scholarly journals Factors associated with hospitalization and critical illness among 4,103 patients with Covid-19 disease in New York City

2020 ◽  
Author(s):  
Christopher M. Petrilli ◽  
Simon A. Jones ◽  
Jie Yang ◽  
Harish Rajagopalan ◽  
Luke O’Donnell ◽  
...  
Keyword(s):  
New York ◽  
Mechanical Ventilation ◽  
New York City ◽  
Critical Illness ◽  
Decision Tree ◽  
York City ◽  
Adverse Outcomes ◽  
Maximum Information ◽  
Factors Associated ◽  
Markers Of Inflammation

AbstractBackgroundLittle is known about factors associated with hospitalization and critical illness in Covid-19 positive patients.MethodsWe conducted a cross-sectional analysis of all patients with laboratory-confirmed Covid-19 treated at an academic health system in New York City between March 1, 2020 and April 2, 2020, with follow up through April 7, 2020. Primary outcomes were hospitalization and critical illness (intensive care, mechanical ventilation, hospice and/or death). We conducted multivariable logistic regression to identify risk factors for adverse outcomes, and maximum information gain decision tree classifications to identify key splitters.ResultsAmong 4,103 Covid-19 patients, 1,999 (48.7%) were hospitalized, of whom 981/1,999 (49.1%) have been discharged, and 292/1,999 (14.6%) have died or been discharged to hospice. Of 445 patients requiring mechanical ventilation, 162/445 (36.4%) have died. Strongest hospitalization risks were age ≥75 years (OR 66.8, 95% CI, 44.7-102.6), age 65-74 (OR 10.9, 95% CI, 8.35-14.34), BMI>40 (OR 6.2, 95% CI, 4.2-9.3), and heart failure (OR 4.3 95% CI, 1.9-11.2). Strongest critical illness risks were admission oxygen saturation <88% (OR 6.99, 95% CI 4.5-11.0), d-dimer>2500 (OR 6.9, 95% CI, 3.2-15.2), ferritin >2500 (OR 6.9, 95% CI, 3.2-15.2), and C-reactive protein (CRP) >200 (OR 5.78, 95% CI, 2.6-13.8). In the decision tree for admission, the most important features were age >65 and obesity; for critical illness, the most important was SpO2<88, followed by procalcitonin >0.5, troponin <0.1 (protective), age >64 and CRP>200.ConclusionsAge and comorbidities are powerful predictors of hospitalization; however, admission oxygen impairment and markers of inflammation are most strongly associated with critical illness.

scholarly journals Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study

BMJ ◽  
2020 ◽  
pp. m1966 ◽  
Author(s):  
Christopher M Petrilli ◽  
Simon A Jones ◽  
Jie Yang ◽  
Harish Rajagopalan ◽  
Luke O’Donnell ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Mechanical Ventilation ◽  
New York City ◽  
Cohort Study ◽  
Critical Illness ◽  
Hospital Admission ◽  
York City ◽  
Hospice Care ◽  
Male Sex

AbstractObjectiveTo describe outcomes of people admitted to hospital with coronavirus disease 2019 (covid-19) in the United States, and the clinical and laboratory characteristics associated with severity of illness.DesignProspective cohort study.SettingSingle academic medical center in New York City and Long Island.Participants5279 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection between 1 March 2020 and 8 April 2020. The final date of follow up was 5 May 2020.Main outcome measuresOutcomes were admission to hospital, critical illness (intensive care, mechanical ventilation, discharge to hospice care, or death), and discharge to hospice care or death. Predictors included patient characteristics, medical history, vital signs, and laboratory results. Multivariable logistic regression was conducted to identify risk factors for adverse outcomes, and competing risk survival analysis for mortality.ResultsOf 11 544 people tested for SARS-Cov-2, 5566 (48.2%) were positive. After exclusions, 5279 were included. 2741 of these 5279 (51.9%) were admitted to hospital, of whom 1904 (69.5%) were discharged alive without hospice care and 665 (24.3%) were discharged to hospice care or died. Of 647 (23.6%) patients requiring mechanical ventilation, 391 (60.4%) died and 170 (26.2%) were extubated or discharged. The strongest risk for hospital admission was associated with age, with an odds ratio of >2 for all age groups older than 44 years and 37.9 (95% confidence interval 26.1 to 56.0) for ages 75 years and older. Other risks were heart failure (4.4, 2.6 to 8.0), male sex (2.8, 2.4 to 3.2), chronic kidney disease (2.6, 1.9 to 3.6), and any increase in body mass index (BMI) (eg, for BMI >40: 2.5, 1.8 to 3.4). The strongest risks for critical illness besides age were associated with heart failure (1.9, 1.4 to 2.5), BMI >40 (1.5, 1.0 to 2.2), and male sex (1.5, 1.3 to 1.8). Admission oxygen saturation of <88% (3.7, 2.8 to 4.8), troponin level >1 (4.8, 2.1 to 10.9), C reactive protein level >200 (5.1, 2.8 to 9.2), and D-dimer level >2500 (3.9, 2.6 to 6.0) were, however, more strongly associated with critical illness than age or comorbidities. Risk of critical illness decreased significantly over the study period. Similar associations were found for mortality alone.ConclusionsAge and comorbidities were found to be strong predictors of hospital admission and to a lesser extent of critical illness and mortality in people with covid-19; however, impairment of oxygen on admission and markers of inflammation were most strongly associated with critical illness and mortality. Outcomes seem to be improving over time, potentially suggesting improvements in care.

