Objective To determine the incidence of and risk-factors for development of acute kidney injury (AKI) and investigate the association between AKI and mortality in patients hospitalized with Covid-19. Patients and Methods This retrospective case series includes the first 370 patients consecutively hospitalized with confirmed Covid-19 illness between March 10, 2020 and May 13, 2020, at a 242-bed teaching hospital. To determine independent association between demographic factors, comorbidities and AKI incidence, multivariable-logistic regression models were used to estimate odds ratios adjusted for clinical covariates. Results Median age of patients was 71 (59–82) years and 44.3% were female. Patients with AKI were significantly older with a higher comorbidity-burden and mortality-rate (58.1% vs 19.6%, p<.001) when compared to those without AKI. Increasing age, chronic kidney disease, hyperlipidemia and being of African-American descent showed higher odds of AKI. Patients with AKI had significantly higher odds of mortality when compared to patients without AKI, and this effect was proportional to the stage of AKI. Increasing age and acute respiratory distress syndrome also revealed higher adjusted odds of mortality. Conclusion AKI is a common complication among hospitalized Covid-19 patients. We found significantly higher odds of AKI with increasing age, among hyperlipidemics and patients with chronic kidney disease and among African-Americans. We demonstrate an independent association between AKI and mortality with increasingly higher odds of mortality from progressively worsening renal failure in hospitalized Covid-19 patients.

Background Advancing age and male sex have been identified as risk factors for poor outcomes in coronavirus disease 2019 (COVID-19). However, there is a dearth of data investigating the impact of age on the risk reported with male sex. We aimed to determine the risk associated with male sex in people of different age groups, that is, in people younger or older than 65 years of age. Methods This is a retrospective cohort study that included 370 adult patients hospitalized with COVID-19 between March 12, 2020, and May 13, 2020, at a 242-bed teaching community hospital in the New York City metropolitan region. Patients were classified into younger (age<65 years, n=132) and older individuals (age>=65, n=238). We calculated odds ratios for poor outcomes in men compared to women separately in these two groups. Results Among older individuals, there was no difference in the odds of poor outcomes between men and women. In contrast, among younger people, men had higher odds of severe pneumonia, need for high oxygen support, acute kidney injury and acute liver injury when compared to women. Conclusions Among people older than 65 years, sex did not impact disease severity and outcomes in COVID-19. Thus, older women were equally likely to have severe COVID-19 when compared to age-matched men. In contrast, among younger middle-aged adults (29-64 years), men had higher odds of end-organ damage from COVID-19 compared to women. Based on these observations, age is a more important driver of poor outcomes in COVID-19 than sex. Public health policies need to create awareness for the increased risk of older individuals to COVID-19, regardless of sex.

Introduction: Obesity has been recognized as a risk factor for poor outcomes in coronavirus disease 2019 illness. We analyzed the impact of patient characteristics including obesity on hospital mortality and specifically analyzed the effect of obesity by body mass index (BMI) class and by sex.Methods: This retrospective case series included adult patients consecutively hospitalized with confirmed COVID-19 illness between March 12, 2020 and May 13, 2020, at a teaching hospital in the New York City (NYC) metropolitan area. Data were manually extracted from electronic health records by the authors and included demographics, comorbidities, laboratory parameters, and outcomes (hospital mortality or discharge). We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.Results: Some 348 patients were included in this study, of whom 207 were discharged and 141 died in the hospital. Multivariable regression showed increasing odds of in-hospital death with older age and excess weight. Interestingly obesity increased mortality in women [odds ratio (OR) 4.4, confidence interval (CI) (1.4-13.5) p=0.01] but not among men [OR 1.4, CI (0.5-3.6) p=0.5]. Among women, the effect of excess weight on mortality was seen in a "dose-effect" fashion, with increasingly higher odds of mortality from progressively worsening obesity (OR ranging between 2.7 and 6.9). Out of all the comorbidities, only obesity positively correlated with peak levels of C-reactive protein (CRP). Conclusion:Advancing age is a risk factor for in-hospital death during COVID-19 illness. Obese women could be at a higher risk for mortality due to COVID-19 and should take extra precautions to prevent contamination by social distancing and other measures. Immunomodulators may be more effective in obese women affected by COVID-19. Further studies are needed to help elucidate this association.

Introduction Several comorbid conditions have been identified as risk factors in patients with coronavirus disease 2019 (COVID-19). However, there is a dearth of data describing the impact of COVID-19 infection in patients with end-stage renal disease on hemodialysis (ESRD-HD). Methods This retrospective case series analyzed 362 adult patients consecutively hospitalized with confirmed COVID-19 illness between March 12, 2020, and May 13, 2020, at a teaching hospital in the New York City metropolitan area. The primary outcome was severe pneumonia as defined by the World Health Organization. Secondary outcomes were the (1) the Combined Outcome of Acute respiratory distress syndrome or in-hospital Death (COAD), and (2) need for high levels of oxygen supplementation (HiO 2). Results Patients with ESRD-HD had lower odds for poor outcomes including severe pneumonia [odds ratio (OR) 0.4, confidence interval (CI) 0.2-0.9, p=.04], HiO 2 [OR 0.3, CI (0.1-0.8), p=.02] and COAD [OR 0.4, CI (0.2-1.05), p=.06], when compared to patients without ESRD. In contrast, higher odds for severe pneumonia, COAD and HiO 2 were seen with advancing age. African Americans were over-represented in the hospitalized patient cohort, when compared to their representation in the community (35% vs 18%). Hispanics had higher odds for severe illness and HiO 2 when compared to Caucasians. Conclusions Patients with ESRD-HD had a milder course of illness with a lower likelihood of severe pneumonia and a lesser need for aggressive oxygen supplementation when compared to patients not on chronic dialysis. The lower odds of severe illness in ESRD-HD patients might have a pathophysiologic basis and need to be further explored.

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