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Introduction: The SARS-CoV-2 pandemic has left an ever-lasting impression on the healthcare system, however, less attention has been paid to hospitalized patients without SARS-CoV-2. This study evaluated hospitalized, non-COVID patients presenting with NSTEMI and the affect on trends in mortality rate, initial troponin value, and length of stay compared to the prior non-pandemic period Hypothesis: During the pandemic period, length of stay and mortality were increased compared to the prior non-pandemic year. Methods: This retrospective multi-center study involved a total of 62,690 patients admitted across 151 hospitals within the HCA network. Eligible patients had a negative SARS-CoV-2 polymerase chain reaction (PCR) upon admission. Using the time period of March-May of both 2019 and 2020, a total of 43,129 patients were investigated in 2019 and 19,561 patients in 2020. Results: Initial troponin values were higher in the non-pandemic year of 2019 (3.0 +/-11.97, std error: 0.0645, p = 0.001) when compared to those of the pandemic period of 2020 (2.69 +/-9.88, std error: 0.0075, p = 0.001). However, outcomes including mortality and length of stay were found to be worse in 2020 compared to 2019 (Mortality: 7.53% vs 6.65% respectively p= <.001 ) & (length of stay: 6.97 +/-7.77 days vs 6.00 +/-7.15 days respectively, p= <0.001). Multivariable Logistic Regression analysis revealed that those NSTEMI patients hospitalized in 2020 had a 13% higher likelihood of mortality compared those in 2019 (OR 1.13 [95% CI (1.05, 1.21), p= <0.001), independent of demographic, comorbidities, or home use statins, anti-platelet agents, or beta blockers. Additionally, length of stay in 2020 was increased by +0.935 days compared to 2019 (std error 0.063, p= <0.001) while holding other factors constant. Conclusions: This study demonstrated hospitalized NSTEMI patients without SARS-CoV-2 suffered an increase in mortality rates and length of stay compared to the prior year despite having lower troponin values. Multiple factors may have contributed to the burden faced by hospitals including delays in presentation, lack of outpatient care, and fear of contracting the virus while hospitalized. Further investigation into the impact of the pandemic remains vital for future of healthcare.
ABSTRACT
Introduction: As COVID 19 swept across the nation, the pandemic imposed many challenges to the United States healthcare system. With limitations in access to care, common conditions including an exacerbation of congestive heart failure (CHF) accounted for a significant proportion of hospitalizations. What remains unclear is the impact that the pandemic had on outcomes including mortality of patients who tested negative for SARS-CoV-2 compared to the year prior. Hypothesis: During the COVID-19 pandemic, COVID 19 negative CHF exacerbations patients had increased mortality than patients from the prior non-pandemic period. Methods: This was a retrospective multi-center study including 37,340 patients admitted in 154 hospitals in the HCA network. The study primarily evaluated the mortality difference between patients hospitalized with congestive heart failure that tested negative for SARS-CoV-2 polymerase chain reaction (PCR) during the pandemic during the months of March through May 2020 (N=15282) and compared to patients hospitalized with congestive heart failure during the same months in 2019, pre-pandemic (N=22058). Results: There was an observed increase in mortality in patients admitted in 2020 when compared to 2019 (2.34% vs 1.98% respectively, p = 0.020). Multivariable logistic regression analysis showed mortality was 24% higher in CHF patients admitted in the studied months March through May 2020 when compared to CHF patients admitted in the same period in 2019 (OR = 1.24, CI [1.07-1.43], p = 0.003), when correcting for age, demographics, comorbidities, and prior beta blocker or diuretic use. Although there was no statistically significant difference in BNP between the two groups as a measure of disease severity, patients that presented to the ED in the studied months in 2020 had higher admission rates (OR = 0.90 CI [0.86-0.95] p<0.001). Conclusions: The study revealed that there was an increased mortality rate in hospitalized CHF exacerbation patients who tested negative for SARS-CoV-2 during the pandemic when compared to those the year prior. This illustrates some of the unforeseen consequences of the pandemic on patient healthcare. Further studies are needed to determine the effects of the pandemic in COVID19 negative patients.
