Functional status of mechanically ventilated COVID-19 survivors at ICU and hospital discharge

Musheyev, Benjamin; Borg, Lara; Janowicz, Rebeca; Matarlo, Michael; Boyle, Hayle; Singh, Gurtej; Ende, Victoria; Babatsikos, Ioannis; Hou, Wei; Duong, Timothy Q.

doi:10.1186/s40560-021-00542-y

Cited by 53 publications

(62 citation statements)

References 31 publications

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“…This retrospective study was approved by Stony Brook University Institutional Research Board with exemption of informed consent. A subset of these data has been used to study different aspects of COVID-19 disease (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Figure 1 shows patients who presented to the emergency department (ED) and were hospitalized with COVID-19 from February 7, 2020, to June 30, 2020.…”

Section: Study Population and Data Collectionmentioning

confidence: 99%

Longitudinal Clinical Profiles of Hospital vs. Community-Acquired Acute Kidney Injury in COVID-19

Babatsikos

Fisher

et al. 2021

Front. Med.

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Acute kidney injury (AKI) is associated with high mortality in coronavirus disease 2019 (COVID-19). However, it is unclear whether patients with COVID-19 with hospital-acquired AKI (HA-AKI) and community-acquired AKI (CA-AKI) differ in disease course and outcomes. This study investigated the clinical profiles of HA-AKI, CA-AKI, and no AKI in patients with COVID-19 at a large tertiary care hospital in the New York City area. The incidence of HA-AKI was 23.26%, and CA-AKI was 22.28%. Patients who developed HA-AKI were older and had more comorbidities compared to those with CA-AKI and those with no AKI (p < 0.05). A higher prevalence of coronary artery disease, heart failure, and chronic kidney disease was observed in those with HA-AKI compared to those with CA-AKI (p < 0.05). Patients with CA-AKI received more invasive and non-invasive mechanical ventilation, anticoagulants, and steroids compared to those with HA-AKI (p < 0.05), but patients with HA-AKI had significantly higher mortality compared to those with CA-AKI after adjusting for demographics and clinical comorbidities (adjusted odds ratio = 1.61, 95% confidence interval = 1.1–2.35, p < 0.014). In addition, those with HA-AKI had higher markers of inflammation and more liver injury (p < 0.05) compared to those with CA-AKI. These results suggest that HA-AKI is likely part of systemic multiorgan damage and that kidney injury contributes to worse outcomes. These findings provide insights that could lead to better management of COVID-19 patients in time-sensitive and potentially resource-constrained environments.

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Section: Study Population and Data Collectionmentioning

confidence: 99%

Longitudinal Clinical Profiles of Hospital vs. Community-Acquired Acute Kidney Injury in COVID-19

Babatsikos

Fisher

et al. 2021

Front. Med.

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“…Our COVID-19 Persons Under Investigation Registry consisted of 6678 patients clinically suspected of COVID-19 infection from February 7, 2020 to June 30, 2020 [16][17][18][19][20], of which 2892 were tested positive using real-time polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on a nasopharyngeal swab specimen. Exclusion criteria included patients who were not hospitalized, without alanine aminotransferase (ALT) and aspartate aminotransferase (AST) data, less than 18 years old, and still in the hospital.…”

Section: Study Population and Data Collectionmentioning

confidence: 99%

Longitudinal progression of clinical variables associated with graded liver injury in COVID-19 patients

Anand

Frager

et al. 2021

Hepatol Int

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Background Hospital-acquired liver injury is associated with worse outcomes in COVID-19. This study investigated the temporal progression of clinical variables of in-hospital liver injury in COVID-19 patients. Methods COVID-19 patients (n = 1361) were divided into no, mild and severe liver injury (nLI, mLI and sLI) groups. Time courses of laboratory variables were time-locked to liver-injury onset defined by alanine aminotransferase level. Predictors of liver injury were identified using logistic regression. Results The prevalence of mLI was 39.4% and sLI was 9.2%. Patients with escalated care had higher prevalence of sLI (23.2% vs. 5.0%, p < 0.05). sLI developed 9.4 days after hospitalization. sLI group used more invasive ventilation, anticoagulants, steroids, and dialysis (p < 0.05). sLI, but not mLI, had higher adjusted mortality odds ratio (= 1.37 [95% CI 1.10, 1.70], p = 0.005). Time courses of the clinical variables of the sLI group differed from those of the nLI and mLI group. In the sLI group, alanine aminotransferase, procalcitonin, ferritin, and lactate dehydrogenase showed similar temporal profiles, whereas white-blood-cell count, D-dimer, C-reactive protein, respiration and heart rate were elevated early on, and lymphocyte and SpO2 were lower early on. The top predictors of sLI were alanine aminotransferase, lactate dehydrogenase, respiration rate, ferritin, and lymphocyte, yielding an AUC of 0.98, 0.92, 0.88 and 0.84 at 0, − 1, − 2 and − 3 days prior to onset, respectively. Conclusions This study identified key clinical variables predictive of liver injury in COVID-19, which may prove useful for management of liver injury. Late onset of sLI and more aggressive care are suggestive of treatment-related hepatotoxicity.

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“…We previously reported the functional status of critically ill COVID-19 patients at discharge 28 . In that study, the majority (94.1%) were functionally independent prior to COVID-19 illness, whereas most critically ill COVID-19 patients were not functionally independent at hospital discharge (22% discharged with cane or rolling walker, 49% discharged with durable medical equipment).…”

Section: Discussionmentioning

confidence: 99%

Characterizing non-critically ill COVID-19 survivors with and without in-hospital rehabilitation

Musheyev

Janowicz

Borg

et al. 2021

Sci Rep

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This study investigated pre-COVID-19 admission dependency, discharge assistive equipment, discharge medical follow-up recommendation, and functional status at hospital discharge of non-critically ill COVID-19 survivors, stratified by those with (N = 155) and without (N = 162) in-hospital rehabilitation. “Mental Status”, intensive-care-unit (ICU) Mobility, and modified Barthel Index scores were assessed at hospital discharge. Relative to the non-rehabilitation patients, rehabilitation patients were older, had more comorbidities, worse pre-admission dependency, were discharged with more assistive equipment and supplemental oxygen, spent more days in the hospital, and had more hospital-acquired acute kidney injury, acute respiratory failure, and more follow-up referrals (p < 0.05 for all). Cardiology, vascular medicine, urology, and endocrinology were amongst the top referrals. Functional scores of many non-critically ill COVID-19 survivors were abnormal at discharge (p < 0.05) and were associated with pre-admission dependency (p < 0.05). Some functional scores were negatively correlated with age, hypertension, coronary artery disease, chronic kidney disease, psychiatric disease, anemia, and neurological disorders (p < 0.05). In-hospital rehabilitation providing restorative therapies and assisting discharge planning were challenging in COVID-19 circumstances. Knowledge of the functional status, discharge assistive equipment, and follow-up medical recommendations at discharge could enable appropriate and timely post-discharge care. Follow-up studies of COVID-19 survivors are warranted as many will likely have significant post-acute COVID-19 sequela.

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Functional status of mechanically ventilated COVID-19 survivors at ICU and hospital discharge

Cited by 53 publications

References 31 publications

Longitudinal Clinical Profiles of Hospital vs. Community-Acquired Acute Kidney Injury in COVID-19

Longitudinal Clinical Profiles of Hospital vs. Community-Acquired Acute Kidney Injury in COVID-19

Longitudinal progression of clinical variables associated with graded liver injury in COVID-19 patients

Characterizing non-critically ill COVID-19 survivors with and without in-hospital rehabilitation

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