Male Sex, Severe Obesity, Older Age, and Chronic Kidney Disease Are Associated With COVID-19 Severity and Mortality in New York City

Background: Coronavirus disease 2019 (COVID-19) has evolved into a true global pandemic infecting more than 30 million people worldwide. Predictive models for key outcomes have the potential to optimize resource utilization and patient outcome as outbreaks continue to occur worldwide. We aimed to design and internally validate a web-based calculator predictive of hospitalization and length of stay (LOS) in a large cohort of COVID-19 positive patients presenting to the Emergency Department (ED) in a New York City health system. Methods The study cohort consisted of consecutive adult (>18 years) patients presenting to the ED of one of the Mount Sinai Health System hospitals between March, 2020 and April, 2020 who were diagnosed with COVID-19. Logistic regression was utilized to construct predictive models for hospitalization and prolonged (>3 days) LOS. Discrimination was evaluated using area under the receiver operating curve (AUC). Internal validation with bootstrapping was performed, and a web-based calculator was implemented. Results The cohort consisted of 5859 patients with a hospitalization rate of 65% and a prolonged LOS rate of 75% among hospitalized patients. Independent predictors of hospitalization included older age (OR=6.29; 95% CI [1.83-2.63], >65 vs. 18-44), male sex (OR=1.35 [1.17-1.55]), chronic obstructive pulmonary disease (OR=1.74; [1.00-3.03]), hypertension (OR=1.39; [1.13-1.70]), diabetes (OR=1.45; [1.16-1.81]), chronic kidney disease (OR=1.69; [1.23-2.32]), elevated maximum temperature (OR=4.98; [4.28-5.79]), and low minimum oxygen saturation (OR=13.40; [10.59-16.96]). Predictors of extended LOS included older age (OR=1.03 [1.02-1.04], per year), chronic kidney disease (OR=1.91 [1.35-2.71]), elevated maximum temperature (OR=2.91 [2.40-3.53]), and low minimum percent oxygen saturation (OR=3.89 [3.16-4.79]). AUCs of 0.881 and 0.770 were achieved for hospitalization and LOS, respectively. A calculator was made available under the following URL: https://covid19-outcome-prediction.shinyapps.io/COVID19_Hospitalization_Calculator/ Conclusion The prediction tool derived from this study can be used to optimize resource allocation, guide quality of care, and assist in designing future studies on the triage and management of patients with COVID-19.

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1552-P: Relationship between Diabetes Status and Chronic Kidney Disease in New York City Chinese and Non-Chinese Populations

Diabetes ◽

10.2337/db19-1552-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1552-P ◽

Cited By ~ 3

Author(s):

TA-MIN CHANG ◽

GEORGE LIU ◽

JOHN D. GEORGE ◽

JAMES W. SHARP ◽

ANTHONY HU

Keyword(s):

Chronic Kidney Disease ◽

New York ◽

New York City ◽

Kidney Disease ◽

York City ◽

Chinese Populations ◽

Diabetes Status

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Is There a Racial Disparity in Coronavirus Disease 2019 Patients with Chronic Kidney Disease? An Experience in New York City

Authorea ◽

10.22541/au.158750376.61560929 ◽

2020 ◽

Author(s):

Takayuki Yamada ◽

Takahisa Mikami ◽

Nitin Chopra ◽

Hirotaka Miyashita ◽

Svetlana Chernyavsky ◽

...

Keyword(s):

Chronic Kidney Disease ◽

New York ◽

New York City ◽

Kidney Disease ◽

York City ◽

Racial Disparity

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COVID-19 in Patients with Chronic Kidney Disease in New York City

Kidney360 ◽

10.34067/kid.0004142020 ◽

2020 ◽

pp. 10.34067/KID.0004142020

Author(s):

Oleh Akchurin ◽

Kelly Meza ◽

Sharmi Biswas ◽

Michaela Greenbaum ◽

Alexandra P. Licona-Freudenstein ◽

...

