ABSTRACT
Background: In COVID-19, hospitalized patients are at high risk for malnutrition upon admission due to intense catabolic processes coupled with comorbidities. Malnutrition has been strongly linked to adverse health economic outcomes in the hospital setting and society guidelines recommend early intervention to preserve lean body mass and mitigate adverse health economic outcomes. We have previously reported that malnourished African Americans (P=0.014) and females (P<0.001) were less likely to receive oral nutrition supplement (ONS) orders in a cohort of 8,713 adult malnourished patients hospitalized in a tertiary care center over a one-year period. We determined if there were disparities in the ordering of ONS in hospitalized COVID-19 patients during the height of the pandemic in 2020. Methods: This is a retrospective cohort study consisting of 3,431 COVID-19 adult (18 years and older) inpatient encounters at five Johns Hopkins affiliated hospitals between March 1, 2020, and December 3, 2020. Patients diagnosed with COVID-19 were identified as those who were assigned an ICD-10 billing code of U07.1 for COVID-19. Malnourishment among patients was identified as those who risk screen positive upon admission by use of the malnutrition universal screening tool (MUST) and confirmed by registered dietitians. Patient feeding status was identified as those who had a record of diet orders placed. Patient data was derived from JH-CROWN: The COVID-19 Precision Medicine Analytics Platform (PMAP) Registry and extracted using Python 3, version 3.7.5, kernel in JupyerLab, version 1.1.4. Statistics were conducted with SAS (version 9.4) software to examine the effect of malnutrition on mortality and hospital length of stay among COVID-19 inpatient encounters while accounting for possible covariates. Results: Older patients were more likely to have received ONS (P<0.001) (Table 1). Patients with diabetes (P=0.0410), hypertension (P=0.0296), COPD (P=0.0013), and malnutrition (P=0.0106) were also more likely to have received ONS (Table 1). Males were more likely to receive ONS than females (0.0089) (Table 1). Whites were more likely to receive ONS than Blacks, Asian, or Other races (P=0.0037) (Table 1). In the logistic regression model, females (P=0.0079), blacks (P=0.0026), and Other races (P=0.0143) were less likely to receive ONS (Table 2). Patients with diabetes were more likely to receive ONS (P=0.0255) (Table 2). Older (P=0.059) patients and those with COPD (P=0.0709) are suggestive of an increased likelihood of receiving ONS (Table 2). Conclusions: Gender and race disparities exist in the ordering of ONS was in a robust cohort of COVID-19 adult inpatients from five US hospitals. Further studies should be conducted to determine if there is a widespread racial and gender bias in the ordering of ONS.(Table Presented)(Table Presented)
ABSTRACT
Background. Malnutrition has been linked to longer hospital stays and adverse health economic outcomes. In COVID-19, there is a paucity of data on whether malnutrition is associated with adverse outcomes in the hospital setting. Methods. This is a retrospective cohort study consisting of 4,311 COVID-19 adult (18 years and older) inpatients at five Johns Hopkins affiliated hospitals between March 1, 2020, and December 3, 2020. Patient data were derived from their COVID-19 database JH-CROWN: The COVID-19 Precision Medicine Analytics Platform (PMAP) Registry and extracted using Python 3, version 3.7.5, kernel in JupyterLab, version 1.1.4. Malnourishment among patients was identified as those who were malnutrition nutrition risk screen positive upon admission by use of the malnutrition universal screening tool (MUST) and confirmed by registered dietitians, Statistics were conducted with SAS v9.4 (Cary, NC) software to examine the effect of malnutrition on mortality and hospital length of stay among COVID-19 inpatient encounters while accounting for possible covariates in linear regression analysis predicting log-transformed length of stay. Results. COVID-19 patients who are older, male, or have lower BMIs have a higher likelihood of mortality (Table 1). In the linear regression model, for every 1% increase in BMI, the length of stay decreased by 0.38% (p<0.001) (Table 2). Differences in race (p=0.001) (Table 1), were associated with differences in the likelihood of mortality and length of stay;being Asian (p=0.0029), Black (p<0.001), or Other (p<0.001) were associated with decreased length of stay compared to Whites (Table 2). Patients with diabetes, hypertension, diarrhea, COPD, and malnutrition were more likely to have higher mortality (p<0.001) (Table 1) and more likely to have a longer hospital length of stay (p<0.001) (Table 2). Overall, 12.9% (555/4,311) of adult COVID-19 patients were diagnosed with malnutrition and were associated with an 87.9% (p<0.001) (Table 2) increase in hospital length of stay. Differences in the source of admission to the hospital affected the likelihood of mortality (p<0.001) (Table 1) and length of stay (Table 2). Conclusions. In a cohort of COVID-19 adult inpatients, malnutrition was associated with a higher likelihood of mortality and increased hospital length of stay. In the linear regression model, malnutrition was associated with an increase in the length of stay by 87.9%. Interestingly, decreases in BMI were associated with increased hospital length of stay. Race and admission source also plays a key role in affecting a patient's hospital length of stay and mortality. These results support the idea that malnutrition appears to be a predictor for COVID-19 inpatient outcomes similar to that of other known highrisk comorbidities like diabetes, hypertension, and COPD.(Table Presented)(Table Presented)
