scholarly journals Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study

BMJ ◽  
2020 ◽  
pp. m1966 ◽  
Author(s):  
Christopher M Petrilli ◽  
Simon A Jones ◽  
Jie Yang ◽  
Harish Rajagopalan ◽  
Luke O’Donnell ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Mechanical Ventilation ◽  
New York City ◽  
Cohort Study ◽  
Critical Illness ◽  
Hospital Admission ◽  
York City ◽  
Hospice Care ◽  
Male Sex

AbstractObjectiveTo describe outcomes of people admitted to hospital with coronavirus disease 2019 (covid-19) in the United States, and the clinical and laboratory characteristics associated with severity of illness.DesignProspective cohort study.SettingSingle academic medical center in New York City and Long Island.Participants5279 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection between 1 March 2020 and 8 April 2020. The final date of follow up was 5 May 2020.Main outcome measuresOutcomes were admission to hospital, critical illness (intensive care, mechanical ventilation, discharge to hospice care, or death), and discharge to hospice care or death. Predictors included patient characteristics, medical history, vital signs, and laboratory results. Multivariable logistic regression was conducted to identify risk factors for adverse outcomes, and competing risk survival analysis for mortality.ResultsOf 11 544 people tested for SARS-Cov-2, 5566 (48.2%) were positive. After exclusions, 5279 were included. 2741 of these 5279 (51.9%) were admitted to hospital, of whom 1904 (69.5%) were discharged alive without hospice care and 665 (24.3%) were discharged to hospice care or died. Of 647 (23.6%) patients requiring mechanical ventilation, 391 (60.4%) died and 170 (26.2%) were extubated or discharged. The strongest risk for hospital admission was associated with age, with an odds ratio of >2 for all age groups older than 44 years and 37.9 (95% confidence interval 26.1 to 56.0) for ages 75 years and older. Other risks were heart failure (4.4, 2.6 to 8.0), male sex (2.8, 2.4 to 3.2), chronic kidney disease (2.6, 1.9 to 3.6), and any increase in body mass index (BMI) (eg, for BMI >40: 2.5, 1.8 to 3.4). The strongest risks for critical illness besides age were associated with heart failure (1.9, 1.4 to 2.5), BMI >40 (1.5, 1.0 to 2.2), and male sex (1.5, 1.3 to 1.8). Admission oxygen saturation of <88% (3.7, 2.8 to 4.8), troponin level >1 (4.8, 2.1 to 10.9), C reactive protein level >200 (5.1, 2.8 to 9.2), and D-dimer level >2500 (3.9, 2.6 to 6.0) were, however, more strongly associated with critical illness than age or comorbidities. Risk of critical illness decreased significantly over the study period. Similar associations were found for mortality alone.ConclusionsAge and comorbidities were found to be strong predictors of hospital admission and to a lesser extent of critical illness and mortality in people with covid-19; however, impairment of oxygen on admission and markers of inflammation were most strongly associated with critical illness and mortality. Outcomes seem to be improving over time, potentially suggesting improvements in care.

scholarly journals Factors associated with hospitalization and critical illness among 4,103 patients with Covid-19 disease in New York City

2020 ◽  
Author(s):  
Christopher M. Petrilli ◽  
Simon A. Jones ◽  
Jie Yang ◽  
Harish Rajagopalan ◽  
Luke O’Donnell ◽  
...  
Keyword(s):  
New York ◽  
Mechanical Ventilation ◽  
New York City ◽  
Critical Illness ◽  
Decision Tree ◽  
York City ◽  
Adverse Outcomes ◽  
Maximum Information ◽  
Factors Associated ◽  
Markers Of Inflammation

