Is There a Racial Disparity in Coronavirus Disease 2019 Patients with Chronic Kidney Disease? An Experience 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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Male Sex, Severe Obesity, Older Age, and Chronic Kidney Disease Are Associated With COVID-19 Severity and Mortality in New York City

CHEST Journal ◽

10.1016/j.chest.2020.08.2065 ◽

2021 ◽

Vol 159 (1) ◽

pp. 112-115 ◽

Cited By ~ 2

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

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

PLoS ONE ◽

10.1371/journal.pone.0243027 ◽

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.

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