scholarly journals Characteristics and outcomes of COVID-19 patients in New York City’s public hospital system

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243027
Author(s):  
Roopa Kalyanaraman Marcello ◽  
Johanna Dolle ◽  
Sheila Grami ◽  
Richard Adule ◽  
Zeyu Li ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
New York ◽  
New York City ◽  
Kidney Disease ◽  
Public Hospital ◽  
Case Series ◽  
Ethnically Diverse ◽  
Hospital System ◽  
Public Hospital System

Background New York City (NYC) bore the greatest burden of COVID-19 in the United States early in the pandemic. In this case series, we describe characteristics and outcomes of racially and ethnically diverse patients tested for and hospitalized with COVID-19 in New York City’s public hospital system. Methods We reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed. Results 22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5–64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7–72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes. Conclusions and relevance This is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in New York City to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.

scholarly journals Characteristics and Outcomes of COVID-19 Patients in New York City’s Public Hospital System

2020 ◽  
Author(s):  
Roopa Kalyanaraman Marcello ◽  
Johanna Dolle ◽  
Sheila Grami ◽  
Richard Adule ◽  
Zeyu Li ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
New York ◽  
Kidney Disease ◽  
Public Hospital ◽  
Case Series ◽  
Ethnically Diverse ◽  
The United States ◽  
Hospital System ◽  
Public Hospital System

AbstractBackgroundNew York City (NYC) has borne the greatest burden of COVID-19 in the United States, but information about characteristics and outcomes of racially/ethnically diverse individuals tested and hospitalized for COVID-19 remains limited. In this case series, we describe characteristics and outcomes of patients tested for and hospitalized with COVID-19 in New York City’s public hospital system.MethodsWe reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed.Results22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5-64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7-72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes.Conclusions and RelevanceThis is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in the United States to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.

scholarly journals A Novel Evidence-Based Predictor Tool for Hospitalization and Length of Stay: Insights from COVID19 Patients in New York City

2021 ◽  
Author(s):  
Maan El Halabi ◽  
James Feghali ◽  
Paulino Tallon de Lara ◽  
Bharat Narasimhan ◽  
Kam Ho ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
New York ◽  
New York City ◽  
Kidney Disease ◽  
Length Of Stay ◽  
Oxygen Saturation ◽  
Predictive Models ◽  
York City ◽  
Maximum Temperature ◽  
Web Based

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.

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

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1552-P ◽  
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

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

CHEST Journal ◽  
2021 ◽  
Vol 159 (1) ◽  
pp. 112-115 ◽  
Author(s):  
Joseph L. Rapp ◽  
Wil Lieberman-Cribbin ◽  
Stephanie Tuminello ◽  
Emanuela Taioli
Keyword(s):  
Chronic Kidney Disease ◽  
New York ◽  
New York City ◽  
Kidney Disease ◽  
York City ◽  
Severe Obesity ◽  
Older Age ◽  
Male Sex

scholarly journals Impact of a Novel Emergency Department Forward Treatment Area During the New York City COVID-19 Surge

2021 ◽  
Vol 22 (4) ◽  
pp. 871-877
Author(s):  
Joshua Moskovitz ◽  
Kaushal Khambhati ◽  
Comilla Sasson ◽  
Jason D’Amore ◽  
Michael Jones ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
New York City ◽  
York City ◽  
Treatment Area ◽  
Hospital System ◽  
Number Of Patients ◽  
Lower Oxygen ◽  
Disproportionate Number ◽  
Public Hospital System

Introduction: Coronavirus disease 2019 (COVID-19) caused a disproportionate number of patients to seek emergency care at hospitals in New York City (NYC) during the initial crisis. Our urban emergency department (ED), a member of the NYC public hospital system had to process the increased volume while also differentiating our patients’ critical needs. We established a forward treatment area (FTA) directly in front of the ED to accomplish these goals from March 23–April 16, 2020. Methods: A clinical greeter evaluated patients 18 years and older who presented to the walk-in entrance of the ED where they were screened for COVID-19-like complaints. If they did not appear critically ill and could ambulate they were directed into the FTA. Clinical and non-clinical staff worked in concert to register, evaluate, and process patients with either a disposition of directly home or into the ED for further care. Results: A total of 634 patients were seen in the FTA from March 23–April 16, 2020. Of the 634 patients evaluated, 135 (21%) were referred into the ED for further evaluation, of whom 81 (12.7% of the total) were admitted. These patients were disproportionately male (91 into the ED and 63 admitted) and tended to have a higher heart rate (105.4 vs 93.7), a higher respiratory rate (21.5 vs 18.1), and lower oxygen saturation (93.9% vs 97.8%). Conclusion: A forward treatment area is an effective method to rapidly screen and process an increased volume of COVID-19 patients when resources are limited. This treatment area helped decompress the ED by being rapidly deployable and effectively screening patients for safe discharge home.