scholarly journals Comorbidity and clinical factors associated with COVID-19 critical illness and mortality at a large public hospital in New York City in the early phase of the pandemic (March-April 2020)

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242760
Author(s):  
Thomas D. Filardo ◽  
Maria R. Khan ◽  
Noa Krawczyk ◽  
Hayley Galitzer ◽  
Savannah Karmen-Tuohy ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Critical Illness ◽  
Critically Ill ◽  
York City ◽  
Public Hospital ◽  
Care Delivery ◽  
Public Hospitals ◽  
Clinical Factors ◽  
Factors Associated

Background Despite evidence of socio-demographic disparities in outcomes of COVID-19, little is known about characteristics and clinical outcomes of patients admitted to public hospitals during the COVID-19 outbreak. Objective To assess demographics, comorbid conditions, and clinical factors associated with critical illness and mortality among patients diagnosed with COVID-19 at a public hospital in New York City (NYC) during the first month of the COVID-19 outbreak. Design Retrospective chart review of patients diagnosed with COVID-19 admitted to NYC Health + Hospitals / Bellevue Hospital from March 9th to April 8th, 2020. Results A total of 337 patients were diagnosed with COVID-19 during the study period. Primary analyses were conducted among those requiring supplemental oxygen (n = 270); half of these patients (135) were admitted to the intensive care unit (ICU). A majority were male (67.4%) and the median age was 58 years. Approximately one-third (32.6%) of hypoxic patients managed outside the ICU required non-rebreather or non-invasive ventilation. Requirement of renal replacement therapy occurred in 42.3% of ICU patients without baseline end-stage renal disease. Overall, 30-day mortality among hypoxic patients was 28.9% (53.3% in the ICU, 4.4% outside the ICU). In adjusted analyses, risk factors associated with mortality included dementia (adjusted risk ratio (aRR) 2.11 95%CI 1.50–2.96), age 65 or older (aRR 1.97, 95%CI 1.31–2.95), obesity (aRR 1.37, 95%CI 1.07–1.74), and male sex (aRR 1.32, 95%CI 1.04–1.70). Conclusion COVID-19 demonstrated severe morbidity and mortality in critically ill patients. Modifications in care delivery outside the ICU allowed the hospital to effectively care for a surge of critically ill and severely hypoxic patients.

scholarly journals COVID-19-Associated Critical Illness—Report of the First 300 Patients Admitted to Intensive Care Units at a New York City Medical Center

2020 ◽  
Vol 35 (10) ◽  
pp. 963-970 ◽  
Author(s):  
Sudham Chand ◽  
Sumit Kapoor ◽  
Deborah Orsi ◽  
Melissa J. Fazzari ◽  
Tristan G. Tanner ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
Mechanical Ventilation ◽  
New York City ◽  
Intensive Care ◽  
Critical Illness ◽  
Mortality Rate ◽  
York City ◽  
Medical Center ◽  
The United States

