ABSTRACT
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated Coronavirus Disease 2019 (COVID-19) is a public health emergency. Acute kidney injury (AKI) is a common complication in hospitalized patients with COVID-19 although mechanisms underlying AKI are yet unclear. There may be a direct effect of SARS-CoV-2 virus on the kidney;however, there is currently no data linking SARS-CoV-2 viral load (VL) to AKI. We explored the association of SARS-CoV-2 VL at admission to AKI in a large diverse cohort of hospitalized patients with COVID-19. Methods and findings: We included patients hospitalized between March 13th and May 19th, 2020 with SARS-CoV-2 in a large academic healthcare system in New York City (N = 1,049) with available VL at admission quantified by real-time RT-PCR. We extracted clinical and outcome data from our institutional electronic health records (EHRs). AKI was defined by KDIGO guidelines. We fit a Fine-Gray competing risks model (with death as a competing risk) using demographics, comorbidities, admission severity scores, and log10 transformed VL as covariates and generated adjusted hazard ratios (aHR) and 95% Confidence Intervals (CIs). VL was associated with an increased risk of AKI (aHR = 1.04, 95% CI: 1.01-1.08, p = 0.02) with a 4% increased hazard for each log10 VL change. Patients with a viral load in the top 50th percentile had an increased adjusted hazard of 1.27 (95% CI: 1.02-1.58, p = 0.03) for AKI as compared to those in the bottom 50th percentile. Conclusions: VL is weakly but significantly associated with in-hospital AKI after adjusting for confounders. This may indicate the role of VL in COVID-19 associated AKI. This data may inform future studies to discover the mechanistic basis of COVID-19 associated AKI.
ABSTRACT
Weather observations from commercial aircraft constitute an essential component of the global observing system and have been shown to be the most valuable observation source for short-range numerical weather prediction (NWP) systems over North America. However, the distribution of aircraft observations is highly irregular in space and time. In this study, we summarize the recent state of aircraft observation coverage over the globe and provide an updated quantification of its impact upon short-range NWP forecast skill. Aircraft observation coverage is most dense over the contiguous United States and Europe, with secondary maxima in East Asia and Australia/New Zealand. As of late November 2019, 665 airports around the world had at least one daily ascent or descent profile observation;400 of these come from North American or European airports. Flight reductions related to the COVID-19 pandemic have led to a 75% reduction in aircraft observations globally as of late April 2020. A set of data denial experiments with the latest version of the Rapid Refresh NWP system for recent winter and summer periods quantifies the statistically significant positive forecast impacts of assimilating aircraft observations. A special additional experiment excluding approximately 80% of aircraft observations reveals a reduction in forecast skill for both summer and winter amounting to 30%-60% of the degradation seen when all aircraft observations are excluded. These results represent an approximate quantification of the NWP impact of COVID-19-related commercial flight reductions, demonstrating that regional NWP guidance is degraded as a result of the decreased number of aircraft observations.