BACKGROUND: New York City emerged as an epicenter of the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: To describe the clinical characteristics and risk factors associated with mortality in a large patient population in the USA. DESIGN: Retrospective cohort study. PARTICIPANTS: 6493 patients who had laboratoryconfirmed COVID-19 with clinical outcomes between March 13 and April 17, 2020, who were seen in one of the 8 hospitals and/or over 400 ambulatory practices in the New York City metropolitan area MAIN MEASURES: Clinical characteristics and risk factors associated with in-hospital mortality. KEY RESULTS: A total of 858 of 6493 (13.2%) patients in our total cohort died: 52/2785 (1.9%) ambulatory patients and 806/3708 (21.7%) hospitalized patients. Cox proportional hazard regression modeling showed an increased risk of in-hospital mortality associated with age older than 50 years (hazard ratio [HR] 2.34, CI 1.47-3.71), systolic blood pressure less than 90 mmHg (HR 1.38, CI 1.06-1.80), a respiratory rate greater than 24 per min (HR 1.43, CI 1.13-1.83), peripheral oxygen saturation less than 92% (HR 2.12, CI 1.56-2.88), estimated glomerular filtration rate less than 60 mL/min/1.73m 2 (HR 1.80, CI 1.60-2.02), IL-6 greater than 100 pg/mL (HR 1.50, CI 1.12-2.03), D-dimer greater than 2 mcg/mL (HR 1.19, CI 1.02-1.39), and troponin greater than 0.03 ng/mL (HR 1.40, CI 1.23-1.62). Decreased risk of in-hospital mortality was associated with female sex (HR 0.84, CI 0.77-0.90), African American race (HR 0.78 CI 0.65-0.95), and hydroxychloroquine use (HR 0.53, CI 0.41-0.67). CONCLUSIONS: Among patients with COVID-19, older age, male sex, hypotension, tachypnea, hypoxia, impaired renal function, elevated D-dimer, and elevated troponin were associated with increased in-hospital mortality and hydroxychloroquine use was associated with decreased in-hospital mortality.

Abstract-Recent evidence indicates that the type of atherosclerotic plaque, rather than the degree of obstruction to flow, is an important determinant of the risk of cardiovascular complications. In previous work, the feasibility of using MRI for the characterization of plaque components was shown. This study extends the previous work to all the plaque components and shows the accuracy of this method. Twenty-two human carotid endarterectomy specimens underwent ex vivo MRI and histopathological examination. Sixty-six cross sections were matched between MRI and histopathology. In each cross section, the presence or absence of plaque components were prospectively identified on the MRI images. The overall sensitivity and specificity for each tissue component were very high. Calcification and fibrocellular tissue were readily identified. Lipid core was also identifiable. However, thrombus was the plaque component for which MRI had the lowest sensitivity. A semiautomated algorithm was created to identify all major atherosclerotic plaque components. MRI can characterize carotid artery plaques with a high level of sensitivity and specificity. isruption of atherosclerotic plaques is the most frequent underlying cause of the unpredictable onset of acute thromboembolic vascular events including sudden death, myocardial infarction, unstable angina, stroke, transient cerebral ischemia, and peripheral thromboemboli. 1,2 Although clinical risk factors for atherosclerosis help predict risk of these events, identification of patients with plaques vulnerable to disruption is not possible by angiography that only visualizes the lumen. There is therefore a need for an in vivo noninvasive method for characterizing atherosclerotic plaques and identifying the "vulnerable" plaque.Previous work has shown that MRI can characterize both ex vivo 3-7 and in vivo 8 -11 the composition of human atherosclerotic plaques. However, the sensitivity and specificity of MRI have not been determined.This study reports the development of high-resolution MRI criteria for the ex vivo tissue characterization of human carotid atherosclerotic plaques and their sensitivity and specificity in comparison with histopathology. Using these criteria, a semiautomatic segmentation algorithm is developed for characterizing the constituents of an atherosclerotic plaque. Methods SpecimensHuman carotid endarterectomy specimens were studied. Specimens were obtained fresh and intact from the operating room, washed in phosphate buffered saline, grossly described, and samples taken for routine surgical pathology. The remaining 1-to 2-cm-long segments were flash frozen at Ϫ80°C until imaged. On the day of imaging, the specimens were placed in saline and slowly warmed to 37°C in a water bath. The artery was placed in either a 10-or 12-mm MR tube (Wilmad Glass) using the smallest possible tube for a given specimen. Care was taken to remove any air bubbles. Previous studies have shown no change in the T1 and T2 of atheromatous plaques under these conditions of freezing and rewa...