Background: The first confirmed case of novel coronavirus (2019-nCoV) infection in the United States was reported from the state of Washington in January, 2020. By March, 2020, New York City had become the epicenter of the outbreak in the United States. Methods: We tracked all patients with confirmed coronavirus-19 (COVID-19) infection admitted to intensive care units (ICU) at Montefiore Medical Center (Bronx, NY). Data were obtained through manual review of electronic medical records. Patients had at least 30 days of follow-up. Results: Our first 300 ICU patients were admitted March 10 through April 11, 2020. The majority (60.7%) of patients were men. Acute respiratory distress syndrome (ARDS) was documented in 91.7% of patients; 91.3% required mechanical ventilation. Prone positioning was employed in 58% of patients and neuromuscular blockade in 47.8% of mechanically-ventilated patients. Neither intervention was associated with decreased mortality. Vasopressors were required in 77.7% of patients. Acute kidney injury (AKI) was present on admission in 40.7% of patients, and developed subsequently in 36.0%; 50.9% of patients with AKI received renal replacement therapy (RRT). Overall 30-day mortality rate was 52.3%, and 55.8% among patients receiving mechanical ventilation. In univariate analysis, higher mortality rate was associated with increasing age, male sex, hypertension, obesity, smoking, number of comorbidities, AKI on presentation, and need for vasopressor support. A representative multivariable model for 30-day mortality is also presented, containing patient age, gender, body mass index, and AKI at admission. As of May 11, 2020, 2 patients (0.7%) remained hospitalized. Conclusions: Mortality in critical illness associated with COVID-19 is high. The majority of patients develop ARDS requiring mechanical ventilation, vasopressor-dependent shock, and AKI. The variation in mortality rates reported to date likely reflects differences in the severity of illness of the evaluated populations.

Abstract S11-02: Factors associated with developing COVID-19 among cancer patients in New York City

2021 ◽  
Author(s):  
Monica F. Chen ◽  
Monica T. Coronel ◽  
Samuel Pan ◽  
Arreum Kim ◽  
Jessica Hawley ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Cancer Patients ◽  
York City ◽  
Factors Associated

Dental Caries Experience, Tooth Loss, and Factors Associated with Unmet Needs of Haitian Immigrants in New York City

2001 ◽  
Vol 61 (4) ◽  
pp. 203-209 ◽  
Author(s):  
Gustavo D. Cruz ◽  
Xiaonan Xue ◽  
Racquel Z. LeGeros ◽  
Nandor Halpert ◽  
Diana L. Galvis ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Dental Caries ◽  
York City ◽  
Tooth Loss ◽  
Unmet Needs ◽  
Caries Experience ◽  
Haitian Immigrants ◽  
Factors Associated

scholarly journals Coronavirus 2019 and People Living With Human Immunodeficiency Virus: Outcomes for Hospitalized Patients in New York City

2020 ◽  
Vol 71 (11) ◽  
pp. 2933-2938 ◽  
Author(s):  
Keith Sigel ◽  
Talia Swartz ◽  
Eddye Golden ◽  
Ishan Paranjpe ◽  
Sulaiman Somani ◽  
...  
Keyword(s):  
New York ◽  
Human Immunodeficiency Virus ◽  
Mechanical Ventilation ◽  
New York City ◽  
York City ◽  
Cumulative Incidence ◽  
Clinical Characteristics ◽  
Hiv Status ◽  
Immunodeficiency Virus ◽  
Race Ethnicity

Abstract Background There are limited data regarding the clinical impact of coronavirus disease 2019 (COVID-19) on people living with human immunodeficiency virus (PLWH). In this study, we compared outcomes for PLWH with COVID-19 to a matched comparison group. Methods We identified 88 PLWH hospitalized with laboratory-confirmed COVID-19 in our hospital system in New York City between 12 March and 23 April 2020. We collected data on baseline clinical characteristics, laboratory values, HIV status, treatment, and outcomes from this group and matched comparators (1 PLWH to up to 5 patients by age, sex, race/ethnicity, and calendar week of infection). We compared clinical characteristics and outcomes (death, mechanical ventilation, hospital discharge) for these groups, as well as cumulative incidence of death by HIV status. Results Patients did not differ significantly by HIV status by age, sex, or race/ethnicity due to the matching algorithm. PLWH hospitalized with COVID-19 had high proportions of HIV virologic control on antiretroviral therapy. PLWH had greater proportions of smoking (P &lt; .001) and comorbid illness than uninfected comparators. There was no difference in COVID-19 severity on admission by HIV status (P = .15). Poor outcomes for hospitalized PLWH were frequent but similar to proportions in comparators; 18% required mechanical ventilation and 21% died during follow-up (compared with 23% and 20%, respectively). There was similar cumulative incidence of death over time by HIV status (P = .94). Conclusions We found no differences in adverse outcomes associated with HIV infection for hospitalized COVID-19 patients compared with a demographically similar patient group.

