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Made available in DSpace on 2022-04-28T19:44:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-02-01 This analysis, using data from the Brazilian kidney transplant (KT) COVID-19 study, seeks to develop a prediction score to assist in COVID-19 risk stratification in KT recipients. In this study, 1379 patients (35 sites) were enrolled, and a machine learning approach was used to fit models in a derivation cohort. A reduced Elastic Net model was selected, and the accuracy to predict the 28-day fatality after the COVID-19 diagnosis, assessed by the area under the ROC curve (AUC-ROC), was confirmed in a validation cohort. The better calibration values were used to build the applicable ImAgeS score. The 28-day fatality rate was 17% (n = 235), which was associated with increasing age, hypertension and cardiovascular disease, higher body mass index, dyspnea, and use of mycophenolate acid or azathioprine. Higher kidney graft function, longer time of symptoms until COVID-19 diagnosis, presence of anosmia or coryza, and use of mTOR inhibitor were associated with reduced risk of death. The coefficients of the best model were used to build the predictive score, which achieved an AUC-ROC of 0.767 (95% CI 0.698–0.834) in the validation cohort. In conclusion, the easily applicable predictive model could assist health care practitioners in identifying non-hospitalized kidney transplant patients that may require more intensive monitoring. Trial registration: ClinicalTrials.gov NCT04494776. Department of Internal Medicine Universidade Estadual Paulista-UNESP Department of Clinical Medicine Federal University of Ceará Hospital Universitário Walter Cantídio Hospital Geral de Fortaleza Department of Medicine Nephrology Division Federal University of São Paulo Department of Transplantation Hospital do Rim Fundação Oswaldo Ramos Renal Transplant Unit Hospital Israelita Albert Einstein Santa Casa de Misericórdia de Porto Alegre Hospital de Base Medical School FAMERP Federal University of Maranhão Hospital de Clínicas de Porto Alegre Federal Univertisy of Rio Grande do Sul Division of Nephrology and Kidney Transplantation Onofre Lopes University Hospital Hospital Santa Isabel Division of Nephrology School of Medical Sciences Renal Transplant Unit Renal Transplant Research Laboratoy University of Campinas – UNICAMP Hospital de Base de Brasília Hospital Beneficência Portuguesa de São Paulo (BP) Division of Nephrology School of Medicine of Ribeirão Preto University of Sao Paulo Hospital Santa Marcelina Hospital Universitário de Brasília University of Brasília - UnB, DF Hospital São Francisco na Providência de Deus Department of Internal Medicine Universidade Estadual Paulista-UNESP

Made available in DSpace on 2022-04-29T08:46:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-02-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Novartis Pharma Data from the general population suggest that fatality rates declined during the course of the pandemic. This analysis, using data extracted from the Brazilian Kidney Transplant COVID-19 Registry, seeks to determine fatality rates over time since the index case on March 3rd, 2020. Data from hospitalized patients with RT-PCR positive SARS-CoV-2 infection from March to August 2020 (35 sites, 878 patients) were compared using trend tests according to quartiles (Q1: 140 days after the index case). The 28-day fatality decreased from 29.5% (Q1) to 18.8% (Q4) (pfor-trend = 0.004). In multivariable analysis, patients diagnosed in Q4 showed a 35% reduced risk of death. The trend of reducing fatality was associated with a lower number of comorbidities (20.7–10.6%, pfor-trend = 0.002), younger age (55–53 years, pfor-trend = 0.062), and better baseline renal function (43.6–47.7 ml/min/1.73 m2, pfor-trend = 0.060), and were confirmed by multivariable analysis. The proportion of patients presenting dyspnea (pfor-trend = 0.001) and hypoxemia (pfor-trend < 0.001) at diagnosis, and requiring intensive care was also found reduced (pfor-trend = 0.038). Despite possible confounding variables and time-dependent sampling differences, we conclude that COVID-19-associated fatality decreased over time. Differences in demographics, clinical presentation, and treatment options might be involved. Programa de Pós-Graduação em Ciências Médicas Departamento de Medicina Clínica Faculdade de Medicina Universidade Federal do Ceará Hospital Universitário Walter Cantídio Hospital Geral de Fortaleza Hospital do Rim Departamento de Medicina Divisão de Nefrologia Universidade Federal de São Paulo Unidade de Transplante Renal Hospital Israelita Albert Einstein Departamento de Medicina Interna Universidade Estadual Paulista-UNESP Santa Casa de Misericórdia de Porto Alegre Hospital de Base Faculdade de Medicina de São José do Rio Preto (FAMERP) Universidade Federal do Maranhão Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul Divisão de Nefrologia e Transplante Renal Hospital Universitário Onofre Lopes (HOUL) Hospital Santa Isabel Santa Casa de Misericórdia de Juiz de Fora Hospital de Base do Distrito Federal Hospital Municipal São José (HMSJ) Hospital Beneficência Portuguesa de São Paulo (BP) Divisão de Nefrologia Hospital das Clínicas Faculdade de Medicina Universidade de São Paulo Unidade de Transplantes Hospital Universitário de Brasília Universidade de Brasília (UnB) Hospital São Francisco na Providência de Deus Departamento de Medicina Interna Universidade Estadual Paulista-UNESP