[Risk prediction of pneumonia in maintenance hemodialysis patients after severe acute respiratory syndrome coronavirus 2 infection].

OBJECTIVE

To analyze the risk factors for pneumonia after severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection in maintenance hemodialysis patients from a single center in China, and to establish a multivariate model to predict the risk of pneumonia.

METHODS

A retrospective analysis was performed on maintenance hemodialysis patients with positive SARS-CoV-2 antigen or nucleic acid tests treated at Peking University Third Hospital from December 1, 2022 to January 31, 2023. Demographic data, comorbidities, dialysis-related parameters, and laboratory test results were collected. Multivariate Logistic regression and receiver operating characteristic (ROC) curve were adopted to explore risk factors of pneumonia, and a multivariate model was established to predict the risk of pneumonia occurrence.

RESULTS

A total of 209 hemodialysis patients with SARS-CoV-2 infection were enrolled, including 80 patients (38.3%) with pneumonia and 129 patients (61.7%) without pneumonia. Compared with the non-pneumonia group, the pneumonia group presented a significantly higher mean age [(65.8±13.7) years vs. (58.9±12.6) years, P < 0.001] and elevated C-reactive protein levels [4.58(1.62, 9.99) mg/L vs. 2.35(0.95, 6.50) mg/L, P=0.007]. In contrast, the pneumonia group had markedly lower hemoglobin [(109±15) g/L vs. (116±11) g/L, P=0.001], serum phosphorus [(1.60±0.52) mmol/L vs. (1.78±0.53) mmol/L, P=0.022], serum albumin [(35.9±4.1) g/L vs. (38.6±2.5) g/L, P < 0.001], arteriovenous fistula utilization rate (81.3% vs. 96.9%, P < 0.001), and single dialysis session duration [(232±14) min vs. (236±11) min, P=0.046]. Multivariate Logistic analysis revealed that advanced age (OR=1.030, 95%CI: 1.002-1.059, P=0.036), lower hemoglobin (OR=0.968, 95%CI: 0.942-0.995, P=0.019), lower albumin (OR=0.834, 95%CI: 0.738-0.943, P=0.004) were independent risk factors for pneumonia. Patients over 65 years old, with hemoglobin < 115 g/L or serum albumin < 36.8 g/L had elevated risk of pneumonia. A combined predictive factor Q composed of these three indicators was developed for risk prediction of pneumonia. We drew the ROC curve with the predictive factor Q [area under the curve (AUC) =0.756, 95%CI: 0.687-0.825, P < 0.001]. Taking the cut-off value of 0.575, the sensitivity and specificity of predictive factor Q for predicting pneumonia were 44.0% and 94.5%, respectively.

CONCLUSION

Advanced age, anemia and hypoalbuminemia are risk factors for pneumonia in maintenance hemodialysis patients following SARS-CoV-2 infection. A predictive marker Q value less than 0.575 indicates low risk of pneumonia, which can be applied for rapid risk stratification among hemodialysis patients with SARS-CoV-2 infection.