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Transcatheter aortic valve replacement in patients with chronic kidney disease: a multi-centre retrospective study

Al Jarallah M, Abdulsalam S, Rajan R, Dashti R, Zhanna KD, Setiya P, et al.

Ann Med Surg (Lond), 2024 Feb;86(2):697-702.
PMID: 38333245 DOI: 10.1097/MS9.0000000000001590

BACKGROUND: Chronic kidney disease (CKD) is a common comorbid condition in patients undergoing transcatheter aortic valve replacement (TAVR). Reported outcome studies on the association of baseline CKD and mortality is currently limited.
OBJECTIVES: To determine the prevalence of chronic kidney disease in patients undergoing TAVR and analyse their overall procedural outcomes.
METHODS: This retrospective observational study was conducted at 43 publicly funded hospitals in Hong Kong. Severe aortic stenosis patients undergoing TAVR between the years 2010 and 2019 were enroled in the study. Two groups were identified according to the presence of baseline chronic kidney disease.
RESULTS: A total of 499 patients (228, 58.6% men) were enroled in the study. Baseline hypertension was more prevalent in patients with CKD (82.8%; P=0.003). As for primary end-points, mortality rates of CKD patients were significantly higher compared to non-CKD patients (10% vs. 4.1%; P=0.04%). Gout and hypertension were found to be significantly associated with CRF. Patients with gout were nearly six times more likely to have CRF than those without gout (odds ratio = 5.96, 95% CI = 3.12-11.29, P<0.001). Patients with hypertension had three times the likelihood of having CRF compared to those without hypertension (odds ratio=2.83, 95% CI=1.45-6.08, P=0.004).
CONCLUSION: In patients with severe aortic stenosis undergoing TAVR, baseline CKD significantly contributes to mortality outcomes at long-term follow up.
Fulltext Outcomes of tocilizumab therapy in severe or critical COVID-19 patients: A retrospective cohort, single-centre study

Abdelnaby H, Aboelhassan W, Al-Jarallah M, Rajan R, Dashti R, Zhanna KD, et al.

Trop Med Int Health, 2021 Dec;26(12):1689-1699.
PMID: 34601803 DOI: 10.1111/tmi.13685

OBJECTIVES: To assess the effectiveness and safety of tocilizumab, a humanised anti-interleukin-6 receptor antibody, in the treatment of critical or severe coronavirus disease 2019 (COVID-19) patients.
METHODS: This was a retrospective cohort study of severe or critical COVID-19 patients (≥18 years) admitted to one hospital in Kuwait. Fifty-one patients received intravenous tocilizumab, while 78 patients received the standard of care at the same hospital. Both groups were compared for clinical improvement and in-hospital mortality.
RESULTS: The tocilizumab (TCZ) group had a significantly lower 28-day in-hospital mortality rate than the standard-of care-group (21.6% vs. 42.3% respectively; p = 0.015). Fifty-five per cent of patients in the TCZ group clinically improved vs. 11.5% in the standard-of-care group (p
Fulltext In-hospital Mortality Rates in SARS-CoV-2 Patients Treated with Enoxaparin and Heparin

Alroomi M, Alsaber A, Al-Bader B, Almutairi F, Malhas H, Pan J, et al.

Clin Appl Thromb Hemost, 2022;28:10760296221131802.
PMID: 36285386 DOI: 10.1177/10760296221131802

OBJECTIVES: This study aimed to investigate in-hospital mortality rates in patients with coronavirus disease (COVID-19) according to enoxaparin and heparin use.
METHODS: This retrospective cohort study included 962 patients admitted to two hospitals in Kuwait with a confirmed diagnosis of COVID-19. Cumulative all-cause mortality rate was the primary outcome.
RESULTS: A total of 302 patients (males, 196 [64.9%]; mean age, 57.2 ± 14.6 years; mean body mass index, 29.8 ± 6.5 kg/m2) received anticoagulation therapy. Patients receiving anticoagulation treatment tended to have pneumonia (n = 275 [91.1%]) or acute respiratory distress syndrome (n = 106 [35.1%]), and high D-dimer levels (median [interquartile range]: 608 [523;707] ng/mL). The mortality rate in this group was high (n = 63 [20.9%]). Multivariable logistic regression, the Cox proportional hazards, and Kaplan-Meier models revealed that the use of therapeutic anticoagulation agents affected the risk of all-cause cumulative mortality.
CONCLUSION: Age, hypertension, pneumonia, therapeutic anticoagulation, and methylprednisolone use were found to be strong predictors of in-hospital mortality. In elderly hypertensive COVID-19 patients on therapeutic anticoagulation were found to have 2.3 times higher risk of in-hospital mortality. All cause in-hospital mortality rate in the therapeutic anticoagulation group was up to 21%.
Fulltext In-hospital mortality in SARS-CoV-2 stratified by hemoglobin levels: A retrospective study

Al-Jarallah M, Rajan R, Saber AA, Pan J, Al-Sultan AT, Abdelnaby H, et al.

EJHaem, 2021 Aug;2(3):335-339.
PMID: 34226901 DOI: 10.1002/jha2.195

This study is to estimate in-hospital mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients stratified by hemoglobin (Hb) level. Patients were stratified according to hemoglobin level into two groups, that is, Hb <100 g/L and Hb >100 g/L. A total of 6931 patients were included. Of these, 6377 (92%) patients had hemoglobin levels >100 g/L. The mean age was 44 ± 17 years, and 66% of the patients were males. The median length of overall hospital stay was 13 days [2; 31]. The remaining 554 (8%) patients had a hemoglobin level <100 g/L. Overall mortality was 176 patients (2.54%) but was significantly higher in the group with hemoglobin levels <100 g/L (124, 22.4%) than in the group with hemoglobin levels >100 g/L (52, 0.82%). Risk factors associated with increased mortality were determined by multivariate analysis. The Kaplan-Meier survival analysis showed hemoglobin as a predictor of mortality. Cox proportional hazards regression coefficients for hemoglobin for the HB ≤ 100 category of hemoglobin were significant, B = 2.79, SE = 0.17, and HR = 16.34, p
Fulltext Ferritin level: A predictor of severity and mortality in hospitalized COVID-19 patients

Alroomi M, Rajan R, Omar AA, Alsaber A, Pan J, Fatemi M, et al.

Immun Inflamm Dis, 2021 Dec;9(4):1648-1655.
PMID: 34438471 DOI: 10.1002/iid3.517

INTRODUCTION: This study aims to investigate in-hоsрitаl mоrtаlity in severe асute resрirаtоry syndrоme соrоnаvirus 2 раtients strаtified by serum ferritin levels.
METHODS: Patients were stratified based on ferritin levels (ferritin levels ≤ 1000 or >1000).
RESULTS: Approximately 89% (118) of the patients with ferritin levels > 1000 had pneumonia, and 51% (67) had hypertension. Fever (97, 73.5%) and shortness of breath (80, 61%) were two major symptoms among the patients in this group. Logistic regression analysis indicated that ferritin level (odds ratio [OR] = 0.36, 95% confidence interval [CI] = 0.21-0.62; p 1000.
CONCLUSION: In this study, higher levels of serum ferritin were found to be an independent predictor of in-hоsрitаl mоrtаlity.