Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

Clinical profiles and outcomes of patients receiving acute renal replacement therapy in the cardiac intensive care unit at a South African tertiary centre

Background At least a quarter of patients admitted to the Cardiac Intensive Care Unit (CICU) will develop Acute Kidney Injury (AKI) and some of these patients receive Renal Replacement Therapy (RRT). The clinical profiles and outcomes of CICU patients receiving RRT in resource constraint settings like South Africa is unknown. Objectives The objectives of this study were to determine the clinical profiles and outcomes of patients receiving RRT in the CICU in a South African Tertiary Centre. Methods In this retrospective study we included consecutive patients admitted and receiving RRT at the Groote Schuur Hospital CICU from 01/01/2012 to 31/12/2016. Results During the study period 3247 patients were admitted to the CICU and 46 received RRT. The RRT patients had a mean (SD) age of 52 (17) years, 56% were males, and 65% had a background history of systemic hypertension. Heart failure syndromes accounted for 60.9% of CICU admission in the RRT patient group, followed by acute coronary syndromes and arrhythmias, which accounted for 26.1% and 13.0% respectively. The RRT patient population had an in-hospital and 30-day mortality of 58.7% and 60.9% respectively. Baseline use of Angiotensin Converting Enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) was associated with a reduced 30 day mortality, Hazards Ratio (HR) 0.43; 95% Confidence interval (95%CI) 0.20 – 0.93; p = 0.031. In addition, heart failure was associated with an increased 30 day mortality, HR 2.52; 95% CI 1.10 – 5.78; p = 0.029. Conclusion Heart failure syndrome accounts for a majority of RRT patients admitted to the our CICU. Patients receiving RRT in CICU have a high in-hospital and 30-day mortality