AbstractBackgroundLittle is known about factors associated with hospitalization and critical illness in Covid-19 positive patients.MethodsWe conducted a cross-sectional analysis of all patients with laboratory-confirmed Covid-19 treated at an academic health system in New York City between March 1, 2020 and April 2, 2020, with follow up through April 7, 2020. Primary outcomes were hospitalization and critical illness (intensive care, mechanical ventilation, hospice and/or death). We conducted multivariable logistic regression to identify risk factors for adverse outcomes, and maximum information gain decision tree classifications to identify key splitters.ResultsAmong 4,103 Covid-19 patients, 1,999 (48.7%) were hospitalized, of whom 981/1,999 (49.1%) have been discharged, and 292/1,999 (14.6%) have died or been discharged to hospice. Of 445 patients requiring mechanical ventilation, 162/445 (36.4%) have died. Strongest hospitalization risks were age ≥75 years (OR 66.8, 95% CI, 44.7-102.6), age 65-74 (OR 10.9, 95% CI, 8.35-14.34), BMI>40 (OR 6.2, 95% CI, 4.2-9.3), and heart failure (OR 4.3 95% CI, 1.9-11.2). Strongest critical illness risks were admission oxygen saturation <88% (OR 6.99, 95% CI 4.5-11.0), d-dimer>2500 (OR 6.9, 95% CI, 3.2-15.2), ferritin >2500 (OR 6.9, 95% CI, 3.2-15.2), and C-reactive protein (CRP) >200 (OR 5.78, 95% CI, 2.6-13.8). In the decision tree for admission, the most important features were age >65 and obesity; for critical illness, the most important was SpO2<88, followed by procalcitonin >0.5, troponin <0.1 (protective), age >64 and CRP>200.ConclusionsAge and comorbidities are powerful predictors of hospitalization; however, admission oxygen impairment and markers of inflammation are most strongly associated with critical illness.

scholarly journals COVID-19-Associated Critical Illness—Report of the First 300 Patients Admitted to Intensive Care Units at a New York City Medical Center

2020 ◽  
Vol 35 (10) ◽  
pp. 963-970 ◽  
Author(s):  
Sudham Chand ◽  
Sumit Kapoor ◽  
Deborah Orsi ◽  
Melissa J. Fazzari ◽  
Tristan G. Tanner ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
Mechanical Ventilation ◽  
New York City ◽  
Intensive Care ◽  
Critical Illness ◽  
Mortality Rate ◽  
York City ◽  
Medical Center ◽  
The United States

Background: The first confirmed case of novel coronavirus (2019-nCoV) infection in the United States was reported from the state of Washington in January, 2020. By March, 2020, New York City had become the epicenter of the outbreak in the United States. Methods: We tracked all patients with confirmed coronavirus-19 (COVID-19) infection admitted to intensive care units (ICU) at Montefiore Medical Center (Bronx, NY). Data were obtained through manual review of electronic medical records. Patients had at least 30 days of follow-up. Results: Our first 300 ICU patients were admitted March 10 through April 11, 2020. The majority (60.7%) of patients were men. Acute respiratory distress syndrome (ARDS) was documented in 91.7% of patients; 91.3% required mechanical ventilation. Prone positioning was employed in 58% of patients and neuromuscular blockade in 47.8% of mechanically-ventilated patients. Neither intervention was associated with decreased mortality. Vasopressors were required in 77.7% of patients. Acute kidney injury (AKI) was present on admission in 40.7% of patients, and developed subsequently in 36.0%; 50.9% of patients with AKI received renal replacement therapy (RRT). Overall 30-day mortality rate was 52.3%, and 55.8% among patients receiving mechanical ventilation. In univariate analysis, higher mortality rate was associated with increasing age, male sex, hypertension, obesity, smoking, number of comorbidities, AKI on presentation, and need for vasopressor support. A representative multivariable model for 30-day mortality is also presented, containing patient age, gender, body mass index, and AKI at admission. As of May 11, 2020, 2 patients (0.7%) remained hospitalized. Conclusions: Mortality in critical illness associated with COVID-19 is high. The majority of patients develop ARDS requiring mechanical ventilation, vasopressor-dependent shock, and AKI. The variation in mortality rates reported to date likely reflects differences in the severity of illness of the evaluated populations.

scholarly journals Sex-specificity of mortality risk factors among hospitalized COVID-19 patients in New York City: prospective cohort study

2020 ◽  
Author(s):  
Tomi Jun ◽  
Sharon Nirenberg ◽  
Patricia Kovatch ◽  
Kuan-lin Huang
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
New York ◽  
New York City ◽  
Cohort Study ◽  
Coronary Artery ◽  
Lactate Dehydrogenase ◽  
York City ◽  
Male Sex ◽  
Artery Disease

