Should COVID-19 Patients &amp;gt; 75 Years be Ventilated? An Outcome Study

Raheja, Hitesh; Chukwuka, Nnamdi; Agarwal, Chirag; Sharma, Dikshya; Munoz-Martinez, Alejandro; Fogel, Joshua; Khalid, Mohammad; Hashmi, Arsalan Talib; Ehrlich, Samantha F.; Waheed, Maham Akbar; Siddiqui, Sabah; Gomes, Bruno Augusto de Brito; Aslam, Awais; Gualan, C J Merino; Aftab, Iqra; Tiwari, Atul; Singh, Sukhdev; Pouching, K; Somal, Navjot; Shani, Jacob; Rojas-Marte, Geurys

doi:10.1093/qjmed/hcab029

Cited by 7 publications

(2 citation statements)

References 23 publications

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“…We also found that patients presented after about a week of symptom onset (mean 6.7 days) as reported in Table 1. Studies with other racial groups have also consistently shown that older age is associated with worse outcomes [9,10,11]. Increasing susceptibility to Covid-19 disease with age can be attributed to the immunosenescence of the aging immune system [12].…”

Section: Discussionmentioning

confidence: 95%

Hispanic Patients Hospitalized with COVID-19 Disease-Characteristics and Clinical Outcomes at a Tertiary Care Center in New York City

Waheed

Munoz-Martinez

Raheja

et al. 2021

JAMMR

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Background: COVID-19 disease has disproportionately affected ethnic minorities in the US. Objective: To describe the characteristics and predictors of mortality and length of hospital stay (LOS) in patients of Hispanic ethnicity hospitalized for COVID-19 disease. Design: Retrospective cohort study of 162 patients. Setting: Tertiary care teaching hospital in Brooklyn, NY. Patients: Hispanic patients hospitalized with principal diagnosis of COVID-19 disease between March 8, and April 25, 2020. Methods: Patients were classified into mild/moderate, severe/very severe, and critical disease (intubated) based on oxygen requirements. The primary endpoint was overall mortality rate and the secondary endpoint was LOS. Results: Mean age was 55.6 years and 40.1% had critical disease. The overall mortality was 35.8%. Increasing age (OR:1.09, 95% CI:1.04, 1.13, p<0.001) and vasopressor use (OR:198.55, 95% CI:15.89, 2480.66, p<0.001) were each independently associated with increased odds for mortality. Steroid use was significantly associated with decreased odds for mortality (OR:0.05, 95% CI:0.004, 0.61, p<0.05). Mean LOS was 14 days. Severe/very severe disease was significantly associated with increased LOS while critical disease was significantly associated with decreased LOS. The use of hydroxychloroquine, steroids, antibiotics, vasopressor, blood transfusion, and diagnosis of bacteremia/fungemia were each significantly associated with increased LOS. Spanish-speaking patients were older than English-speaking ones, however, there was no difference in mortality or LOS between the groups. Conclusion: Age and vasopressor use was associated with increased mortality in Hispanics. Steroid use was associated with decreased mortality but increased LOS. No difference in outcomes was observed between English- and Spanish-speaking Hispanics.

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Section: Discussionmentioning

confidence: 95%

Hispanic Patients Hospitalized with COVID-19 Disease-Characteristics and Clinical Outcomes at a Tertiary Care Center in New York City

Waheed

Munoz-Martinez

Raheja

et al. 2021

JAMMR

Self Cite

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“…Dementia has also been reported as an independent risk factor for mortality. [20] Since it is di cult to obtain informed consent from patients with dementia, the focus shifts to the patient's family members or relatives who can provide proxy consent for IMV. However, as mentioned above, it is di cult to have a discussion with the patient's family members and relatives in the acute phase of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with withholding of invasive mechanical ventilation in the early phase of the COVID-19 response and their ethical analyses

