New York Inner City Hospital COVID-19 Experience and Current Data: Retrospective Analysis at the Epicenter of the American Coronavirus Outbreak

Abstract

Background In the midst of the coronavirus disease pandemic, emerging clinical data across the world has equipped frontline health care workers, policy makers, and researchers to better understand and combat the illness. Objective The aim of this study is to report the correlation of clinical and laboratory parameters with patients requiring mechanical ventilation and the mortality in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We did a review of patients with SARS-CoV-2 confirmed infection admitted and managed by our institution during the last month. Patients were grouped into intubated and nonintubated, and subgrouped to alive and deceased. A comprehensive analysis using the following parameters were performed: age, sex, ethnicity, BMI, comorbidities, inflammatory markers, laboratory values, cardiac and renal function, electrocardiogram (EKG), chest x-ray findings, temperature, treatment groups, and hospital-acquired patients with SARS-CoV-2. Results A total of 184 patients were included in our study with ages ranging from 28-97 years (mean 64.72 years) and including 73 females (39.67%) and 111 males (60.33%) with a mean BMI of 29.10. We had 114 African Americans (61.96%), 58 Hispanics (31.52%), 11 Asians (5.98%), and 1 Caucasian (0.54%), with a mean of 1.70 comorbidities. Overall, the mortality rate was 17.39% (n=32), 16.30% (n=30) of our patients required mechanical ventilation, and 11.41% (n=21) had hospital-acquired SARS-CoV-2 infection. Pertinent and statistically significant results were found in the intubated versus nonintubated patients with confirmed SARS-CoV-2 for the following parameters: age (P=.01), BMI (P=.07), African American ethnicity (P<.001), Hispanic ethnicity (P=.02), diabetes mellitus (P=.001), creatinine (P=.29), blood urea nitrogen (BUN; P=.001), procalcitonin (P=.03), C-reactive protein (CRP; P=.007), lactate dehydrogenase (LDH; P=.001), glucose (P=.01), temperature (P=.004), bilateral pulmonary infiltrates in chest x-rays (P<.001), and bilateral patchy opacity (P=.02). The results between the living and deceased subgroups of patients with confirmed SARS-CoV-2 (linking to or against mortality) were BMI (P=.04), length of stay (P<.001), hypertension (P=.02), multiple comorbidity (P=.045), BUN (P=.04), and EKG findings with arrhythmias or blocks (P=.02). Conclusions We arrived at the following conclusions based on a comprehensive review of our study group, data collection, and statistical analysis. Parameters that were strongly correlated with the need for mechanical ventilation were younger age group, overweight, Hispanic ethnicity, higher core body temperature, EKG findings with sinus tachycardia, and bilateral diffuse pulmonary infiltrates on the chest x-rays. Those intubated exhibited increased disease severity with significantly elevated levels of serum procalcitonin, CRP, LDH, mean glucose, creatinine, and BUN. Mortality was strongly correlated with BMI, African American ethnicity, hypertension, presence of multiple comorbidities (with a mean of 2.32), worsening renal function with acute kidney injury or acute chronic kidney injury, and EKG findings of arrhythmias and heart blocks.

Predictors of COVID‐19 severity: A literature review

“…Abnormalities in markers of cellular injury, particularly elevated lactate dehydrogenase (LDH), have been linked to greater disease severity. 6,9,10,20,75,81,103 Recent data suggest that LDH may be related to respiratory function and be an important predictor of respiratory failure in COVID-19 patients. 104 A prediction model using age, LDH, and CD4+ ([age × LDH]/CD4) showed that the area under the receiver operating characteristic (ROC) curve was significantly higher than the areas for each of these variables alone.…”

Sex Disparities in COVID-19 Severity and Outcome: Are Men Weaker or Women Stronger?

“…Although global epidemiological data suggest a similar prevalence in virus infection between men and women, a clear sex-related difference in the severity of the disease, with a more favorable outcome in women compared to men, has been described [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Indeed, according to the last update of the global situation on October 14, 2020 the overall prevalence of infection in men and women was 53.3 and 46.7%, respectively, whereas the prevalence of death in men and women was 58.3 and 41.7%, respectively.…”

Outcomes of coronavirus 2019 infection in patients with chronic kidney disease: a systematic review and meta-analysis

“…After screening, 27 articles were included for further analysis. 20 – 46 The process of selection of the included studies is shown in Figure 1 .…”

“…Of the 22,578 patients with COVID-19 infection in 15 of the included studies, [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] a total of 6315 patients died during the study period: 725 patients in the CKD group and 5590 patients in the non-CKD group. The heterogeneity test showed moderate heterogeneity among these studies (I 2 = 43%), and a random-effects model was used for this meta-analysis.…”