Clinical Characteristics of Hospitalized Covid-19 Patients in New York City

Paranjpe, Ishan; Russak, Adam; Freitas, Jessica K De; Lala, Anuradha; Miotto, Riccardo; Vaid, Akhil; Johnson, Kipp W.; Danieletto, Matteo; Golden, Eddye; Meyer, Dara; Singh, Manbir; Somani, Sulaiman; Manna, Sayan; Nangia, Udit; Kapoor, Arjun; O’Hagan, Ross; O’Reilly, Paul; Huckins, Laura; Glowe, Patricia; Kia, Arash; Timsina, Prem; Freeman, Robert; Levin, Matthew A.; Jhang, Jeffrey S.; Firpo, Adolfo; Kovatch, Patricia; Finkelstein, Joseph; Aberg, Judith A.; Bagiella, Emilia; Horowitz, Carol R.; Murphy, Barbara; Fayad, Zahi A.; Narula, Jagat; Nestler, Eric J.; Fuster, Valentín; Cordon‐Cardo, Carlos; Charney, Dennis S.; Reich, David L.; Just, Allan C.; Böttinger, Erwin P.; Charney, Alexander; Glicksberg, Benjamin S.; Nadkarni, Girish N.

doi:10.1101/2020.04.19.20062117

Cited by 91 publications

(96 citation statements)

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“…Of these, 6,875 patients were on IMV. Nine studies were from the USA [8][9][10][11]17,18,23,25,26], 13 from China [12,14,16,[20][21][22][27][28][29][30][31][32][33], two from the UK [24,32], and one each from Italy [15], Spain [13], France [19], and Mexico [35]. (Table 1) Fifteen studies were good and 13 were fair as assessed by the NIH tool.…”

Section: Search Resultsmentioning

confidence: 99%

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COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

Chang

Elhusseiny

Yeh

et al. 2020

Preprint

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Background To characterize COVID-19 ICU admissions, their outcome and associated features, as well as identify their regional discrepancies. Methods Scopus, Embase, preprint servers bioRvix and medRvix and the Intensive Care National Audit and Research Center (ICNARC) website was searched for reports through May 1st 2020 on COVID-19 ICU admissions and outcomes using pre-defined search terms and eligibility criteria.Relevant data was extracted and pooled using fixed or random effects meta-analysis depending on heterogeneity. Study quality was assessed by the NIH tool and heterogeneity was assessed by I2 and Q tests. Baseline patient characteristics, ICU and IMV outcomes were pooled and meta-analyzed. Pooled odds ratios (pOR) were calculated for clinical features against ICU, MV mortality. Subgroup analysis was carried out based on patient regions.Results Twenty-eight studies comprising 12,437 COVID-19 ICU admissions from seven countries were meta-analyzed. Pooled ICU admission rate was 21%[95% CI 0.12 to 0.34] and 69% of cases needed IMV[95% CI 0.61-0.75]. ICU and IMV mortality were 28.3%[95% CI 0.25 to 0.32], 43%[95% CI 0.29 to 0.58] and ICU, IMV duration was 7.78[95% CI 6.99 to 8.63] and 10.12[95% CI 7.08 to 13.16] days respectively. Besides confirming the significance of comorbidities and clinical findings of COVID-19, major correlates with ICU mortality were found to be IMV [pOR 16.46, 95% CI 4.37 to 61.96], acute kidney injury (AKI) [pOR 12.47, 95% CI 1.52 to 102.7], and acute respiratory distress syndrome (ARDS) [pOR 6.52, 95% CI 2.66 to 16.01]. Subgroup analyses confirm significant regional discrepancies in outcomes.Conclusions This is the most comprehensive systematic review and meta-analysis of COVID-19 ICU and IMV cases and associated outcomes to date and the only analysis to analyze and associate IMV with COVID-19 ICU mortality. The significant association of AKI, ARDS and IMV with mortality has implications for ICU resource planning for AKI and ARDS as well as research into optimal ventilation strategies for patients. Regional differences in outcome implies a need to develop region specific protocols for ventilatory support as well as overall treatment.Study Registration PROSPERO registration number CRD42020182482.

