scholarly journals Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study

2020 ◽  
Author(s):  
Matthew J. Cummings ◽  
Matthew R. Baldwin ◽  
Darryl Abrams ◽  
Samuel D. Jacobson ◽  
Benjamin J. Meyer ◽  
...  
Keyword(s):  
New York ◽  
Mechanical Ventilation ◽  
New York City ◽  
Hospital Mortality ◽  
Critically Ill ◽  
York City ◽  
Clinical Course ◽  
Invasive Mechanical Ventilation ◽  
Critically Ill Adults ◽  
Ill Adults

AbstractBackgroundNearly 30,000 patients with coronavirus disease-2019 (COVID-19) have been hospitalized in New York City as of April 14th, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed.MethodsWe prospectively collected clinical, biomarker, and treatment data on critically ill adults with laboratory-confirmed-COVID-19 admitted to two hospitals in northern Manhattan between March 2nd and April 1st, 2020. The primary outcome was in-hospital mortality.Secondary outcomes included frequency and duration of invasive mechanical ventilation, frequency of vasopressor use and renal-replacement-therapy, and time to clinical deterioration following hospital admission. The relationship between clinical risk factors, biomarkers, and in-hospital mortality was modeled using Cox-proportional-hazards regression. Each patient had at least 14 days of observation.ResultsOf 1,150 adults hospitalized with COVID-19 during the study period, 257 (22%) were critically ill. The median age was 62 years (interquartile range [IQR] 51-72); 170 (66%) were male. Two-hundred twelve (82%) had at least one chronic illness, the most common of which were hypertension (63%; 162/257) and diabetes mellitus (36%; 92/257). One-hundred-thirty-eight patients (54%) were obese, and 13 (5%) were healthcare workers. As of April 14th, 2020, in-hospital mortality was 33% (86/257); 47% (122/257) of patients remained hospitalized. Two-hundred-one (79%) patients received invasive mechanical ventilation (median 13 days [IQR 9-17]), and 54% (138/257) and 29% (75/257) required vasopressors and renal-replacement-therapy, respectively. The median time to clinical deterioration following hospital admission was 3 days (IQR 1-6). Older age, hypertension, chronic lung disease, and higher concentrations of interleukin-6 and d-dimer at admission were independently associated with in-hospital mortality.ConclusionsCritical illness among patients hospitalized with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extra-pulmonary organ dysfunction, and substantial in-hospital mortality.

scholarly journals Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study

The Lancet ◽  
2020 ◽  
Vol 395 (10239) ◽  
pp. 1763-1770 ◽  
Author(s):  
Matthew J Cummings ◽  
Matthew R Baldwin ◽  
Darryl Abrams ◽  
Samuel D Jacobson ◽  
Benjamin J Meyer ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Cohort Study ◽  
Critically Ill ◽  
Prospective Cohort Study ◽  
York City ◽  
Prospective Cohort ◽  
Clinical Course ◽  
Critically Ill Adults ◽  
Ill Adults

International Practice Variation in Weaning Critically Ill Adults from Invasive Mechanical Ventilation

2018 ◽  
Vol 15 (4) ◽  
pp. 494-502 ◽  
Author(s):  
Karen E. A. Burns ◽  
Stavroula Raptis ◽  
Rosane Nisenbaum ◽  
Leena Rizvi ◽  
Andrew Jones ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Invasive Mechanical Ventilation ◽  
Practice Variation ◽  
Critically Ill Adults ◽  
Ill Adults

scholarly journals Weaning critically ill adults from invasive mechanical ventilation: a national survey

2009 ◽  
Vol 56 (8) ◽  
pp. 567-576 ◽  
Author(s):  
Karen E. A. Burns ◽  
Francois Lellouche ◽  
France Loisel ◽  
Arthur S. Slutsky ◽  
Aleksander Meret ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
National Survey ◽  
Invasive Mechanical Ventilation ◽  
Critically Ill Adults ◽  
Ill Adults

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 < .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.

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.

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