Pre-Existing Traits Associated with Covid-19 Illness Severity

AbstractBackgroundCertain individuals, when infected by SARS-CoV-2, tend to develop the more severe forms of Covid-19 illness for reasons that remain unclear.MethodsWe studied N=442 patients who presented with laboratory confirmed Covid-19 illness to our U.S. metropolitan healthcare system. We curated data from the electronic health record, and used multivariable logistic regression to examine the association of pre-existing traits with a Covid-19 illness severity defined by level of required care: need for hospital admission, need for intensive care, and need for intubation.ResultsOf all patients studied, 48% required hospitalization, 17% required intensive care, and 12% required intubation. In multivariable-adjusted analyses, patients requiring a higher levels of care were more likely to be older (OR 1.5 per 10 years, P<0.001), male (OR 2.0, P=0.001), African American (OR 2.1, P=0.011), obese (OR 2.0, P=0.021), with diabetes mellitus (OR 1.8, P=0.037), and with a higher comorbidity index (OR 1.8 per SD, P<0.001). Several clinical associations were more pronounced in younger compared to older patients (Pinteraction<0.05). Of all hospitalized patients, males required higher levels of care (OR 2.5, P=0.003) irrespective of age, race, or morbidity profile.ConclusionsIn our healthcare system, greater Covid-19 illness severity is seen in patients who are older, male, African American, obese, with diabetes, and with greater overall comorbidity burden. Certain comorbidities paradoxically augment risk to a greater extent in younger patients. In hospitalized patients, male sex is the main determinant of needing more intensive care. Further investigation is needed to understand the mechanisms underlying these findings.

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Characteristics and Outcomes of US Patients Hospitalized With COVID-19

American Journal of Critical Care ◽

10.4037/ajcc2022549 ◽

2021 ◽

pp. e1-e12

Author(s):

Ithan D. Peltan ◽

Ellen Caldwell ◽

Andrew J. Admon ◽

Engi F. Attia ◽

Stephanie J. Gundel ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Health Care Services ◽

Older Age ◽

Respiratory Support ◽

Care Services ◽

Comorbidity Burden ◽

Male Sex

Background Understanding COVID-19 epidemiology is crucial to clinical care and to clinical trial design and interpretation. Objective To describe characteristics, treatment, and outcomes among patients hospitalized with COVID-19 early in the pandemic. Methods A retrospective cohort study of consecutive adult patients with laboratory-confirmed, symptomatic SARS-CoV-2 infection admitted to 57 US hospitals from March 1 to April 1, 2020. Results Of 1480 inpatients with COVID-19, median (IQR) age was 62.0 (49.4-72.9) years, 649 (43.9%) were female, and 822 of 1338 (61.4%) were non-White or Hispanic/Latino. Intensive care unit admission occurred in 575 patients (38.9%), mostly within 4 days of hospital presentation. Respiratory failure affected 583 patients (39.4%), including 284 (19.2%) within 24 hours of hospital presentation and 413 (27.9%) who received invasive mechanical ventilation. Median (IQR) hospital stay was 8 (5-15) days overall and 15 (9-24) days among intensive care unit patients. Hospital mortality was 17.7% (n=262). Risk factors for hospital death identified by penalized multivariable regression included older age; male sex; comorbidity burden; symptoms-to-admission interval; hypotension; hypoxemia; and higher white blood cell count, creatinine level, respiratory rate, and heart rate. Of 1218 survivors, 221 (18.1%) required new respiratory support at discharge and 259 of 1153 (22.5%) admitted from home required new health care services. Conclusions In a geographically diverse early-pandemic COVID-19 cohort with complete hospital folllow-up, hospital mortality was associated with older age, comorbidity burden, and male sex. Intensive care unit admissions occurred early and were associated with protracted hospital stays. Survivors often required new health care services or respiratory support at discharge.

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Racial and Ethnic Disparities in Covid-19 Illness Severity Accounting for Concomitant Comorbidities: A Cohort Study

10.21203/rs.3.rs-40310/v1 ◽

2020 ◽

Author(s):

Hongwei Ji ◽

Natalie Achamallah ◽

Nancy Sun ◽

Patrick Botting ◽

Peter Chen ◽

...

