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Objectives: Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus maybe candidates for acute revascularization treatments (intravenous thrombolysis and/or mechanical thrombectomy). Materials and Methods: We analyzed the data from 62 healthcare facilities to determine the odds of receiving acute revascularization treatments in severe acute respiratory syndrome coronavirus infected patients and odds of composite of death and non-routine discharge with severe acute respiratory syndrome coronavirus infected and non-infected patients undergoing acute revascularization treatments after adjusting for potential confounders. Results: Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments (odds ratio 0.6, 95% confidence interval 0.5-0.8, p=0.0001). Among ischemic stroke patients who received acute revascularization treatments, severe acute respiratory syndrome coronavirus infection was associated with increased odds of death or non-routine discharge (odds ratio 3.0, 95% confidence interval 1.8-5.1). The higher odds death or non-routine discharge (odds ratio 2.1, 95% confidence interval 1.9-2.3) with severe acute respiratory syndrome coronavirus infection were observed in all ischemic stroke patients without any modifying effect of acute revascularization treatments (interaction term for death (p=0.9) or death or non-routine discharge (p=0.2). Conclusions: Patients with acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments. Severe acute respiratory syndrome coronavirus infection was associated with a significantly higher rate of death or non-routine discharge among acute ischemic stroke patients receiving revascularization treatments.
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Introduction: Considerable research has addressed the impact and increased severity of coronavirus disease 2019 (COVID-19) in adult patients with type 2 diabetes (T2D). However, findings from older adult patients cannot be generalized to affected children and young adults. Objectives: In this retrospective cohort study, we examine whether race/ethnicity and other factors are associated with hospitalization in pediatric and young adult patients with T2D and COVID-19 infection. Methods: The de-identified COVID-19 patient cohort from the December 2020 release of Cerner Real-World Data™ includes longitudinal data for patients who received care at 87 US-based health systems between December 2019 and September 2020. A rigorous, multi-step algorithm was used to identify patients with T2D (n=229). Analysis was limited to patients <27 years old with a positive laboratory test or billing code consistent with COVID-19 infection. A generalized linear mixed model was used to evaluate race/ethnicity, gender, HbA1c, body mass index (BMI), mean blood glucose, age, payer, and Elixhauser comorbidity score as correlates of hospital admission. Results: In this cohort, 204 (89.1%) patients were 18-26 years old, and 133 (58.1%) were female. Fifty-two percent were Hispanic, 27.1% were non-Hispanic Black, and 12.2% were non-Hispanic White. Median BMI was 37.9 kg/m2 (IQR 32.3-45.1 kg/m2);median HbA1c was 9.25% (IQR 7.2-12.3%). Ninety-four patients (41.0%), including all 21 patients in diabetic ketoacidosis (DKA;9.2%) were hospitalized. Male gender (OR 2.46 [CI 1.23-4.91], p=0.011), HbA1c (OR 1.29 [CI 1.10-1.52], p=0.001), and BMI (OR 1.44 [CI 1.02-2.03], p=0.040) were associated with hospitalization. Conclusions: Male gender, increased HbA1c, and increased BMI are associated with hospitalization in youths and young adults with T2D and COVID-19 infection. Further study is needed to identify targeted interventions to prevent hospitalization in youths and young adults with T2D.
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Objective: Acute ischemic stroke may occur in patients with Coronavirus disease 2019 but risk factors, in hospital events, and outcomes are not well studied in large cohorts. Background: We identified risk factors, co-morbidities, and outcomes in patients with Coronavirus disease 2019 with or without acute ischemic stroke and compared with patients without Coronavirus disease 2019 and acute ischemic stroke. Design/Methods: We analyzed the data from 54 healthcare facilities using the Cerner deidentified Coronavirus disease 2019 dataset. The dataset included patients with an emergency department or inpatient encounter with a discharge diagnoses codes that could be associated to suspicion of or exposure to Coronavirus disease 2019, or confirmed Coronavirus disease 2019. Results: A total of 103 (1.3%) patients developed acute ischemic stroke among 8,163 patients with Coronavirus disease 2019. Among all Coronavirus disease 2019 patients, the proportion of patients with hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation and congestive heart failure was significantly higher among those with acute ischemic stroke. Acute ischemic stroke was associated with discharge to destination other than home or death (relative risk 2.1, 95% confidence interval 1.7-2.4, p<.0001) after adjusting for potential confounders. A total of 199 (1.0%) patients developed acute ischemic stroke among 19,513 patents without Coronavirus disease 2019. Among all ischemic stroke patients, Coronavirus disease 2019 was associated with discharge to destination other than home or death (relative risk 1.2, 95% confidence interval 1.0- 1.3, p=.03) after adjusting for potential confounders Conclusions: Acute ischemic stroke was infrequent in patients with Coronavirus disease 2019 and usually occurs in presence of other cardiovascular risk factors. The risk of discharge to destination other than home or death increased two folds with occurrence of acute ischemic stroke in patients with Coronavirus disease 2019.
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INTRODUCTION: As of December 18, 2020, there have been nearly 17 million cases of COVID-19 in the United States. Early studies reported intubation rates between 12.2-29.2% with varying criteria between sites and as the pandemic has progressed. With the rapid spread of infection and increased use of ventilators, triage of patients based on factors such as their past medical history can help guide resource allocation. This retrospective study examined a large multi-center cohort of patients with COVID-19 infection to identify risk factors associated with intubation. METHODS: Adult patients with an emergency department or inpatient encounter from December 1, 2019 to June 30, 2020 with COVID-19 were included in the Cerner COVID-19 dataset, which was extracted from 62 hospital systems throughout the United States. Only patients with at least two previous visits in the past 5 years were included. ICD-10 diagnosis codes, demographic data, and discharge status were collected and classified based on intubation status. Logistic regression model identified independently associated risk factors for intubation. RESULTS:18,467 patients with confirmed SARS-CoV-2 infection were identified, with 5,525 seen only in the ED and 12,942 hospitalized. The mean age was 54.3 ± 20.5 years, the mean body mass index (BMI) was 30.42 ± 11.72, 8,397 (45.6%) patients were male, and 938 (7.2%) were intubated. 1,829 (14.1%) patients died in the hospital and 4,185 (22.7%) had a non-routine discharge, which encompasses home health care, short-term hospital, other facility including intermediate care and skilled nursing home. Using multivariate logistic regression, patients who were intubated were more likely to present with stroke, pneumonia, acute kidney injury, septic shock, respiratory failure, cardiac arrest, and encephalopathy. From patient demographics and past medical history, male sex (p=0.011), age > 35 (p=0.035 for 35-49 years old;p<0.001 for >50 years old), BMI > 30 (p=0.013 for BMI 30-40;p=0.004 for BMI >40), and previous respiratory failure (p=0.014) were independently associated with intubation. CONCLUSIONS: Among patients with COVID-19, male sex, increased age, BMI > 30, and previous respiratory failure were independently associated with the risk for intubation. Intubated patients were also more likely to present with stroke, pneumonia, acute kidney injury, septic shock, respiratory failure, cardiac arrest, and encephalopathy. Clinicians should be aware of these independent risk factors for intubation to facilitate resource allocation and minimize the possibility of unanticipated crash intubations.