背景:Covid-19大流行对许多病理的进展产生了巨大的影响,尤其是肿瘤。医院活动朝着SARS-Cov2感染患者的护理方向发展,导致许多其他病理的诊断和治疗显着延迟。严重的高钙血症呢?这项工作的目的是确定临床和生物学表现,病因,死亡率,以及Covid-19大流行对严重高钙血症的影响。
方法:我们在MohammedVI大学医院肾内科进行了84个月(2014年9月至2021年9月)的回顾性研究。Oujda,摩洛哥。包括所有诊断为严重高钙血症(定义为校正后的总血清钙>3.5mmol/l或>14.0mg/dl)并从一次或多次血液透析中受益的成年患者。
结果:64例患者发生66次严重高钙血症。平均年龄为57±15岁,女性占57.6%。入院时平均校正血清钙为16.9±2.1mg/dl,33.3%的患者超过18.0mg/dl。恶性肿瘤占所有病因的80.4%。急性肾损伤占69.7%。开始药物治疗后48小时血清钙的δ下降为4.64±1.63mg/dl。在所有病例中,死亡率为14%。心电图异常占58.3%,87.5%和85.7%,分别,在第1组(14.0-16.0mg/dl)中,第2组(16.1-18.0mg/dl),和第3组(>18.0mg/dl)(p=0.04)。平均血清钾值分别为5.1±1.3、4.0±1.0和3.7±0.7,在第1组(14.0-16.0mg/dl)中,第2组(16.1-18.0mg/dl),和第3组(>18.0mg/dl)(p<0.001)。新诊断的肿瘤,重度高钙血症(>16.0mg/dl),和死亡率已观察到15.4%与23.7%(p=0.31),25%vs.50%(p=0.03),和35.7%vs.分别为52.6%(p=0.13),在Covid-19大流行之前和期间的患者中。
结论:Covid-19大流行导致高钙血症的发生率和严重程度增加,在这种情况下进行的血液透析仍然是有效和安全的。
BACKGROUND: The Covid-19 pandemic has had dramatic consequences on the progression of numerous pathologies, especially neoplastic ones. The orientation of hospital activities toward the care of patients with SARS-Cov2 infection has caused significant delays in the diagnosis and therapy of many other pathologies. What about severe hypercalcemia? The aim of this work was to determine the clinical and biological presentation, etiologies, mortality, and the impact of the Covid-19 pandemic on severe hypercalcemia.
METHODS: we conducted a retrospective study for 84 months (September 2014 to September 2021) at the Nephrology Unit in University Hospital Mohammed VI, Oujda, Morocco. Included were all adult patients diagnosed with severe hypercalcemia (defined as corrected total serum calcium of >3.5 mmol/l or > 14.0 mg/dl) and who had benefited from one or more hemodialysis sessions.
RESULTS: 66 episodes of severe hypercalcemia occurred in 64 patients. The mean age was 57 ± 15 years and 57.6% were female. The mean corrected serum calcium at admission was 16.9 ± 2.1 mg/dl and 33.3% had more than 18.0 mg/dl. Malignancies represented 80.4% of all etiologies. Acute kidney injury was observed in 69.7%. The delta drop in serum calcium 48 h after initiation of medical treatment was 4.64 ± 1.63 mg /dl. Mortality was noted in 14% of all cases. Electrocardiographic abnormalities were observed in 58.3%, 87.5% and 85.7%, respectively, in group 1 (14.0-16.0 mg/dl), group 2 (16.1-18.0 mg/dl), and group 3 (> 18.0 mg/dl) (p = 0.04). The mean serum potassium value was 5.1 ± 1.3, 4.0 ± 1.0, and 3.7 ± 0.7 respectively, in group 1 (14.0-16.0 mg/dl), group 2 (16.1-18.0 mg/dl), and group 3 (> 18.0 mg/dl) (p < 0.001). Newly diagnosed neoplasia, severe hypercalcemia (> 16.0 mg/dl), and mortality have been observed in 15.4% vs. 23.7% (p = 0.31), 25% vs. 50% (p = 0.03), and 35.7% vs. 52.6% (p = 0.13) respectively, in patients before and during the Covid-19 pandemic.
CONCLUSIONS: The Covid-19 pandemic caused an increase in both the incidence and severity of hypercalcemia and the hemodialysis practiced in this context remains efficient and safe.