Keyword(s):

African American ◽

Intensive Care ◽

Ethnic Disparities ◽

Total Sample ◽

Illness Severity ◽

Racial And Ethnic Disparities ◽

Hospital System ◽

Racial And Ethnic Differences ◽

Illness Severity Score ◽

Differential Timing

Abstract Background Multiple reports have highlighted important racial and ethnic differences in the degree to which Americans may be vulnerable to severe forms of Covid-19 illness. Whether or not racial or ethnic disparities are related to variations in the underlying burden of comorbidities or other predisposing factors remains unclear.Methods We identified patients diagnosed with Covid-19, based on a positive PCR for SARS-CoV-2, from the electronic health record of a large multi-hospital system located in Southern California. We developed an illness severity score, based on the level of care each patient required (not admitted to the hospital; required hospital admission but never required intensive care; required intensive level care but never intubation; and, required intubation during hospitalization) and assessed for associations with clinical and demographic factors for each patient using ordinal logistic regression.Results A total of 571 patients with Covid-19 were identified a majority of whom were male (56%), with a mean age of 55±21 years. There were 81 (14%) patient who identified as African American, and 101 (18%) as Hispanic. A total of 202 (36%) patients required hospitalization without need for intensive care, 43 (8%) required intensive care without intubation, and 64 (11%) required intubation while also receiving intensive care. Of the total sample, African American race (OR 2.33, 95% CI 1.44-3.78, P=0.001) and Hispanic ethnicity (OR 1.97, 95% CI 1.14-3.12, P=0.004) were associated with greater illness severity.Conclusions Racial and ethnic disparities in the severity of Covid-19 illness persist, even when controlling for baseline comorbidities. It remains unclear if these differences are related to variations in physiologic response to SARS-CoV-2, differential timing of presentation or disparities in care.

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Faculty Opinions recommendation of Intensive care unit bed availability and outcomes for hospitalized patients with sudden clinical deterioration.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718021968.793479060 ◽

2013 ◽

Author(s):

Rik Gerritsen

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospitalized Patients ◽

Clinical Deterioration

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Risk Factors for Undernutrition at Admission Among Adult Hospitalized Patients at a Referral Hospital in Indonesia

SAGE Open ◽

10.1177/2158244020983310 ◽

2021 ◽

Vol 11 (5) ◽

pp. 215824402098331

Author(s):

Nur Chandra Bunawan ◽

Dwi Suseno ◽

Drupadi H. S. Dillon ◽

Ikhwan Rinaldi ◽

Dyah Purnamasari

Keyword(s):

Associated Factors ◽

Multivariate Analyses ◽

Gastrointestinal Disease ◽

Cross Sectional Study ◽

Hospitalized Patients ◽

Bivariate Analysis ◽

Cross Sectional ◽

Neutrophil Lymphocyte Ratio ◽

Initial Hospital ◽

Comorbidity Index

Patients with undernutrition at admission have higher risks to worsen their nutritional status, which is linked to an increase in morbidity and mortality. This study investigated the prevalence of undernutrition at admission and its associated factors. A cross-sectional study was conducted on patients aged 18 to 59 years old in Internal Medicine ward at Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, between July and September 2019. Factors that might be associated with undernutrition at admission, such as age, sex, marital status, Charlson Comorbidity Index (CCI) and type of comorbidity, depression, and neutrophil–lymphocyte ratio (NLR), were assessed. Bivariate and multivariate analyses were used to determine the associated factors. Sixty hospitalized patients with median age of 42 years and 76.7% with married status joined the study. The most common reason for hospitalization was acute gastrointestinal disease with gallstones as the most common comorbidity. Undernutrition exists in 26.7% of subjects. High CCI score was observed among 11.7% subjects and half of subjects had NLR category ≥5. Bivariate analysis revealed that unmarried status, age ≥40 years, and malignancy were associated with undernutrition at admission. Logistic regression analysis showed malignancy as an independent predictor of undernutrition during the initial hospital admission (odds ratio [OR] = 11.8; 95% confidence interval [CI]: [1.1, 125.7]). The prevalence of undernutrition at admission was 26.7%. Factors associated with an increased prevalence of undernutrition at admission were age <40 years, unmarried status, and malignancy. Malignancy was an independent factor of the prevalence of undernutrition at admission.

