords

SARS-CoV-2, immünoglobulin, kan üre nitrojeni, COVID-19, mortalite

References

• Liu X, Liu C, Liu G, Luo W, Xia N. COVID-19: Progress in diagnostics, therapy and vaccination. Theranostics. 2020;10(17):7821-35.
• Pollard CA, Morran MP, Nestor-Kalinoski AL. The COVID-19 pandemic: a global health crisis. Physiol Genomics. 2020;52(11):549-57.
• Ferrer R. [COVID-19 Pandemic: the greatest challenge in the history of critical care]. Med Intensiva (Engl Ed). 2020;44(6):323-4. Spanish.
• Asselah T, Durantel D, Pasmant E, Lau G, Schinazi RF. COVID-19: Discovery, diagnostics and drug development. J Hepatol. 2021;74(1):168-84.
• Echeverría-Esnal D, Martin-Ontiyuelo C, Navarrete-Rouco ME, De-Antonio Cuscó M, Ferrández O, Horcajada JP, et al. Azithromycin in the treatment of COVID-19: a review. Expert Rev Anti Infect Ther. 2021;19(2):147-63.
• Stasi C, Fallani S, Voller F, Silvestri C. Treatment for COVID-19: An overview. Eur J Pharmacol. 2020;889:173644.
• Wang MY, Zhao R, Gao LJ, Gao XF, Wang DP, Cao JM. SARS-CoV-2: Structure, biology, and structure-based therapeutics development. Front Cell Infect Microbiol. 2020;10:587269.
• Demirbilek Y, Pehlivantürk G, Özgüler ZÖ, Alp Meşe E. COVID-19 outbreak control, example of ministry of health of Turkey. Turk J Med Sci. 2020;50(SI-1):489-94.
• Mazeraud A, Gonçalves B, Aegerter P, Mancusi L, Rieu C, Bozza F, et al. Effect of early treatment with polyvalent immunoglobulin on acute respiratory distress syndrome associated with SARS-CoV-2 infections (ICAR trial): study protocol for a randomized controlled trial. Trials. 2021;22(1):170.
• Xie Y, Cao S, Dong H, Li Q, Chen E, Zhang W, et al. Effect of regular intravenous immunoglobulin therapy on prognosis of severe pneumonia in patients with COVID-19. J Infect. 2020;81(2):318-56.
• Hadian M, Mazaheri E, Jabbari A. Different approaches to confronting the biological epidemic; prevention tools with an emphasis on COVID-19: A systematized study. Int J Prev Med. 2021;12:127.
• Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209-18.
• Orbach H, Katz U, Sherer Y, Shoenfeld Y. Intravenous immunoglobulin: adverse effects and safe administration. Clin Rev Allergy Immunol. 2005;29(3):173-84.
• Cheng A, Hu L, Wang Y, Huang L, Zhao L, Zhang C, et al. Diagnostic performance of initial blood urea nitrogen combined with D-dimer levels for predicting in-hospital mortality in COVID-19 patients. Int J Antimicrob Agents. 2020;56(3):106110.
• Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-38.
• Liu Q, Wang Y, Zhao X, Wang L, Liu F, Wang T, et al. Diagnostic performance of a blood urea nitrogen to creatinine ratio-based nomogram for predicting in-hospital mortality in COVID-19 patients. Risk Manag Healthc Policy. 2021;14:117-28.
• Liu YM, Xie J, Chen MM, Zhang X, Cheng X, Li H, et al. Kidney function indicators predict adverse outcomes of COVID-19. Med (N Y). 2021;2(1):38-48.e2.
• Ng JH, Hirsch JS, Wanchoo R, Sachdeva M, Sakhiya V, Hong S, et al. Outcomes of patients with end-stage kidney disease hospitalized with COVID-19. Kidney Int. 2020;98(6):1530-9.
• Shao M, Li X, Liu F, Tian T, Luo J, Yang Y. Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: A systematic review and meta-analysis of 40 studies and 24,527 patients. Pharmacol Res. 2020;161:105107.
• Nogueira SÁR, Oliveira SCS, Carvalho AFM, Neves JMC, Silva LSVD, Silva Junior GBD, et al. Renal changes and acute kidney injury in COVID-19: a systematic review. Rev Assoc Med Bras (1992). 2020;66(Suppl 2):112-7.