The impact of SARS-Cov-2 vaccination on clinical events in maintenance hemodialysis patients with COVID-19

[V. Lj. Brković]

62 str.

Medicina - Nefrologija / Medicine - Nephrology

Bolesnici na hroničnom programu lečenja hemodijalizama su podložni težim kliničkim oblicima infektivnih bolesti. Razlog tome je i određen stepen disfunkcije imunskog sistema ovih bolesnika, a posledica te disfunkcije je i slabiji imunski odgovora na vakcinaciju. Cilj: Ciljevi su bili ispitivanje uticaja vakcinacije protiv SARS-CoV-2 virusa na prevenciju teških kliničkih formi i mortaliteta od kovid-19, utvrđivanje broja doza vakcina koje obezbeđuju adekvatnu protekciju i određivanje prediktora mortaliteta usled kovid-19. Metode: Sprovedena je kohortna longitudinalna, opservaciona, studija koja je obuhvatila bolesnike na hroničnom programu lečenja hemodijalizom obolelih od kovid-19. Ishod je definisan kao ozdravljenje ili nastanak letalnog ishoda. Demografski i klinički podaci su preuzeti iz istorije bolesti. Rezultati: Istraživanje je obuhvatilo 442 bolesnika (64,5% muškaraca). Prosečna starost je bila 63 godine. Bilateralna pneumonija je najređe nastajala kod bolesnika vakcinisanih sa 3 doze (34,1% bolesnika naspram 61,8% kod nevakcinisanih, 63,2% sa 1 dozom i 54,5% sa primljene 2 doze; p<0,001, p=0,003, p=0,002, po navedenom redosledu). Vakcinisani sa tri doze su imali nižu stopu mortaliteta u poređenju sa drugim grupama (p<0,05), koje se međusobno nisu razlikovali po tom ishodu. Nezavisni prediktori mortaliteta su kardiomiopatija (HR 3,364, p<0,001), CRP na prijemu (HR 1,004, p=0,005), maksimalna vrednost CRP-a (HR 1,006, p=0,003) i maksimalna vrednost IL-6 (HR 1,001, p<0,001). Zaključak: Vakcinacija protiv SARS-CoV-2 virusa ima velikog značaja u prevenciji teških kliničkih formi i mortaliteta usled kovid-19 kod dijaliznih bolesnika i to jedino primenom tri doze vakcine. Povišene koncentracije CRP-a i IL-6 u serumu su značajni prediktori mortaliteta.

Patients on maintenance hemodialysis are prone to severe clinical forms of infectious diseases. One reason for this is a certain degree of dysfunction of the immune system in these patients, and the consequence of this dysfunction is a weaker immune response to vaccination. Objective: The objectives were to investigate the impact of vaccination against the SARS-CoV-2 virus on the prevention of severe clinical forms and mortality from COVID-19, determine the number of vaccine doses that provide adequate protection, and determine predictors of mortality due to COVID-19. Methods: A cohort longitudinal observational study was conducted, including patients on maintenance hemodialysis who contracted COVID-19. The outcome was defined as recovery or occurrence of a lethal outcome. Demographic and clinical data were obtained from medical records. Results: The study included 442 patients (64.5% male). The average age was 63 years. Bilateral pneumonia occurred least frequently in patients vaccinated with 3 doses (34.1% of patients compared to 61.8% in the unvaccinated group, 63.2% with 1 dose, and 54.5% with 2 doses received; p<0.001, p=0.003, p=0.002, in the mentioned order). Patients vaccinated with three doses had a lower mortality rate compared to other groups (p<0.05), which did not differ from each other in terms of this outcome. Independent predictors of mortality were cardiomyopathy (HR 3.364, p<0.001), CRP on admission (HR 1.004, p=0.005), maximum CRP value (HR 1.006, p=0.003), and maximum IL-6 value (HR 1.001, p<0.001). Conclusion: Vaccination against the SARS-CoV-2 virus is of great importance in preventing severe clinical forms and mortality from COVID-19 in dialysis patients, particularly through the administration of three vaccine doses. Elevated concentrations of CRP and IL-6 in serum are significant predictors of mortality.

kovid-19, vakcinacija, hronična bubrežna insuficijencija, hemodijaliza

COVID-19, vaccination, end-stage renal disease, hemodialysis

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