scholarly journals Disaggregating Asian Race Reveals COVID-19 Disparities among Asian Americans at New York City’s Public Hospital System

2020 ◽  
Author(s):  
Roopa Kalyanaraman Marcello ◽  
Johanna Dolle ◽  
Areeba Tariq ◽  
Sharanjit Kaur ◽  
Linda Wong ◽  
...  
Keyword(s):  
New York ◽  
Asian Americans ◽  
Public Hospital ◽  
South Asians ◽  
Chinese Americans ◽  
Chinese Patients ◽  
Hospital System ◽  
Ethnic Subgroups ◽  
Public Hospital System ◽  
Racial Ethnic

AbstractThere is growing recognition of the burden of COVID-19 among Asian Americans, but data on outcomes among Asian ethnic subgroups remain extremely limited. We conducted a retrospective analysis of 85,328 patients tested for COVID-19 at New York City’s public hospital system between March 1 and May 31, 2020, to describe characteristics and COVID-19 outcomes of Asian ethnic subgroups compared to Asians overall and other racial/ethnic groups. South Asians had the highest rates of positivity and hospitalization among Asians, second only to Hispanics for positivity and Blacks for hospitalization. Chinese patients had the highest mortality rate of all groups and were nearly 1.5 times more likely to die than Whites. The high burden of COVID-19 among South Asian and Chinese Americans underscores the urgent needs for improved data collection and reporting as well as public health program and policy efforts to mitigate the disparate impact of COVID-19 among these communities.

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

Authorea ◽  
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

scholarly journals Incidence of Thrombosis and Associated Risk Factors in Hospitalized COVID-19 Patients in a New York City Hospital System

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 32-33
Author(s):  
Poy P. Theprungsirikul ◽  
Sunil E. Saith
Keyword(s):  
Risk Factors ◽  
New York ◽  
New York City ◽  
York City ◽  
Smoking Status ◽  
Thrombotic Event ◽  
Case Series ◽  
Acute Limb Ischemia ◽  
City Hospital ◽  
Hospital System

Introduction: As of August 10, 2020, there have been over 5 million cases of the 2019 novel coronavirus disease (COVID-19) in the United States, resulting in 162,000 deaths. New York City became the first epicenter, with several case series based on over 56,000 hospitalizations and 18,900 deaths. These case series expanded our understanding of a broader clinical spectrum of COVID-19, extending beyond the initial descriptions of a viral pneumonia. This clinical spectrum has included arterial and venous thrombotic events. Factors upon admission, which are associated with development of thrombosis in hospitalized COVID-19 patients is less well defined. Our aim is to characterize the incidence of thrombosis and the associated clinical and demographic risk factors of patients hospitalized across a New York City hospital system. Methods: We conducted a retrospective observational study of all patients, age 18 and older, hospitalized with a reverse transcriptase-polymerase chain reaction (RT-PCR) confirming severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between March 13 and April 4, 2020 in two hospitals in New York City. Clinical demographics, admission labs and medications prior to admission were collected. Thrombotic events were identified manually by chart review and were defined as experiencing arterial and/or venous thrombotic events, including pulmonary embolism (PE), deep vein thrombosis (DVT), cerebrovascular accident (CVA), myocardial infarction (MI), acute limb ischemia, and splenic infarct, among others. Results: There were 1,352 patients hospitalized during the study period. Overall median age was 62 years (IQR: 49-72), with 455 females (33.7%). There were 160 (11.8%) thrombotic events, including 102 with venous thromboembolism (VTE), 45 with PE, 69 with DVT, 32 with CVA and 55 with other thrombotic events (e.g. MI, acute limb ischemia, and splenic infarct). Females were 46% less likely than males to experience a thrombotic event (OR: 0.54 [CI: 0.36-0.79]). Patients who racially self-identify as Asian or Pacific Islander were observed to have a 2.06 odds compared to other races of having a thrombotic event with COVID-19 (95%[CI: 1.27-3.34]). Age, admission BMI, ethnicity, smoking status, and comorbidities were not associated with the incidence of thrombosis during hospitalization. Thrombotic events were associated with higher mortality in hospitalized COVID-19 patients (35% vs 25.3%, p = 0.009). Conclusion: Traditional risk factors (age, obesity, ethnicity, smoking status, and comorbidities) were not associated with an increased risk for thrombotic events in COVID-19 patients, while admission laboratory values (d-dimer, ESR, CRP, and ferritin) among patients experiencing an event were significantly different, highlighting the impact of the cytokine storm in mediating thrombotic events. Since the incidence of thrombosis associated with COVID-19 infection may vary according to clinical demographics, further investigation to identify high risk patients may enable us to consider the role of adjunctive treatment, such as therapeutic coagulation. Disclosures No relevant conflicts of interest to declare.

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