Keyword(s):

Chronic Kidney Disease ◽

New York ◽

New York City ◽

Kidney Disease ◽

Elderly Patients ◽

Serum Creatinine ◽

Hospital Mortality ◽

York City ◽

Kidney Injury ◽

Chronic Kidney Injury

Background: Coronavirus disease 2019 (COVID-19) has affected millions of people, and several chronic medical conditions appear to increase the risk of severe COVID-19. However, our understanding of COVID-19 outcomes in patients with chronic kidney disease (CKD) remains limited. Methods: This was a retrospective cohort study of patients with and without CKD consecutively admitted with COVID-19 to three affiliated hospitals in New York City. Pre-COVID-19 CKD diagnoses were identified by billing codes and verified by manual chart review. In-hospital mortality was compared between patients with and without underlying CKD. Logistic regression was used to adjust this analysis for confounders and to identify patient characteristics associated with mortality. Results: We identified 280 patients with CKD, and 4098 patients without CKD hospitalized with COVID-19. The median age of CKD group was 75 (65-84) years, and age of non-CKD group 62 (48-75) years. Baseline (pre-COVID-19) serum creatinine in patients with CKD was 1.5 (1.2-2.2) mg/dL. In-hospital mortality was 30% in patients with CKD vs. 19.9% in patients without CKD (p<0.001). The risk of in-hospital death in patients with CKD remained significantly higher after adjustment for comorbidities (hypertension, diabetes mellitus, asthma, and chronic obstructive pulmonary disease), adjusted OR 1.4 [1.1-1.9]. When stratified by age, elderly patients with CKD (above age 70) had higher mortality than their age-matched control patients without CKD. In patients with CKD, factors associated with in-hospital mortality were age (adjusted OR 1.09 [1.06-1.12]), baseline and admission serum phosphorus (adjusted ORs 1.5 [1.03-2.1] and 1.4 [1.1-1.7]), serum creatinine on admission >0.3 mg/dL above the baseline (adjusted OR 2.6 [1.2-5.4]), and diagnosis of acute on chronic kidney injury during hospitalization (adjusted OR 4.6 [2.3-8.9]). Conclusions: CKD is an independent risk factor for COVID-19 associated in-hospital mortality in elderly patients. Acute on chronic kidney injury increases odds of in-hospital mortality in CKD patients hospitalized with COVID-19.

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Comorbidity and Sociodemographic determinants in COVID-19 Mortality in an US Urban Healthcare System

10.1101/2020.06.11.20128926 ◽

2020 ◽

Cited By ~ 1

Author(s):

An-Li Wang ◽

Xiaobo Zhong ◽

Yasmin L Hurd

Keyword(s):

Chronic Kidney Disease ◽

New York ◽

New York City ◽

Kidney Disease ◽

York City ◽

Sociodemographic Factors ◽

Chronic Obstructive ◽

Logistic Regression Models ◽

The Us ◽

Sociodemographic Determinants

ABSTRACTBackgroundNew York City is the US epicenter of the coronavirus disease 2019 (COVID-19) pandemic. Early international data indicated that comorbidity contributes significantly to poor prognosis and fatality in patients infected with SARS-CoV-2. It is not known to what degree medical comorbidity and sociodemographic determinants impact COVID-19 mortality in the US.MethodsEvaluation of de-identified electronic health records of 7,592 COVID-19 patients confirmed by SARS-CoV-2 lab tests in New York City. Medical comorbidites and outcome of mortality, and other covariates, including clinical, sociodemographic, and medication measures were assessed by bivariate and multivariate logistic regression models.ResultsOf common comorbid conditions (hypertension, chronic kidney disease, chronic obstructive pulmonary disease, asthma, obesity, diabetes, HIV, cancer), when adjusted for covariates, chronic kidney disease remained significantly associated with increased odds of mortality. Patients who had more than one comorbidities, former smokers, treated with Azithromycin without Hydroxychloroquine, reside within the boroughs of Brooklyn and Queens Higher had higher odds of death.ConclusionsIncreasing numbers of comorbid factors increase COVID-19 mortality, but several clinical and sociodemographic factors can mitigate risk. Continued evaluation of COVID-19 in large diverse populations is important to characterize individuals at risk and improve clinical outcomes.

