The Epidemiology and Predictors of Outcomes Among Confirmed COVID-19 Cases in a Large Community Healthcare System in South Florida

Abstract

The novel coronavirus disease 2019 (COVID-19) continues to be a major public health concern. The aim of this study was to describe the presenting characteristics, epidemiology and predictors of outcomes among confirmed COVID-19 cases seen at a large community healthcare system which serves the epicenter and diverse region of Florida. We conducted a retrospective analysis of individuals with lab-confirmed SARS-CoV-2 infection who were seen, from March 2, 2020 to May 31, 2020, at Memorial Healthcare System in South Florida. Data was extracted from a COVID-19 registry of patients with lab-confirmed SARS-CoV-2 infection. Univariate and backward stepwise multivariate logistic regression models were used to determine predictors of key study outcomes. There were a total of 1692 confirmed COVID-19 patients included in this study. Increasing age was found to be a significant predictor of hospitalization, 30-day readmission and death. Having a temperature of 38 °C or more and increasing comorbidity score were also associated with an increased risk of hospitalization. Significant predictors of ICU admission included having a saturated oxygen level less than 90%, hypertension, dementia, rheumatologic disease, having a respiratory rate greater than 24 breaths per minute. Being of Hispanic ethnicity and immunosuppressant utilization greatly increased the risk of 30-day readmission. Having an oxygen saturation less than 90% and an underlying neurological disorder were associated with an increased likelihood of death. Results show that a patient’s demographic, underlying condition and vitals at triage may increase or reduce their risk of hospitalization, ICU admission, 30-day readmission or death.

Neurological comorbidities and COVID-19-related case fatality: A cohort study

“…Again, our results confirm previous data on both institutionalized patients [10] and general population [4,10], and highlight the importance of the association between cognitive impairment and a more severe form of COVID-19 [6,8]. Some Authors postulated a higher COVID-19-related mortality in demented patients as due to a reduced access to care facilities [26], in particular ICUs [17], in favor of younger and less debilitated people. However, in our current study, the rate of patients with neurodegenerative diseases who were admitted to ICU or treated with mechanical respiratory support was similar to that of matched patients not suffering from neurodegenerative diseases.…”

“…Samuels and colleagues [17] reported a general mortality rate of 16% in patients evaluated in the Florida Memorial Healthcare System facilities, with neurological diseases associated with a 4-fold higher mortality rate; based on these observations, we estimated that a sample of 54 neurological patients would have been sufficiently large to detect an increased CFR of at least 2.5-fold in patients with neurological compared to those without a neurological diseases, with 80% power at the 5% level of significance.…”

“…A retrospective analysis of 2820 patients reported increased adjusted odds of having severe COVID-19 and fatal outcome in patients with neurological disease [16]. Two observational studies reported a 4.6-fold [17] and a 2.9-fold [18] higher COVID-19-related mortality in neurological patients, evaluated by a multivariate approach, while other studies reported, in univariate analyses only, a significant association between mortality and neurological diseases [23] or cerebrovascular and neurodegenerative disorders [11,12]. Using a large health electronic analytic platform (OpenSAFELY) that includes 40% of all patients in England, Williamson and colleagues [4] evaluated the cause of nearly 11,000 COVID-19-related deaths, identifying a 2.1-fold and a 2.5-fold increased mortality risk in patients affected by stroke or dementia, and other neurological diseases, respectively.…”

“…In addition, some studies investigating specific neurological diseases, reported that dementia [4,6,10], stroke [4,[11][12][13], and Parkinson's disease (PD) [14,15] may be associated with higher mortality. Other studies, applying a generic definition of "neurological disorders", reported higher mortality in patients affected by neurological diseases [4,[16][17][18], while a recent systematic review and meta-analysis on the impact of comorbidities on COVID-19 severity, hospitalization, and mortality did not include any neurological disease in the analysis due to the lack of data available [19]. Against this background, no previous studies have comprehensively analyzed the impact of different types of neurological diseases on the outcome of COVID-19 using a cohort design with matched patients.…”

Characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients: A systematic review and meta-analysis

“…1 ). Eventually, 36 studies were included in the present systematic review and 28 were incorporated in the meta-analysis [ 7 , 9 , 11 , [13] , [14] , [15] , [16] , 19 , 20 , 23 , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] ]. Overall, 28 articles were included in phase 1 to determine risk factors and outcome of readmitted COVID-19 patients, and 19 articles were included in phase 2 to determine the cause of readmissions.…”