Objective: To identify sex-specific effects of risk factors for in-hospital mortality among COVID-19 patients admitted to a hospital system in New York City. Design: Prospective observational cohort study with in-hospital mortality as the primary outcome. Setting: Five acute care hospitals within a single academic medical system in New York City. Participants: 3,086 hospital inpatients with COVID-19 admitted on or before April 13, 2020 and followed through June 2, 2020. Follow-up till discharge or death was complete for 99.3% of the cohort. Results: The majority of the cohort was male (59.6%). Men were younger (median 64 vs. 70, p<0.001) and less likely to have comorbidities such as hypertension (32.5% vs. 39.9%, p<0.001), diabetes (22.6% vs. 26%, p=0.03), and obesity (6.9% vs. 9.8%, p=0.004) compared to women. Women had lower median values of laboratory markers associated with inflammation compared to men: white blood cells (5.95 vs. 6.8 K/uL, p<0.001), procalcitonin (0.14 vs 0.21 ng/mL, p<0.001), lactate dehydrogenase (375 vs. 428 U/L, p<0.001), C-reactive protein (87.7 vs. 123.2 mg/L, p<0.001). Unadjusted mortality was similar between men and women (28.8% vs. 28.5%, p=0.84), but more men required intensive care than women (25.2% vs. 19%, p<0.001). Male sex was an independent risk factor for mortality (OR 1.26, 95% 1.04-1.51) after adjustment for demographics, comorbidities, and baseline hypoxia. There were significant interactions between sex and coronary artery disease (p=0.038), obesity (p=0.01), baseline hypoxia (p<0.001), ferritin (p=0.002), lactate dehydrogenase (p=0.003), and procalcitonin (p=0.03). Except for procalcitonin, which had the opposite association, each of these factors was associated with disproportionately higher mortality among women. Conclusions: Male sex was an independent predictor of mortality, consistent with prior studies. Notably, there were significant sex-specific interactions which indicated a disproportionate increase in mortality among women with coronary artery disease, obesity, and hypoxia. These new findings highlight patient subgroups for further study and help explain the recognized sex differences in COVID-19 outcomes.

scholarly journals Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks: an observational cohort study

The Lancet ◽  
2011 ◽  
Vol 378 (9794) ◽  
pp. 898-905 ◽  
Author(s):  
Rachel Zeig-Owens ◽  
Mayris P Webber ◽  
Charles B Hall ◽  
Theresa Schwartz ◽  
Nadia Jaber ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Cohort Study ◽  
York City ◽  
Observational Cohort Study ◽  
Cancer Outcomes ◽  
Early Assessment ◽  
Observational Cohort

Abstract 17878: Hospital Admission Rates for Myocardial Infarction and Stroke in New York City Before and After the Ban on Trans Fatty Acids

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Eric J Brandt ◽  
Rebecca Myerson ◽  
Marcelo Coca Perraillon ◽  
Tamar Polonsky
Keyword(s):  
Fatty Acids ◽  
New York ◽  
New York City ◽  
Hospital Admission ◽  
York City ◽  
Trans Fatty Acids ◽  
Age Groups ◽  
Admission Rates ◽  
Younger Age ◽  
Nyc Hanes

