COVID-19 Computed tomography patterns in renal replacement therapy patients.

IF 1.3 Q3 UROLOGY & NEPHROLOGY

Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia Pub Date : 2024-07-01 DOI:10.1590/2175-8239-JBN-2023-0029en

Gabriel Assis Lopes do Carmo, Mariana Paiva Oliveira, Anna Luiza Lino Campos, Bráulio Roberto Gonçalves Marinho Couto, Lilian Pires de Freitas do Carmo, Tiago Lemos Cerqueira, Camila Alencar Monteiro de Souza, Yan Lopes Goll, Vitor Santos de Souza, Mariana Oliveira Guimarães Vieira, Pedro Alves Soares Vaz de Castro, Pedro Augusto Botelho Lemos, Ana Cristina Simões E Silva

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引用次数: 0

Abstract

Introduction: Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19.

Methods: ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients.

Results: We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12-84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002).

Conclusions: In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19.

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COVID-19 肾脏替代疗法患者的计算机断层扫描模式。

简介：肺部疾病在终末期肾病（ESKD）患者中很常见，因此与 COVID-19 的鉴别诊断是一项挑战。本研究描述了住院接受肾脏替代治疗（RRT）的 ESKD 患者因临床怀疑 COVID-19 而进行肺部胸部断层扫描（CT）的结果：方法：招募临床怀疑患有 COVID-19 的 18 岁以上 ESKD 患者到急诊科就诊。从电子健康记录中提取流行病学基线临床信息。肺部 CT 被分为典型、不确定、不典型或阴性。然后，我们比较了 COVID-19 阳性和阴性患者的 CT 结果：我们在 2020 年 3 月至 12 月间招募了 109 名患者（62.3% COVID-19 阳性），平均年龄为 60 ± 12.5 岁，43% 为女性。ESKD最常见的病因是糖尿病。透析时间中位数为 36 个月，四分位数间距为 12-84 个月。CT 上最常见的肺部病变是磨玻璃不透明。典型的 CT 模式在 COVID-19 患者中更为常见（40 例（61%）与非 COVID-19 患者的 0 例（0%）相比，P < 0.001）。敏感性为 60.61%（40/66），特异性为 100%（40/40）。阳性预测值和阴性预测值分别为 100%和 62.3%。非典型CT模式在COVID-19阴性患者中更常见（9（14%） vs 24（56%），P < 0.001），而不确定模式在两组中相似（13（20%） vs 6（14%），P = 0.606），阴性模式在COVID-19阴性患者中更常见（4（6%） vs 12（28%），P = 0.002）：结论：在接受 RRT 的 ESKD 住院患者中，非典型胸部 CT 图谱不能充分排除 COVID-19 的诊断。

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