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Prejudicial beliefs and COVID-19 disruptions among sexual minority men living with and not living with HIV in a high SARS-CoV-2 prevalence area

Translational Behavioral Medicine ◽

10.1093/tbm/ibab050 ◽

2021 ◽

Author(s):

Seth C Kalichman ◽

Renee El-Krab ◽

Bruno Shkembi ◽

Moira O Kalichman ◽

Lisa A Eaton

Keyword(s):

African American ◽

African American Men ◽

People Living With Hiv ◽

Sex Partners ◽

Black African ◽

Sexual Minority Men ◽

Mediation Analyses ◽

Personal Action ◽

Male Sex ◽

Living With Hiv

Abstract The COVID-19 pandemic has had profound health and social impacts. COVID-19 also affords opportunities to study the emergence of prejudice as a factor in taking protective actions. This study investigated the association of COVID-19 concerns, prejudicial beliefs, and personal actions that involve life disruptions among people not living with and people living with HIV. 338 Black/African American men not living with HIV who reported male sex partners and 148 Black/African American men living with HIV who reported male sex partners completed a confidential survey that measured COVID-19 concern, COVID-19 prejudice, and personal action and institutionally imposed COVID-19 disruptions. Participants reported having experienced multiple social and healthcare disruptions stemming from COVID-19, including reductions in social contacts, canceling medical appointments, and inability to access medications. Mediation analyses demonstrated that COVID-19 concerns and COVID-19 prejudice were associated with personal action disruptions, indicating that these social processes are important for understanding how individuals modified their lives in response to COVID-19. It is imperative that public health efforts combat COVID-19 prejudice as these beliefs undermine investments in developing healthcare infrastructure to address COVID-19 prevention.

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Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

Infection ◽

10.1007/s15010-021-01624-7 ◽

2021 ◽

Author(s):

A. Oliva ◽

G. Ceccarelli ◽

C. Borrazzo ◽

M. Ridolfi ◽

G. D.’Ettorre ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Features ◽

Multivariable Analysis ◽

Invasive Pulmonary Aspergillosis ◽

Lower Percentage ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Single Centre Study ◽

Male Sex

Abstract Background Little is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU). Materials/methods Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19. Results Overall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58–76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029). Conclusions In critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.

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Comorbidity burden may explain adiponectin’s paradox as a marker of increased mortality risk in hemodialysis patients

Scientific Reports ◽

10.1038/s41598-021-88558-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ilia Beberashvili ◽

Tamar Cohen-Cesla ◽

Amin Khatib ◽

Ramzia Abu Hamad ◽

Ada Azar ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Maintenance Hemodialysis ◽

Blood Levels ◽

Low Concentrations ◽

Comorbidity Burden ◽

All Cause Mortality ◽

Markers Of Oxidative Stress ◽

Comorbidity Index ◽

Antiinflammatory Effects ◽

High Comorbidity

AbstractDespite experimental evidence of beneficial metabolic, antiatherosclerotic and antiinflammatory effects of the 30 kDa adipokine, adiponectin, maintenance hemodialysis (MHD) patients with high adiponectin blood levels have paradoxically high mortality rates. We aimed to examine the direction of the associations between adiponectin and all-cause and cardiovascular mortality as well as with markers of oxidative stress, inflammation and nutrition in MHD patients with varying degrees of comorbidities. A cohort of 261 MHD patients (mean age 68.6 ± 13.6 years, 38.7% women), grouped according to baseline comorbidity index (CI) and serum adiponectin levels, were followed prospectively for six years. High and low concentrations were established according to median CI and adiponectin levels and cross-classified. Across the four CI-adiponectin categories, the group with low comorbidities and high adiponectin exhibited the best outcomes. Conversely, the high comorbidity group with high adiponectin levels had the lowest survival rate in both all-cause mortality (log rankχ2 = 23.74, p < 0.001) and cardiovascular mortality (log rankχ2 = 34.16, p < 0.001). Further data adjustment for case-mix covariates including fat mass index did not substantially affect these results. In conclusion, the direction of adiponectin’s prognostic associations in MHD patients is inverse in those with few comorbidities and direct in those with many comorbidities.