ABSTRACT
Coronavirus Disease 2019 (Covid-19) Has Been Diagnosed In Over 50 Million Individuals And Resulted In Greater Than 1 Million Deaths Since Its Discovery In December 2019. Currently, It Is Understood That Cardiovascular Disease, Diabetes, Hypertension, Chronic Lung Disease, Malignancy, Chronic Renal Disease, Obesity, And Smoking Confer Worse Outcomes In Those Afflicted With Covid-19. The Role Of Underlying Gastrointestinal Comorbidities On Covid-19 Prognosis Has Not Been Well Studied. Patients With Inflammatory Bowel Disease (Ibd) Have A Slightly Higher Overall Mortality Than The General Population. While The Pathogenesis Of Ibd Is Not Completely Understood, It Is Thought To Be The Consequence Of Dysregulated Immune Response. A Pair Of Small International Studies Demonstrated That Patients With Ibd Are At Increased Risk Of Covid-19 Infection, Especially When They Have Active Disease And Are Taking Immunosuppressive Therapy. However, The Characteristics And Outcomes Of Covid-19 In Patients With Ibd Remain Unclear. We Conducted A Large-Scale, Multicenter, Retrospective Study To Examine The Outcomes In Ibd Patients Hospitalized For Covid-19. Using Hca Healthcare’S Physician Services Clinical Data Warehouse, We Reviewed 78,756 Adult Patients Across 143 Hospitals Between January Through August 2020 With Covid-19, Yielding 78,572 Covid-19 Patients Without Ibd And 184 With Ibd. Unpaired T-Tests Of Covid-19 Patients With Ibd Compared To Those Without Ibd Showed That Patients With Both Covid-19 And Ibd Experienced Significantly Higher Mortality (8.15% Vs 6.10%, P=0.004), Significantly Higher Rates Of Icu Admission (25.54% Vs 16.49%, P=0.001), Significantly Higher Rates Of Ventilation (13.04% Vs 7%, P=0.002), And Significantly Longer Lengths Of Stay (Los) (7.92 ± 9.84 Vs 4.57 ± 7.87 Days, P<0.001). The Outcomes Of Length Of Stay Remained Significant On Paired T-Test When The 184 Patients With Covid-19 And Ibd Were Age-Matched To Covid-19 Patients Without Ibd. However, There Was No Statistical Significance In Mortality, Icu Admission, And Need For Ventilation When Age-Matched. Ibd Was Independently Associated With Increased Icu Admission (Or 1.5, Ci 1.04 – 2.117, P=0.026) And Need For Ventilation (Or 1.8, Ci 1.124 – 2.775, P=0.010) On Multivariable Regression Analysis, And Los (Or 2.337, Se 0.531, P<0.001) In Linear Regression Analysis. Our Data Corroborates Previous Studies Suggesting Protective Effects Of Female Sex, And Deleterious Effects Of Increasing Age, Myocardial Infarction, Congestive Heart Failure, Cerebrovascular Disease, Chronic Pulmonary Disease, Diabetes, And Cancer. In Summary, Based On Our Study, Patients With Both Ibd And Covid-19 Experienced Significantly Increased Rates Icu Admission, Ventilation, And Lengths Of Stay Compared To Patients With Covid-19 Alone (Table Presented) (Table Presented) (Table Presented) (Table Presented)
ABSTRACT
Background: The COVID-19 pandemic changed the way Americans live and behave. Social isolation, financial crisis, and loss of loved ones add to the stressors. Research has shown increased alcohol consumption as a coping mechanism. Several reports indicate an increase in alcohol sales during the pandemic. Short term and long-term complications of this are unknown currently. We sought to determine the number of hospitalizations for alcoholic hepatitis during the COVID-19 pandemic in the United States. Method: This is a retrospective cohort study comparing hospitalizations for alcoholic hepatitis/ alcoholic hepatic failure during February 2019 to September 2019 and from February 2020 to September 2020. We analyzed HCA Healthcare’s Physician Services clinical data warehouse which aggregates data from 185 hospitals in the US. Patients were identified retrospectively using ICD-10 codes. Patient characteristics, labs, and discharge information were also collected. Categorical variables were compared using the Chi-square test and continuous variables were compared using the t-test. Results: The total number of hospitalizations for alcoholic hepatitis and alcoholic liver failure in February through September was 57,171 in 2020 vs 61,356 in 