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Thromboembolism is a major cause of death in patients who suffer from COVID-19. Studies examining the effects of aspirin (ASA) on mortality relating to this phenomenon have showed conflicting results with varying degrees and certainties of evidence. We performed an aggregate data meta-analysis of fourteen studies encompassing 164,539 COVID-19 patients, which showed a reduced risk of in-hospital mortality associated with ASA use in eight studies that reported risk ratios (RR 0.90; 95 % CI 0.82-0.98; I2 = 27.33 %, P = 0.01), six studies that reported hazard ratios (HR 0.56; 95 % CI 0.41-0.76, P ≤ 0.01; I2 = 85.92 %) and pooled effect size (0.71; 95 % CI 0.59-0.85, P = 0.00, I2 = 91.51 %). The objective of this study is to report the association between low dose ASA and a reduced risk of in-hospital mortality in patients with COVID-19.
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BACKGROUND: The early surge of the novel coronavirus disease 2019 (COVID-19) pandemic introduced a significant clinical challenge due to the high case-fatality rate in absence of evidence-based recommendations. The empirical treatment modalities were relegated to historical expertise from the traditional management of acute respiratory distress syndrome (ARDS) in conjunction with off-label pharmaceutical agents endorsed under the "emergency use authorization" (EUA) paradigm by regulatory agencies. This study was designed to evaluate the insights from the "fail-and-learn" strategy in 2020 before the availability of COVID-19 vaccines and access to reliable insights from high-quality randomized controlled trials. METHODS: A retrospective, multicenter, propensity-matched, case-control study was performed on a data registry comprising 186 hospitals from a national health care system in the United States, designed to investigate the efficacy of empirical treatment modalities during the early surge of the COVID-19 pandemic in 2020. Reflective of the time-windows of the initial two surges of the pandemic in 2020, patients were stratified into "Early 2020" (March 1-June 30) versus "Late 2020" (July 1-December 31) study cohorts. Logistic regression was applied to determine the efficacy of prevalent medications (remdesivir, azithromycin, hydroxychloroquine, corticosteroids, tocilizumab) and supplemental oxygen delivery modalities (invasive vs. non-invasive ventilation) on patient outcomes. The primary outcome measure was in-hospital mortality. Group comparisons were adjusted for covariates related to age, gender, ethnicity, body weight, comorbidities, and treatment modalities pertinent to organ failure replacement. RESULTS: From a total of 87,788 patients in the multicenter data registry screened in this study, 9,638 patients were included who received 19,763 COVID-19 medications during the first two waves of the 2020 pandemic. The results showed a minimal, yet statistically significant, association with hydroxychloroquine in "Early 2020" and remdesivir in "Late 2020" with reduced odds of mortality (odds ratios 0.72 and 0.76, respectively; P = 0.01). Azithromycin was the only medication associated with decreased odds of mortality during both study time-windows (odds ratios 0.79 and 0.68, respectively; P < 0.01). In contrast, the necessity for oxygen supply showed significantly increased odds of mortality beyond the effect of all investigated medications. Of all the covariates associated with increased mortality, invasive mechanical ventilation had the highest odds ratios of 8.34 in the first surge and 9.46 in in the second surge of the pandemic (P < 0.01). CONCLUSION: This retrospective multicenter observational cohort study on 9,638 hospitalized patients with severe COVID-19 during revealed that the necessity for invasive ventilation had the highest odds of mortality, beyond the variable effects observed by administration of the prevalent EUA-approved investigational drugs during the first two surges of the early 2020 pandemic in the United States.
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Background Despite a large amount of evidence evaluating elevated troponin I levels and adverse clinical outcomes, little is known about the role of a normal (negative) troponin I during the first 24 h of admission for risk stratification in patients with Coronavirus Disease 2019 (COVID-19). This study aims to evaluate the utility and negative predictive value of a serum troponin I level to predict in-hospital mortality. Methods We retrospectively analyzed all adult patients (>18 years of age) with COVID-19 admitted to an HCA Healthcare facility between March 2020 and March 2021 who had a troponin I level drawn at admission. Patients were initially stratified into two groups based on their cardiac troponin I value in the first 24 h of admission (elevated vs negative). Results A total of 65,580 patients were included in the final analysis. A negative troponin I value was associated with lesser odds of death during admission (OR = 0.32, 95 % CI 0.31–0.34, p < 0.01) and cardiac complications (OR = 0.38, 95 % CI 0.37–0.40, p < 0.01). The negative predictive value of a negative troponin value for all-cause in-hospital mortality was 85.7 %. Conclusions Our study found a significant association between a negative troponin I value in the first 24 h of admission and decreased odds of death during admission in patients with confirmed COVID-19 infection, in addition to decreased odds of cardiac complications but no significant difference in hospital length of stay. Therefore, the authors suggest that the absence of troponin I elevation may serve as an indicator of a more benign hospital course.