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Patients with chronic kidney disease have a poorer prognosis of coronavirus disease 2019 (COVID-19): an experience in New York City

International Urology and Nephrology ◽

10.1007/s11255-020-02494-y ◽

2020 ◽

Vol 52 (7) ◽

pp. 1405-1406 ◽

Cited By ~ 3

Author(s):

Takayuki Yamada ◽

Takahisa Mikami ◽

Nitin Chopra ◽

Hirotaka Miyashita ◽

Svetlana Chernyavsky ◽

...

Keyword(s):

Chronic Kidney Disease ◽

New York ◽

New York City ◽

Kidney Disease ◽

York City

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Is there a racial disparity in coronavirus disease 2019 patients with chronic kidney disease? An experience in New York City

International Journal of Clinical Practice ◽

10.1111/ijcp.14261 ◽

2021 ◽

Vol 75 (7) ◽

Author(s):

Takayuki Yamada ◽

Takahisa Mikami ◽

Nitin Chopra ◽

Hirotaka Miyashita ◽

Svetlana Chernyavsky ◽

...

Keyword(s):

Chronic Kidney Disease ◽

New York ◽

New York City ◽

Kidney Disease ◽

York City ◽

Racial Disparity

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Severe Obesity Among Children in New York City Public Elementary and Middle Schools, School Years 2006–07 Through 2010–11

Preventing Chronic Disease ◽

10.5888/pcd11.130439 ◽

2014 ◽

Vol 11 ◽

Cited By ~ 18

Author(s):

Sophia E. Day ◽

Kevin J. Konty ◽

Maya Leventer-Roberts ◽

Cathy Nonas ◽

Tiffany G. Harris

Keyword(s):

New York ◽

New York City ◽

Middle Schools ◽

York City ◽

Severe Obesity

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The first consecutive 5000 patients with Coronavirus Disease 2019 from Qatar; a nation-wide cohort study

BMC Infectious Diseases ◽

10.1186/s12879-020-05511-8 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Ali S. Omrani ◽

Muna A. Almaslamani ◽

Joanne Daghfal ◽

Rand A. Alattar ◽

Mohamed Elgara ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Older Age ◽

Icu Admission ◽

Increased Risk ◽

All Cause Mortality ◽

Male Sex

Abstract Background There are limited data on Coronavirus Disease 2019 (COVID-19) outcomes at a national level, and none after 60 days of follow up. The aim of this study was to describe national, 60-day all-cause mortality associated with COVID-19, and to identify risk factors associated with admission to an intensive care unit (ICU). Methods This was a retrospective cohort study including the first consecutive 5000 patients with COVID-19 in Qatar who completed 60 days of follow up by June 17, 2020. The primary outcome was all-cause mortality at 60 days after COVID-19 diagnosis. In addition, we explored risk factors for admission to ICU. Results Included patients were diagnosed with COVID-19 between February 28 and April 17, 2020. The majority (4436, 88.7%) were males and the median age was 35 years [interquartile range (IQR) 28–43]. By 60 days after COVID-19 diagnosis, 14 patients (0.28%) had died, 10 (0.2%) were still in hospital, and two (0.04%) were still in ICU. Fatal COVID-19 cases had a median age of 59.5 years (IQR 55.8–68), and were mostly males (13, 92.9%). All included pregnant women (26, 0.5%), children (131, 2.6%), and healthcare workers (135, 2.7%) were alive and not hospitalized at the end of follow up. A total of 1424 patients (28.5%) required hospitalization, out of which 108 (7.6%) were admitted to ICU. Most frequent co-morbidities in hospitalized adults were diabetes (23.2%), and hypertension (20.7%). Multivariable logistic regression showed that older age [adjusted odds ratio (aOR) 1.041, 95% confidence interval (CI) 1.022–1.061 per year increase; P < 0.001], male sex (aOR 4.375, 95% CI 1.964–9.744; P < 0.001), diabetes (aOR 1.698, 95% CI 1.050–2.746; P 0.031), chronic kidney disease (aOR 3.590, 95% CI 1.596–8.079, P 0.002), and higher BMI (aOR 1.067, 95% CI 1.027–1.108 per unit increase; P 0.001), were all independently associated with increased risk of ICU admission. Conclusions In a relatively younger national cohort with a low co-morbidity burden, COVID-19 was associated with low all-cause mortality. Independent risk factors for ICU admission included older age, male sex, higher BMI, and co-existing diabetes or chronic kidney disease.

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