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) is an unprecedented global pandemic caused by the novel betacoronavirus SARS-CoV-2 Extrapulmonary clinical features such as abnormal liver enzymes are often present, and almost 50% of patients experienced different degrees of liver injury in studies from China However, the prevalence of elevated liver enzymes and the association with clinical outcomes in U S based cohorts have not been well studied Aims: 1 ) To assess the prevalence of elevated liver enzymes in patients with COVID-19 in a U S based cohort 2 ) To compare differences in clinical characteristics and outcomes in patients with and without elevated alanine aminotransferase (ALT) Methods: In this retrospective cohort study, we analyzed data from patients hospitalized at the Johns Hopkins Health System (JHHS) between February 1, 2020, and July 1, 2020, who tested positive for SARSCoV- 2. Identified COVID-19 patients were then stratified into two groups, those with elevated ALT (>35 U/L for men and > 25 U/L for women) at admission or subsequently and thosewith normal ALT Pearson's chi-squared test and analysis of variance and were used to compare variables between the two groups Clinical outcomes assessed included the need for mechanical ventilation or vasopressor support, hospital length of stay (LOS), and mortality Results: During the study period, 2293 patients with COVID-19 were hospitalized at JHHS The mean age was 60 (SD 17 7) years;52 5% were men 35 6% were black, 31 2% white, and 26 3% Hispanic 33 7% were obese;1479 (64 5%) had abnormal liver ALT values Compared to those with normal ALT, patients with elevated ALT were more likely to be non-white (72 3% vs 61 9%, p < 0 001), Hispanic (30 4% vs 18 5%, p < 0 001), obese (43 7% vs 34 2%, p < 0 001), and have underlying liver disease (7 1% vs 3 0%, p < 0 001) Those with elevated ALT more often required mechanical ventilation (23 7% vs 6 0%, p < 0 001) and vasopressor support (23 0% vs 7 2%, p < 0 001) The group with elevated ALT had a longer hospital LOS (11 0 vs 5 9 days, p < 0 001) However, there were no differences in mortality found between the two groups (13 8% vs 15 6%, p = 0 3) Conclusion: There was a high prevalence of elevated ALT among inpatients with COVID-19 (64 5%) The presence of elevated ALT was associated with adverse clinical outcomes, including the need for mechanical ventilation and vasopressor support and prolonged hospital LOS.
ABSTRACT
Background: Patients with coronavirus disease 2019 (COVID-19) often present with various degrees of liver injury Thus, patients with pre-existing chronic liver disease (LD) may be at increased risk of complications from COVID-19, but this has not yet been well characterized Aim: To examine the impact of pre-existing LD on outcomes in patients with COVID-19 Methods: In this retrospective cohort study, we analyzed data from COVID-19 patients hospitalized at the Johns Hopkins Health System between February 1, 2020, and July 1, 2020, who tested positive for COVID-19 Identified patients were then stratified into two groups based on the presence or absence of pre-existing LD The LD group consisted of patients with a diagnosis of pre-existing liver disease at the time of diagnosis of COVID-19 We studied outcomes, including the need for hemodialysis or vasopressor support, hospital length of stay (LOS), and in-hospital mortality We described categorical data as percentages, and continuous data as mean with standard error (SD) We used Pearson's chi-squared tests and analysis of variance to compare variables between the patients with and without LD Results: In a study of 2,293 patients with laboratoryconfirmed COVID-19, 129 (17.8%) patients had pre-existing LD Among them, 32 (24 8%) patients had cirrhosis;18 (14 0%) had non-alcoholic fatty liver disease;20 (15 5%) had chronic hepatitis C;5 (3 87%) had chronic hepatitis B, and 5 (3 87%) were liver transplant recipients Patients with LD were more often black (41 9%) compared to patients with no preexisting LD (35 1%, p = 0 029) LD patients had substantially higher prevalence of comorbidities, including hypertension (79 9% vs 61%, p < 0 001), diabetes (27 9% vs 15 6%, p < 0 001), chronic pulmonary disease (31 0% vs 18 4%, p < 0 0001), and anemia (43 4% vs 22%, p < 0 001) Those with LD required hemodialysis more often (10% vs 4 4%, p = 0 015) There was no difference in need for vasopressor support (20 0% vs 18 8%, p = 0 12) The hospital LOS was similar between the groups (9 5 vs 9 6 days) There was no difference in mortality between the two groups (10 0% vs 14 6%, p = 0 14) Conclusion: Patients with pre-existing LD and COVID-19 infection were more likely black, have underlying comorbidities and require hemodialysis However, they had similar hospital LOS and mortality as those without LD. These findings have important implications for patients with LD but require further validation.