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Background: Despite a large amount of evidence evaluating elevated troponin I levels and adverse clinical outcomes, little is known about the role of a normal (negative) troponin I during the first 24 h of admission for risk stratification in patients with Coronavirus Disease 2019 (COVID-19). This study aims to evaluate the utility and negative predictive value of a serum troponin I level to predict in-hospital mortality. Methods: We retrospectively analyzed all adult patients (>18 years of age) with COVID-19 admitted to an HCA Healthcare facility between March 2020 and March 2021 who had a troponin I level drawn at admission. Patients were initially stratified into two groups based on their cardiac troponin I value in the first 24 h of admission (elevated vs negative). Results: A total of 65,580 patients were included in the final analysis. A negative troponin I value was associated with lesser odds of death during admission (OR = 0.32, 95 % CI 0.31-0.34, p < 0.01) and cardiac complications (OR = 0.38, 95 % CI 0.37-0.40, p < 0.01). The negative predictive value of a negative troponin value for all-cause in-hospital mortality was 85.7 %. Conclusions: Our study found a significant association between a negative troponin I value in the first 24 h of admission and decreased odds of death during admission in patients with confirmed COVID-19 infection, in addition to decreased odds of cardiac complications but no significant difference in hospital length of stay. Therefore, the authors suggest that the absence of troponin I elevation may serve as an indicator of a more benign hospital course.
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Background: We conducted a retrospective cohort study on COVID-19 patients with and without dementia by extracting data from the HCA Healthcare Enterprise Data Warehouse between January-September 2020. Aims: To describe the role of patients' baseline characteristics specifically dementia in determining overall health outcomes in COVID-19 patients. Methods: We grouped in-patients who had ICD-10 codes for dementia (DM) with age and gender-matched (1:2) patients without dementia (ND). Our primary outcome variables were in-hospital mortality, length of stay, Intensive Care Unit (ICU) admission, ICU-free days, mechanical ventilation (MV) use, MV-free days and 90-day re-admission. Results: Matching provided similar age and sex in DM and ND groups. BMI (median, 25.8 vs. 27.6) and proportion of patients who had smoked (23.3 vs. 31.3%) were lower in DM than in ND patients. The median (IQR) Elixhauser Comorbidity Index was higher in dementia patients 7 (5-10) vs. 5 (3-7, p < 0.01). Higher mortality was observed in DM group (30.8%) vs. ND group (26.4%, p < 0.01) as an unadjusted univariate analysis. The 90-day readmission was not different (32.1 vs. 31.8%, p = 0.8). In logistic regression analysis, the odds of dying were not different between patients in DM and ND groups (OR = 1.0; 95% CI 0.86-1.17), but the odds of ICU admissions were significantly lower for dementia patients (OR = 0.58, 95% CI 0.51-0.66). Conclusions: Our data showed that COVID-19 patients with dementia did not fare substantially worse, but in fact, fared better when certain metrics were considered.