Incidence and risk factors for community-associated methicillin-resistant Staphylococcus aureus in New York City, 2006–2012

2015 ◽  
Vol 144 (5) ◽  
pp. 1014-1017 ◽  
Author(s):  
P. BAKER ◽  
B. COHEN ◽  
J. LIU ◽  
E. LARSON
Keyword(s):  
Risk Factors ◽  
New York ◽  
Staphylococcus Aureus ◽  
New York City ◽  
Logistic Regression ◽  
York City ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Methicillin Resistant ◽  
Factors Associated ◽  
History Of

SUMMARYThis study aims to describe changes in incidence and risk factors for community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) infections upon admission to two New York City hospitals from 2006 to 2012. We examined the first hospitalization for adult patients using electronic health record and administrative data and determined the annual incidence/1000 admissions of total S. aureus, total MRSA, and CA-MRSA (within 48 h of admission) in clinical specimens over the study period. Logistic regression was used to identify factors associated with CA-MRSA in 2006 and 2012. In 137 350 admissions, the incidence of S. aureus, MRSA, and CA-MRSA/1000 admissions were 15·6, 7·0, and 3·5, respectively. The total S. aureus and MRSA isolations decreased significantly over the study period (27% and 25%, respectively) while CA-MRSA incidence was unchanged. CA-MRSA increased as a proportion of all MRSA between 2006 (46%) and 2012 (62%), and was most frequently isolated from respiratory (1·5/1000) and blood (0·7/1000) cultures. Logistic regression analysis of factors associated with isolation of CA-MRSA showed that age ⩾65 years [odds ratio (OR) 2·3, 95% confidence interval (CI) 1·2–4·5], male gender (OR 1·8, 95% CI 1·2–2·8) and history of renal failure (OR 2·6, 95% CI 1·6–4·2) were significant predictors of infection in 2006. No predictors were identified in 2012.

scholarly journals Hospital-level factors associated with death during pneumonia-associated hospitalization among adults—New York City, 2010–2014

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0256678
Author(s):  
Kate Whittemore ◽  
Kristian M. Garcia ◽  
Chaorui C. Huang ◽  
Sungwoo Lim ◽  
Demetre C. Daskalakis ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Death Rate ◽  
Teaching Hospitals ◽  
Hospital Death ◽  
Negative Binomial Regression Model ◽  
Hospital Level ◽  
American Hospital ◽  
Factors Associated

Background In New York City (NYC), pneumonia is a leading cause of death and most pneumonia deaths occur in hospitals. Whether the pneumonia death rate in NYC reflects reporting artifact or is associated with factors during pneumonia-associated hospitalization (PAH) is unknown. We aimed to identify hospital-level factors associated with higher than expected in-hospital pneumonia death rates among adults in NYC. Methods Data from January 1, 2010–December 31, 2014 were obtained from the New York Statewide Planning and Research Cooperative System and the American Hospital Association Database. In-hospital pneumonia standardized mortality ratio (SMR) was calculated for each hospital as observed PAH death rate divided by expected PAH death rate. To determine hospital-level factors associated with higher in-hospital pneumonia SMR, we fit a hospital-level multivariable negative binomial regression model. Results Of 148,172 PAH among adult NYC residents in 39 hospitals during 2010–2014, 20,820 (14.06%) resulted in in-hospital death. In-hospital pneumonia SMRs varied across NYC hospitals (0.77–1.23) after controlling for patient-level factors. An increase in average daily occupancy and membership in the Council of Teaching Hospitals were associated with increased in-hospital pneumonia SMR. Conclusions Differences in in-hospital pneumonia SMRs between hospitals might reflect differences in disease severity, quality of care, or coding practices. More research is needed to understand the association between average daily occupancy and in-hospital pneumonia SMR. Additional pneumonia-specific training at teaching hospitals can be considered to address higher in-hospital pneumonia SMR in teaching hospitals.

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