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Predictors of Mortality in Adults Admitted with COVID-19: Retrospective Cohort Study from New York City.
West J Emerg Med. 2020 Jul 08; 21(4):779-784.WJ

Abstract

INTRODUCTION

Rapid spread of coronavirus disease 2019 (COVID-19) in the United States, especially in New York City (NYC), led to a tremendous increase in hospitalizations and mortality. There is very limited data available that associates outcomes during hospitalization in patients with COVID-19.

METHODS

In this retrospective cohort study, we reviewed the health records of patients with COVID-19 who were admitted from March 9-April 9, 2020, to a community hospital in NYC. Subjects with confirmed reverse transcriptase-polymerase chain reaction (RT-PCR) of the nasopharyngeal swab for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were included. We collected data related to demographics, laboratory results, and outcome of hospitalization. Outcome was measured based on whether the patient was discharged home or died during hospitalization.

RESULTS

There were 888 consecutive admissions with COVID-19 during the study period, of which 513 were excluded with pending outcome or incomplete information. We included a total of 375 patients in the study, of whom 215 (57%) survived and 160 (43%) died during hospitalization. The majority of patients were male (63%) and of Hispanic origin (66%) followed by Blacks (25%), and others (9%). Hypertension (60%) stands out to be the most common comorbidity followed by diabetes mellitus (47%), cardiovascular disease (17%), chronic kidney disease (17%), and human immunodeficiency virus/acquired immunodeficiency syndrome (9%). On multiple regression analysis, increasing odds of mortality during hospitalization was associated with older age (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.01-1.06 per year increase; p < 0.0001), admission D-dimer more than 1000 nanograms per milliliter (ng/mL) (OR 3.16; 95% CI, 1.75-5.73; p<0.0001), admission C-reactive protein (CRP) levels of more than 200 milligrams per liter (mg/L) (OR 2.43; 95% CI, 1.36-4.34; p = 0.0028), and admission lymphopenia (OR 2.63; CI, 1.47-4.69; p 0.0010).

CONCLUSION

In this retrospective cohort study originating in NYC, older age, admission levels of D-dimer of more than 1000 ng/mL, CRP of more than 200 mg/L and lymphopenia were associated with mortality in individuals hospitalized for COVID-19. We recommend using these risk factors on admission to triage patients to critical care units or surge units to maximize the use of surge capacity beds.

Authors+Show Affiliations

BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York.BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York.BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York.BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York.BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York.BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York.BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York.BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32726241

Citation

Chilimuri, Sridhar, et al. "Predictors of Mortality in Adults Admitted With COVID-19: Retrospective Cohort Study From New York City." The Western Journal of Emergency Medicine, vol. 21, no. 4, 2020, pp. 779-784.
Chilimuri S, Sun H, Alemam A, et al. Predictors of Mortality in Adults Admitted with COVID-19: Retrospective Cohort Study from New York City. West J Emerg Med. 2020;21(4):779-784.
Chilimuri, S., Sun, H., Alemam, A., Mantri, N., Shehi, E., Tejada, J., Yugay, A., & Nayudu, S. K. (2020). Predictors of Mortality in Adults Admitted with COVID-19: Retrospective Cohort Study from New York City. The Western Journal of Emergency Medicine, 21(4), 779-784. https://doi.org/10.5811/westjem.2020.6.47919
Chilimuri S, et al. Predictors of Mortality in Adults Admitted With COVID-19: Retrospective Cohort Study From New York City. West J Emerg Med. 2020 Jul 8;21(4):779-784. PubMed PMID: 32726241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of Mortality in Adults Admitted with COVID-19: Retrospective Cohort Study from New York City. AU - Chilimuri,Sridhar, AU - Sun,Haozhe, AU - Alemam,Ahmed, AU - Mantri,Nikhitha, AU - Shehi,Elona, AU - Tejada,Jairo, AU - Yugay,Alla, AU - Nayudu,Suresh K, Y1 - 2020/07/08/ PY - 2020/04/27/received PY - 2020/06/11/accepted PY - 2020/7/30/entrez PY - 2020/7/30/pubmed PY - 2020/8/11/medline SP - 779 EP - 784 JF - The western journal of emergency medicine JO - West J Emerg Med VL - 21 IS - 4 N2 - INTRODUCTION: Rapid spread of coronavirus disease 2019 (COVID-19) in the United States, especially in New York City (NYC), led to a tremendous increase in hospitalizations and mortality. There is very limited data available that associates outcomes during hospitalization in patients with COVID-19. METHODS: In this retrospective cohort study, we reviewed the health records of patients with COVID-19 who were admitted from March 9-April 9, 2020, to a community hospital in NYC. Subjects with confirmed reverse transcriptase-polymerase chain reaction (RT-PCR) of the nasopharyngeal swab for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were included. We collected data related to demographics, laboratory results, and outcome of hospitalization. Outcome was measured based on whether the patient was discharged home or died during hospitalization. RESULTS: There were 888 consecutive admissions with COVID-19 during the study period, of which 513 were excluded with pending outcome or incomplete information. We included a total of 375 patients in the study, of whom 215 (57%) survived and 160 (43%) died during hospitalization. The majority of patients were male (63%) and of Hispanic origin (66%) followed by Blacks (25%), and others (9%). Hypertension (60%) stands out to be the most common comorbidity followed by diabetes mellitus (47%), cardiovascular disease (17%), chronic kidney disease (17%), and human immunodeficiency virus/acquired immunodeficiency syndrome (9%). On multiple regression analysis, increasing odds of mortality during hospitalization was associated with older age (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.01-1.06 per year increase; p < 0.0001), admission D-dimer more than 1000 nanograms per milliliter (ng/mL) (OR 3.16; 95% CI, 1.75-5.73; p<0.0001), admission C-reactive protein (CRP) levels of more than 200 milligrams per liter (mg/L) (OR 2.43; 95% CI, 1.36-4.34; p = 0.0028), and admission lymphopenia (OR 2.63; CI, 1.47-4.69; p 0.0010). CONCLUSION: In this retrospective cohort study originating in NYC, older age, admission levels of D-dimer of more than 1000 ng/mL, CRP of more than 200 mg/L and lymphopenia were associated with mortality in individuals hospitalized for COVID-19. We recommend using these risk factors on admission to triage patients to critical care units or surge units to maximize the use of surge capacity beds. SN - 1936-9018 UR - https://www.unboundmedicine.com/medline/citation/32726241/Predictors_of_Mortality_in_Adults_Admitted_with_COVID_19:_Retrospective_Cohort_Study_from_New_York_City_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32726241/ DB - PRIME DP - Unbound Medicine ER -