Morioka,

Takashima,

Asai

et al. 2023

Preprint

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Background End-of-life decision making regarding invasive mechanical ventilation (IMV) for patients with severe coronavirus disease (COVID-19) is challenging. We aimed to explore the factors associated with the withholding of IMV in patients with COVID-19. Methods This retrospective study included patients registered in a nationwide COVID-19 Registry Japan. We enrolled patients with COVID-19 admitted between January 1, 2020, and June 30, 2021, and died during hospitalisation. The enrolled patients were divided into two groups: those who received IMV (IMV group) and those who did not (non-IMV group). To identify the factors associated with withholding of IMV among patients with COVID-19 who died during hospitalisation, we conducted a multivariate logistic regression analysis. Results A total of 2401 patients were enrolled. Of these, 588 (24.5%) were in the IMV group and 1813 (75.5%) in the non-IMV group. Withholding IMV was positively associated with older age (95% confidence interval [CI]: 0.82–0.88, p < 0.0001), dementia (95% CI: 0.81–0.91, p < 0.0001), chronic lung disease (95% CI: 0.88–1.00, p = 0.036), and malignancy (95% CI: 0.82–0.94, p < 0.0004) although inversely associated with male sex (95% CI: 1.04–1.15, p = 0.0008), body mass index (95% CI: 1.01–1.02, p < 0.0001), and National Early Warning Score (95% CI: 1.01–1.03, p < 0.0001). Conclusions We explored factors associated with the withholding of IMV and analysed the results to prepare for future emerging infectious disease pandemics by taking a retrospective look at the decision-making process during the COVID-19 disaster and considering multidisciplinary collaboration.

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Antiviral evaluation of hydroxyethylamine analogs: Inhibitors of SARS-CoV-2 main protease (3CLpro), a virtual screening and simulation approach

Gupta

Kumar

Zak

et al. 2021

Bioorganic & Medicinal Chemistry

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The continued toll of COVID-19 has halted the smooth functioning of civilization on a global scale. With a limited understanding of all the essential components of viral machinery and the lack of structural information of this new virus, initial drug discovery efforts had limited success. The availability of high-resolution crystal structures of functionally essential SARS-CoV-2 proteins, including 3CLpro, supports the development of target-specific therapeutics. 3CLpro, the main protease responsible for the processing of viral polypeptide, plays a vital role in SARS-CoV-2 viral replication and translation and is an important target in other coronaviruses. Additionally, 3CLpro is the target of repurposed drugs, such as lopinavir and ritonavir. In this study, target proteins were retrieved from the protein data bank (PDB IDs: 6M03, 6LU7, 2GZ7, 6W63, 6SQS, 6YB7, and 6YVF) representing different open states of the main protease to accommodate macromolecular substrate. A hydroxyethylamine (HEA) library was constructed from harvested chemical structures from all the series being used in our laboratories for screening against malaria and Leishmania parasites. The database consisted of ∼1000 structure entries, of which 70% were new to ChemSpider at the time of screening. This in-house library was subjected to high throughput virtual screening (HTVS), followed by standard precision (SP) and then extra precision (XP) docking (Schrodinger LLC 2021). The ligand strain and complex energy of top hits were calculated by Molecular Mechanics Generalized Born Surface Area (MM/GBSA) method. Promising hit compounds (n=40) specifically binding to 3CLpro with high energy and average MM/GBSA scores were then subjected to (100-ns) MD simulations. Using this sequential selection followed by an in-silico validation approach, we found a promising HEA-based compound (N,N'-((3S,3'S)-piperazine-1,4-diylbis(3-hydroxy-1-phenylbutane-4,2-diyl))bis(2-(5-methyl-1,3-dioxoisoindolin-2-yl)-3-phenylpropanamide)), which showed high in vitro antiviral activity against SARS-CoV-2. Further to reduce the size of the otherwise larger ligand, a pharmacophore-based predicted library of ∼42 derivatives was constructed, which were added to the previous compound library and rescreened virtually. Out of several hits from the predicted library, two compounds were synthesized, tested against SARS-CoV-2 culture, and found to have markedly improved antiviral activity.

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Should COVID-19 Patients > 75 Years be Ventilated? An Outcome Study

Cited by 7 publications

References 23 publications

Hispanic Patients Hospitalized with COVID-19 Disease-Characteristics and Clinical Outcomes at a Tertiary Care Center in New York City

Hispanic Patients Hospitalized with COVID-19 Disease-Characteristics and Clinical Outcomes at a Tertiary Care Center in New York City

Factors associated with withholding of invasive mechanical ventilation in the early phase of the COVID-19 response and their ethical analyses

Antiviral evaluation of hydroxyethylamine analogs: Inhibitors of SARS-CoV-2 main protease (3CLpro), a virtual screening and simulation approach

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