ABSTRACT
Background To evaluate baseline characteristics, risk factors, outcomes of COVID-19 hospitalized patients. Methods A retrospective observational study at an academic tertiary care center in Northern New Jersey. Study population included 900 adult patients admitted to the hospital with a confirmed COVID-19 infection between March and April 2020. Results Overall in-hospital mortality over 75-day period is 40.7%(n=367) with ICU group showing 77.1%(n=237) mortality and floor group showing 21.9%(n=130). 257/900(28.5%) patients required invasive mechanical ventilation. 145(16.1%) patients managed on BiPAP/AVAPS, 323(35.9%) patients were on High Flow Nasal Cannula. Cardiac injury (elevated troponin >0.05 ng/ml) was noted to be of highest incidence 51.2%(n=461) followed by renal failure 35.1%(n=316). Incidence of end organ injury and shock were significantly higher in ICU group and they had higher levels of inflammatory markers as compared to floor groups. Multiple logistic regression analyses revealed age >65, elevated IL6, acute renal injury, cardiac injury, and invasive mechanical ventilation as risk factors associated with mortality. Conclusion Cardiac injury is more common among hospitalized COVID 19 patients and is associated with increased mortality. Different mechanisms have been postulated for the reasons for cardiac injury including hypercoagulable and pro-inflammatory state and demand ischemia as well. Further in depth analysis is needed to ascertain a definitive cause. [Formula presented]
ABSTRACT
Understanding risk factors for death from Covid-19 is key to providing good quality clinical care. We assessed the presenting characteristics of the 'first wave' of patients with Covid-19 at Royal Oldham Hospital, UK and undertook logistic regression modelling to investigate factors associated with death. Of 470 patients admitted, 169 (36%) died. The median age was 71 years (interquartile range 57-82), and 255 (54.3%) were men. The most common comorbidities were hypertension (n = 218, 46.4%), diabetes (n = 143, 30.4%) and chronic neurological disease (n = 123, 26.1%). The most frequent complications were acute kidney injury (AKI) (n = 157, 33.4%) and myocardial injury (n = 21, 4.5%). Forty-three (9.1%) patients required intubation and ventilation, and 39 (8.3%) received non-invasive ventilation. Independent risk factors for death were increasing age (odds ratio (OR) per 10 year increase above 40 years 1.87, 95% confidence interval (CI) 1.57-2.27), hypertension (OR 1.72, 95% CI 1.10-2.70), cancer (OR 2.20, 95% CI 1.27-3.81), platelets <150 × 103/µl (OR 1.93, 95% CI 1.13-3.30), C-reactive protein ≥100 µg/ml (OR 1.68, 95% CI 1.05-2.68), >50% chest radiograph infiltrates (OR 2.09, 95% CI 1.16-3.77) and AKI (OR 2.60, 95% CI 1.64-4.13). There was no independent association between death and gender, ethnicity, deprivation level, fever, SpO2/FiO2, lymphopoenia or other comorbidities. These findings will inform clinical and shared decision making, including use of respiratory support and therapeutic agents.