Introduction: Numerous bans on the use of trans fatty acids (TF)s in eateries are in effect across the United States. No studies have examined cardiovascular event rates after the bans were enacted. Hypothesis: The July 1, 2007 ban on TFs in restaurants and food trucks in New York City (NYC) was associated with an accelerated decline in MI and stroke. Methods: We used the 2002-2013 New York Department of Health Statewide Planning and Research Cooperative System (SPARCS) data to calculate hospital admission rates for incident of MI and stroke in NYC residents (using county of residence). Diagnosis was established using primary discharge ICD-9-CM codes 410.00-410.99 for MI and 430.00-438.99 for stroke. Rates were calculated using Census 2000 and 2010 data and intercensal estimates. Incidence rates of MI and stroke declined between 2002 and 2007. To analyze whether there was additional decline from these prior trends after implementation of the NYC TF ban, we used negative binomial regression to model event trends and compare this to actual trends. We also used publicly available data from the 2004 NYC Health and Nutrition Examination Survey (NYC HANES) to investigate restaurant usage per week among NYC residents. This was reported as never, less than weekly (we estimated as 0.5 uses per week), or 1 to 25 uses per week. All analyses were stratified by decade of age. Results: After 2007, younger age groups (25-34 and 35-44) experienced an additional decline in stroke (see table), but not MI, that was greater than would have been expected based on temporal trends. Younger age groups also reported higher mean restaurant use in NYC HANES. Conclusions: Stroke rates in NYC among younger adults declined faster than would have been expected after the 2007 TF ban. Additionally, younger age groups were also those that had highest restaurant usage. Further study to compare event trends in NYC counties to other New York counties is warranted to investigate if this trend is related to other secular trends.

scholarly journals COVID-19 Infections and Clinical Outcomes in Patients with Multiple Myeloma in New York City: A Cohort Study from Five Academic Centers

2020 ◽  
Vol 1 (3) ◽  
pp. 234-243 ◽  
Author(s):  
Malin Hultcrantz ◽  
Joshua Richter ◽  
Cara A. Rosenbaum ◽  
Dhwani Patel ◽  
Eric L. Smith ◽  
...  
Keyword(s):  
New York ◽  
Multiple Myeloma ◽  
New York City ◽  
Cohort Study ◽  
Clinical Outcomes ◽  
York City

scholarly journals Coronavirus 2019 and People Living With Human Immunodeficiency Virus: Outcomes for Hospitalized Patients in New York City

2020 ◽  
Vol 71 (11) ◽  
pp. 2933-2938 ◽  
Author(s):  
Keith Sigel ◽  
Talia Swartz ◽  
Eddye Golden ◽  
Ishan Paranjpe ◽  
Sulaiman Somani ◽  
...  
Keyword(s):  
New York ◽  
Human Immunodeficiency Virus ◽  
Mechanical Ventilation ◽  
New York City ◽  
York City ◽  
Cumulative Incidence ◽  
Clinical Characteristics ◽  
Hiv Status ◽  
Immunodeficiency Virus ◽  
Race Ethnicity

Abstract Background There are limited data regarding the clinical impact of coronavirus disease 2019 (COVID-19) on people living with human immunodeficiency virus (PLWH). In this study, we compared outcomes for PLWH with COVID-19 to a matched comparison group. Methods We identified 88 PLWH hospitalized with laboratory-confirmed COVID-19 in our hospital system in New York City between 12 March and 23 April 2020. We collected data on baseline clinical characteristics, laboratory values, HIV status, treatment, and outcomes from this group and matched comparators (1 PLWH to up to 5 patients by age, sex, race/ethnicity, and calendar week of infection). We compared clinical characteristics and outcomes (death, mechanical ventilation, hospital discharge) for these groups, as well as cumulative incidence of death by HIV status. Results Patients did not differ significantly by HIV status by age, sex, or race/ethnicity due to the matching algorithm. PLWH hospitalized with COVID-19 had high proportions of HIV virologic control on antiretroviral therapy. PLWH had greater proportions of smoking (P &lt; .001) and comorbid illness than uninfected comparators. There was no difference in COVID-19 severity on admission by HIV status (P = .15). Poor outcomes for hospitalized PLWH were frequent but similar to proportions in comparators; 18% required mechanical ventilation and 21% died during follow-up (compared with 23% and 20%, respectively). There was similar cumulative incidence of death over time by HIV status (P = .94). Conclusions We found no differences in adverse outcomes associated with HIV infection for hospitalized COVID-19 patients compared with a demographically similar patient group.

scholarly journals Obesity and COVID-19 in New York City: A Retrospective Cohort Study

2020 ◽  
Vol 173 (10) ◽  
pp. 855-858 ◽  
Author(s):  
Parag Goyal ◽  
Joanna Bryan Ringel ◽  
Mangala Rajan ◽  
Justin J. Choi ◽  
Laura C. Pinheiro ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
York City ◽  
Retrospective Cohort
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