2019. This represented 7.4 % of all admissions in 2020 vs 6.5% in 2019. Admissions in Q1 (excluding January), Q2, and Q3 were 6.02%, 8.55%, and 7.74% respectively in 2020, and 6.63%, 7.05%, and 6.08% respectively in 2019. The mortality rate in 2019 was 1.35%, it increased to 2.04% in 2020 (p=0.01). There is also a 7% increase in cases among women in 2020. Conclusions: This study shows that there is a relative increase in hospitalizations for alcoholic hepatitis and alcoholic hepatic failure during the COVID-19 pandemic compared to the year before, especially in the second and third quarters of the year. Interestingly at the beginning of the pandemic when many states issued stay-at-home orders there was a 10% decrease in alcoholic hepatitis hospitalizations versus the previous year. As the prolonged uncertainty and chaos continued the hospitalizations increased by 21% in the second quarter and by 27% in the third quarter versus the prior year. We assume that as uncertainties prevailed, alcohol use increased, resulting in alcohol-related liver injuries. Additionally, the COVID-19 pandemic has seen increased alcoholic hepatitis mortality and an increase in female patients. The results shed light on a different public health aspect of the pandemic which has gone unnoticed and needs to be addressed.
ABSTRACT
Coronavirus disease 2019 (COVID-19) has been diagnosed in at least 63.5 million individuals and resulted in 1.4 million deaths as of December 2020 since its discovery. Various risk factors for severe illness have been investigated;currently it is understood that cardiovascular disease, diabetes mellitus, hypertension, chronic lung disease, malignancy, chronic renal disease, obesity, and smoking confer worse outcomes. Liver cirrhosis is understood to be a significant source of general morbidity and mortality due, in part, to compromise of the immune system. A multicenter, retrospective examination of 50 patients with both COVID-19 and cirrhosis showed that patients with cirrhosis were at increased risk for mortality from COVID-19 than those without cirrhosis. To our knowledge, there exists no large study to examine the effect of cirrhosis on COVID-19 outcomes. We performed a multicenter, retrospective study to further examine outcomes in cirrhotic patients hospitalized for COVID-19 infection. Using the HCA Healthcare Physician Services clinical data warehouse, we reviewed 23,474 adult patients across 143 hospitals admitted from January through August 2020 with COVID-19, yielding 22,467 COVID-19 patients without cirrhosis and 1,007 with cirrhosis. Unpaired T-tests of COVID-19 patients with cirrhosis compared to those without cirrhosis showed that patients with both COVID-19 and cirrhosis experienced significantly higher mortality (17.97% vs 12.96%, p<0.001), significantly higher rates of ICU admission (45.58% vs 33.90%, p<0.001), significantly higher rates of ventilation (24.43% vs 16.07%, p<0.001), and significantly longer lengths of stay (LOS) (11.05 ± 10.86 vs 8.46 ± 10.05 days, p<0.001). The outcomes of ICU admission and length of stay remained significant on paired T-test when the 1,007 patients with COVID-19 and cirrhosis were age-matched to COVID-19 patients without cirrhosis. Cirrhosis was independently associated with increased mortality (OR 1.33, CI 1.11-1.58, p=0.002), ICU admission (OR 2.08, CI 1.16-1.52, p<0.001), and ventilation (OR 1.32, CI 1.13-1.54, p<0.001) on multivariable regression analysis. Our dataset corroborates previous studies suggesting protective effects of female sex;and deleterious effects of increasing age, myocardial infarction, cerebrovascular disease, diabetes, cancer, and obesity. Chronic pulmonary disease was significantly associated with poor outcomes of all measures except mortality. Additionally, length of stay among patients with both COVID and cirrhosis is estimated to increase by 1.65 (SE 0.31, p<0.001) on linear regression analysis. In summary, patients with both cirrhosis and COVID-19 experienced significantly increased rates of mortality, ICU admission, ventilation, and lengths of stay compared to patients with COVID-19 alone. (Table presented.)