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Carbapenem-resistant Enterobacteriaceae carriage risk for parameterization of a regional healthcare network agent-based model

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.667 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s148-s149

Author(s):

Sarah Rhea ◽

Lei Li ◽

Pooja Iyer ◽

Lauren DiBiase ◽

Kasey Jones ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Intensive Care Unit Stay ◽

Agent Based ◽

Healthcare Network ◽

Transmission Parameters ◽

Carbapenem Resistant ◽

Comorbidity Index ◽

Systemic Antibiotics

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly common in the United States and have the potential to spread widely across healthcare networks. Only a fraction of patients with CRE carriage (ie, infection or colonization) are identified by clinical cultures. Interventions to reduce CRE transmission can be explored with agent-based models (ABMs) comprised of unique agents (eg, patients) represented by a synthetic population or model-generated representation of the population. We used electronic health record data to determine CRE carriage risk, and we discuss how these results can inform CRE transmission parameters for hospitalized agents in a regional healthcare network ABM. Methods: We reviewed the laboratory data of patients admitted during July 1, 2016−June 30, 2017, to any of 7 short-term acute-care hospitals of a regional healthcare network in North Carolina (N = 118,022 admissions) to find clinically detected cases of CRE carriage. A case was defined as the first occurrence of Enterobacter spp, Escherichia coli, or Klebsiella spp resistant to any carbapenem isolated from a clinical specimen in an admitted patient. We used Poisson regression to estimate clinically detected CRE carriage risk according to variables common to data from both the electronic health records and the ABM synthetic population, including patient demographics, systemic antibiotic administration, intensive care unit stay, comorbidities, length of stay, and admitting hospital size. Results: We identified 58 (0.05%) cases of CRE carriage among all admissions. Among these cases, 30 (52%) were ≥65 years of age and 37 (64%) were female. During their admission, 47 cases (81%) were administered systemic antibiotics and 18 cases (31%) had an intensive care unit stay. Patients administered systemic antibiotics and those with an intensive care unit stay had CRE carriage risk 6.5 times (95% CI, 3.4–12.5) and 4.9 times (95% CI, 2.8–8.5) higher, respectively, than patients without these exposures (Fig. 1). Patients ≥50 years of age and those with a higher Elixhauser comorbidity index score and with longer length of stay also had increased CRE carriage risk. Conclusions: Among admissions in our dataset, CRE carriage risk was associated with systemic antibiotic exposure, intensive care unit stay, higher Elixhauser comorbidity index score, and longer length of stay. We will use these risk estimates in the ABM to inform agents’ CRE carriage status upon hospital admission and the CRE transmission parameters for short-term acute-care hospitals. We will explore CRE transmission interventions in the parameterized regional healthcare network ABM and assess the impact of CRE carriage underestimation.Funding: This work was supported by Centers for Disease Control and Prevention (CDC) Cooperative Agreement number U01CK000527. The conclusions, findings, and opinions expressed do not necessarily reflect the official position of CDC.Disclosures: None

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Otolaryngology activity in two hospitals in northern and central Italy differently affected by COVID-19 pandemic

Science Progress ◽

10.1177/0036850421998487 ◽

2021 ◽

Vol 104 (2) ◽

pp. 003685042199848

Author(s):

Antonio Minni ◽

Francesco Pilolli ◽

Massimo Ralli ◽

Niccolò Mevio ◽

Luca Roncoroni ◽

...

Keyword(s):

Intensive Care ◽

Severe Acute Respiratory Syndrome ◽

Intensive Care Units ◽

Healthcare System ◽

Central Italy ◽

Northern Italy ◽

Public Hospitals ◽

Geographical Differences ◽

Italian Regions

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic had a significant impact on the Italian healthcare system, although geographical differences were present; regions in northern Italy have been the most severely affected while regions in the south of the country were relatively spared. Otolaryngologists were actively involved in the management of the pandemic. In this work, we analyzed and compared the otolaryngology surgical activity performed during the pandemic in two large public hospitals located in different Italian regions. In northern Italy, otolaryngologists were mainly involved in performing surgical tracheotomies in COVID-19 positive patients and contributed to the management of these patients in intensive care units. In central Italy, where the burden of the infection was significantly lower, otolaryngologists focused on diagnosis and treatment of emergency and oncology patients. This analysis confirms the important role of the otolaryngology specialists during the pandemic, but also highlights specific differences between two large hospitals in different Italian regions.

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