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Section: Search Resultsmentioning

confidence: 99%

“…Follow-up duration was insu cient or unreported in seven [8,10,12,14,26,29,35] among which three had fair assessments. Of note, 14 studies [8,9,[12][13][14][15][17][18][19]21,22,24,25,34] had over 20% of patients with unknown outcome at endpoint of which 8 had fair assessment. Figure 3).…”

Section: Search Resultsmentioning

confidence: 99%

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

Chang

Elhusseiny

Yeh

et al. 2020

Preprint

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“…We did not have sufficient data on inflammatory makers (e.g., interleukin 6, ferritin, and fibrinogen) in a large proportion of patients since they were not routinely checked early in the pandemic and a majority of patients did not have these values. 22 Additionally, urinalysis was also missing in the majority of patients and we did not include in the analysis, although further studies could benefit from characterizing the urinalysis profile of COVID-19 associated AKI. Lastly, baseline medications of interest including angiotensin converting enzyme inhibitors, angiotensin receptor blockers, statins, and other nonsteroidal anti-inflammatory drugs were not included.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Hospitalized Patients with COVID-19

Chan

Chaudhary

Saha

et al. 2020

Preprint

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Importance: Preliminary reports indicate that acute kidney injury (AKI) is common in coronavirus disease (COVID)-19 patients and is associated with worse outcomes. AKI in hospitalized COVID-19 patients in the United States is not well-described. Objective: To provide information about frequency, outcomes and recovery associated with AKI and dialysis in hospitalized COVID-19 patients. Design: Observational, retrospective study. Setting: Admitted to hospital between February 27 and April 15, 2020. Participants: Patients aged ≥18 years with laboratory confirmed COVID-19 Exposures: AKI (peak serum creatinine increase of 0.3 mg/dL or 50% above baseline). Main Outcomes and Measures: Frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aOR) with mortality. We also trained and tested a machine learning model for predicting dialysis requirement with independent validation. Results: A total of 3,235 hospitalized patients were diagnosed with COVID-19. AKI occurred in 1406 (46%) patients overall and 280 (20%) with AKI required renal replacement therapy. The incidence of AKI (admission plus new cases) in patients admitted to the intensive care unit was 68% (553 of 815). In the entire cohort, the proportion with stages 1, 2, and 3 AKI were 35%, 20%, 45%, respectively. In those needing intensive care, the respective proportions were 20%, 17%, 63%, and 34% received acute renal replacement therapy. Independent predictors of severe AKI were chronic kidney disease, systolic blood pressure, and potassium at baseline. In-hospital mortality in patients with AKI was 41% overall and 52% in intensive care. The aOR for mortality associated with AKI was 9.6 (95% CI 7.4-12.3) overall and 20.9 (95% CI 11.7-37.3) in patients receiving intensive care. 56% of patients with AKI who were discharged alive recovered kidney function back to baseline. The area under the curve (AUC) for the machine learned predictive model using baseline features for dialysis requirement was 0.79 in a validation test. Conclusions and Relevance: AKI is common in patients hospitalized with COVID-19, associated with worse mortality, and the majority of patients that survive do not recover kidney function. A machine-learned model using admission features had good performance for dialysis prediction and could be used for resource allocation.

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“…1). Overall, there were six cohort studies [11,[14][15][16][17][18] and two case series [19,20] comparing on-admission D-dimer levels between non-survivors and survivors, and one cohort study [12] comparing patients with elevated D-dimer levels and normal D-dimer levels on admission. Only two studies were prospective studies [14,18], while the others were retrospective in nature.…”

Section: Search Selection and Quality Assessmentmentioning

confidence: 99%

D-dimer levels on admission and all-cause mortality risk in COVID-19 patients: a meta-analysis

Simadibrata

Lubis

2020

Epidemiol. Infect.

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D-dimer level on admission is a promising biomarker to predict mortality in patients with COVID-19. In this study, we reviewed the association between on-admission D-dimer levels and all-cause mortality risk in COVID-19 patients. Peer-reviewed studies and preprints reporting categorised D-dimer levels on admission and all-cause mortality until 24 May 2020 were searched for using the following keywords: ‘COVID-19’, ‘D-dimer’ and ‘Mortality’. A meta-analysis was performed to determine the pooled risk ratio (RR) for all-cause mortality. In total, 2911 COVID-19 patients from nine studies were included in this meta-analysis. Regardless of the different D-dimer cut-off values used, the pooled RR for all-cause mortality in patients with elevated vs. normal on-admission D-dimer level was 4.77 (95% confidence interval (CI) 3.02–7.54). Sensitivity analysis did not significantly affect the overall mortality risk. Analysis restricted to studies with 0.5 μg/ml as the cut-off value resulted in a pooled RR for mortality of 4.60 (95% CI 2.72–7.79). Subgroup analysis showed that the pooled all-cause mortality risk was higher in Chinese vs. non-Chinese studies (RR 5.87; 95% CI 2.67–12.89 and RR 3.35; 95% CI 1.66–6.73; P = 0.29). On-admission D-dimer levels showed a promising prognostic role in predicting all-cause mortality in COVID-19 patients, elevated D-dimer levels were associated with increased risk of mortality.

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Clinical Characteristics of Hospitalized Covid-19 Patients in New York City

Cited by 91 publications

References 13 publications

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

Acute Kidney Injury in Hospitalized Patients with COVID-19

D-dimer levels on admission and all-cause mortality risk in COVID-19 patients: a meta-analysis

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