ABSTRACT
Background: Covid 19 is a new and rapidly spreading corona virus which has reached pandemic proportions. As of 5/22/20 there are 5.08 million confirmed cases and 332,000 deaths worldwide. Primary manifestations are respiratory, with a subset developing severe hypoxic respiratory failure. Several risk factors predispose patients to worse outcomes including age, obesity, hypertension, chronic kidney disease, COPD, asthma, CHF, and diabetes. This is a retrospective cohort analysis of patients with Rheumatoid arthritis, Ankylosing spondylitis, or Psoriatic arthritis who were hospitalized for COVID-19 infection across 165 HCA hospitals from 1/1/2020 to 5/30/2020. We compared endpoints and calculated odds of ICU admission, invasive ventilation, mortality compared to control as well as length of stay and discharge location. Objectives: Our objectives include measuring the outcome of Patients in two arms, the first being those with Rheumatoid arthritis, Ankylosing spondylitis, and Psoriatic arthritis who are infected with COVID 19 to an age matched and comorbidity matched arm (using the Charlson comorbidity index) for the composite endpoint of ICU admission, invasive ventilation, and death. We believe the inflammatory arthropathy arm will have a worse composite endpoint then the control arm. we will also attempt to calculate a hazard ratio of this arm vs the control to the composite endpoint. We will also examine the length of stay as well as inflammatory markers mentioned in between the two arms. We suspect initial inflammatory markers will be lower in the inflammatory arthropathy arm, particularly CRP and LDH, due to chronic immune modulating medication and these markers will not correlate as closely with severe illness represented by the composite endpoint as in the control arm. Methods: We analyzed 86,217 patients admitted with COVID-19 comparing 751 patients who had inflammatory arthropathy to patients who did not. T tests were used for parametric outcome and chi square tests for non-parametric outcomes. Multivariate analysis included potential confounders such as age, and comorbidities such as diabetes, heart disease, etc. Results: The odds ratio for mortality in the arthropathy arm was 1.37 with a confidence interval of 1.09 to 1.71 with a p value of 0.006. The odds ratio for ventilation was 1.35 with CI of 1.09 to 1.67 and p value of 0.006. The odds ratio of ICU admission was 1.46 with CI of 1.24 to 1.72 and P value of 0.000. The average length of stay of the arthropathy arm was 8.51 days +/-10.02 vs 4.59 days +/-8.26 of the control, p < 0.001. The discharge disposition of the arthropathy arm vs control group is as follows, 13.32% died inpatient vs 5.87% in the control, 56.72% were discharged home vs 77.19%, 6.79% went to hospice care vs 3.10%, 4.79% remained inpatient at the end of the study interval vs 3.45%, 17.18% were discharged to rehab vs 8.43%, and other discharges not included in the above groupings were 1.2% vs 1.96%, p<0.001. 31.29% of the arthropathy group required ICU admission vs 16.32% and 13.98% required ventilation vs 6.9%, p <0.001. The average age was higher in the arthropathy arm vs control at 66.56 years old vs 51.53, p <0.001. Charlson comorbidity index was also higher in the arthropathy arm at 2.72 vs 0.96, p <0.001. Conclusion: This is a large analysis of inflammatory arthropathy patients hospitalized with COVID-19. While the arthropathy group was older, and had more co-morbidities, when adjusting for potential confounders, inflammatory arthropathy patients had a higher risk of death and mechanical ventilation, as well as longer length of stay.