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Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic exposed and exacerbated health disparities between socioeconomic groups. Our purpose was to determine if age, sex, race, insurance, and comorbidities predicted patients' length of stay (LOS) in the hospital and in-hospital mortality in patients diagnosed with coronavirus disease 2019 (COVID-19) during the early pandemic. Methods Utilizing retrospective, secondarily sourced electronic health record (EHR) data for patients who tested positive for COVID-19 from HCA Healthcare facilities, predictors of LOS and in-hospital mortality were assessed using regression. LOS and in-hospital mortality were assessed using logistic regression and negative binomial regression, respectively. All models included age, insurance status, and sex, while additional covariates were selected using the least absolute shrinkage and selection operator (LASSO) regression. LOS data were presented as incidence rate ratios (IRR), and in-hospital mortality was presented as odds ratios (OR), followed by their 95% confidence intervals (CI). Results There were 111,849 qualifying patient records from March 1, 2020, to August 23, 2020. After excluding those with missing data (n = 7), without clinically confirmed COVID-19 (n = 27,225), and those from a carceral environment (n = 1,861), there were 84,624 eligible patients. Compared to the population of the United States of America, our COVID-19 cohort had a larger proportion of African American patients (23.17% versus 13.4%). The African American patients were more likely to have private insurance providers (28.52% versus 23.68%) and shorter LOS (IRR = 0.88, 95% CI = 0.86-0.90) than the White patient cohort. In addition, the African American versus White patients did not have increased odds (OR = 0.98, 95% CI = 0.96-1.00) of in-hospital mortality. Patients on Medicaid (OR = 1.04, 95% CI = 1.01-1.07) and self-pay (OR = 1.07, 95% CI = 1.00-1.14, noninclusive endpoints) had higher in-hospital mortality than private insurance. Several comorbidities were predictive of an increased LOS, including anxiety (IRR = 1.94, 95% CI = 1.87-2.01) and sedative abuse (IRR = 2.07, 95% CI = 1.63-2.64). Conclusions Race was not associated with increased LOS or in-hospital mortality in patients with COVID-19 infections during the early pandemic. Insurance type, psychiatric comorbidities, and medical comorbidities significantly impacted outcomes in patients with COVID-19. This research and future research in the field should help to determine rational public policies to help mitigate the risk of diseases and their impact on future pandemics.
ABSTRACT
Thromboembolism is a major cause of death in patients who suffer from COVID-19. Studies examining the effects of aspirin (ASA) on mortality relating to this phenomenon have showed conflicting results with varying degrees and certainties of evidence. We performed an aggregate data meta-analysis of fourteen studies encompassing 164,539 COVID-19 patients, which showed a reduced risk of in-hospital mortality associated with ASA use in eight studies that reported risk ratios (RR 0.90;95 % CI 0.82–0.98;I2 = 27.33 %, P = 0.01), six studies that reported hazard ratios (HR 0.56;95 % CI 0.41–0.76, P ≤ 0.01;I2 = 85.92 %) and pooled effect size (0.71;95 % CI 0.59–0.85, P = 0.00, I2 = 91.51 %). The objective of this study is to report the association between low dose ASA and a reduced risk of in-hospital mortality in patients with COVID-19.
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We grouped in-patients who had ICD-10 codes (F03.90/F01/G31.09) for dementia with age and gender (1:2) matched patients without a dementia diagnosis. In logistic regression analysis, dementia patients had no difference in mortality- OR= 1.0 (95% CI 0.86-1.17), but ICU admissions were significantly lower, OR= 0.58 (95% CI 0.51-0.66). B Conclusions: b Based on our findings, though dementia patients have higher unadjusted hospital mortality compared to non-dementia patients, in logistic regression analysis, there was no difference in hospital mortality. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Background Creating useful recommendations for changes in surgical protocols during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been difficult due to a lack of studies based on representative samples. This study evaluates the clinical outcomes and characteristics of patients undergoing urgent or emergent surgeries. Methods This is a multi-center (eight-hospital), retrospective, observational study of urgent and emergent surgical patients from Colorado and Kansas, the United States, in the early stages of the SARS-CoV-2 pandemic. Patient groups were divided based on their coronavirus disease 2019 (COVID-19) status: positive, negative and untested. COVID-19 testing was performed after the surgery if patients were symptomatic. Results The analysis includes 5,547 patients who underwent surgery from March 1, 2020 to May 17, 2020. Seventy-four percent (4,096) were not tested for COVID-19 due to lack of symptoms. Out of the 1,451 tested patients, 1,412 tested negative, and 39 tested positive. Out of all the patients who tested positive, 69.23% were admitted to the intensive care unit (ICU), whereas 16.72% of untested and 21.25% of the negative patients. The invasive ventilation rate for the patients that tested positive was 46.15%, 4.22% for untested, and 8.85% for patients who tested negative. The mortality rate in the positive group was 7.69%, 1.10% in the untested group, and 1.56% in the positive group. Conclusion Patients who tested positive for COVID-19 had worse clinical outcomes than patients who tested negative and untested. We recommend creating criteria for testing based on patient characteristics and surgical procedure rather than testing all patients awaiting surgery; this would allow us to conserve resources moving forward.