Comparison of patients admitted to an inner-city intensive care unit across 3 COVID-19 waves.

To expand our limited knowledge of COVID-19-related outcomes in patients admitted to inner-city intensive care unit (ICU across multiple infection waves. This retrospective study compared patients admitted to the ICU in Bronx, NY, during 3 COVID-19 waves (March 2020 to February 2022). Outcomes included in hospital mortality, length of stay (LOS), use of mechanical ventilation, and discharge disposition. The study included 716 patients (343, 276, and 97 in the first, second, and third COVID-19 waves, respectively). The number of days on mechanical ventilation and LOS were lower in the first wave. Of the 345 discharged patients, 37% went home directly, whereas 11% were discharged to a skill nursing facility. More patients went home during the second and third waves. Mortality decreased from the first to the third waves (57%-37%; P < .001). Predictors of mortality included age, male gender, COPD, shock, acute kidney injury (AKI), dialysis requirement, and mechanical ventilation. The decreased mortality and better discharge disposition of these inner-city patients during the second and third waves is encouraging, as this population historically had a high COVID-19-related mortality risk.

Outcomes of hospitalized patients with COVID-19 pneumonia, hypoxia, and a normal initial chest roentgenogram.

BACKGROUND: Outcomes of patients with coronavirus disease (COVID-19) pneumonia, hypoxia, and an initial normal chest roentgenogram (CXR) are not well defined. This study aimed to analyze the factors associated with poor outcomes in these patients. METHODS: This retrospective study evaluated patients admitted with COVID-19 pneumonia, a CXR without infiltrates and hypoxemia requiring supplemental oxygen. Outcomes were compared based on D-dimer levels and included in-hospital mortality, need for mechanical ventilation, acute kidney injury, shock, and length of hospital stay. RESULTS: We identified 115 patients, 31 (27%) had D-dimer levels above 4 times upper limit of normal on admission. Predictors of mortality included elevated D-dimers in hypoxic patients, use of mechanical ventilation, acute kidney injury, shock, and elevated admission serum sodium and lactic dehydrogenase. CONCLUSIONS: Patients with COVID-19 and hypoxia on initial presentation despite a normal CXR had significant mortality rates, higher in those with elevated inflammatory markers. The use of inflammatory markers, such as D-dimer and serum ferritin levels, may assist in identifying patients with higher morbidity and mortality risks. Additional imaging with chest computed tomogram should be obtained if clinically indicated and avoidance of overreliance of a normal CXR in those patients.

Change in patterns of hospitalization for influenza during COVID-19 surges.

BACKGROUND: Hospitalization due to influenza has been stable in recent years. In March 2020, New York was an epicenter for coronavirus disease 2019 (COVID-19). Because influenza and COVID-19 present similarly, there were serious concerns that coinfection of these viruses would burden the healthcare system. We compared incidence and outcomes of patients hospitalized with influenza before and during COVID-19 (seasons 2017-2021). METHODS: We conducted a retrospective study evaluating hospitalized patients with influenza. Four influenza seasons were evaluated, 2017-2021, pre- and during COVID-19 pandemic. We compared incidence of influenza and clinical outcomes across the seasons. RESULTS: We found 412 patients hospitalized due to influenza in the study period; 394 had influenza, and 18 had both influenza and COVID-19 infections. Demographics across the four influenza seasons were comparable; the cohort was predominantly female (61%) and had an average age of 60 years old. Comorbid conditions were common. No outcome differences were found for patients with influenza when comparing influenza seasons prior to and during the COVID-19 pandemic. The mortality for the entire cohort was 6.5%. During the COVID-19 pandemic, there were 18 (4.4%) influenza patients coinfected with COVID-19 and 32 (7.8%) patients with bacterial super infection. Predictors of mortality in patients with influenza included presence of shock, heart failure, bacterial pneumonia, and use of mechanical ventilation. Coinfection with COVID-19 did not increase mortality. CONCLUSION: We observed a significant decrease in the incidence of hospitalization due to influenza during the COVID-19 pandemic. Clinical presentations and outcomes for patients with influenza remain stable. Being aware of possible increased mortality for patients with both influenza and bacterial pneumonia is important. Although coinfection with COVID-19 did not increase mortality in influenza patients, identifying the specific virus responsible for infections has major therapeutic implications.

Coronavirus Pneumonia: Outcomes and Characteristics of Patients in an Inner-City Area after 3 Months of Infection.

BACKGROUND: The morbidity and long term pulmonary consequences of COVID-19 infection continue to unfold as we learn and follow survivors of this disease. We report radiological evolution and pulmonary function findings in those patients. METHODS: This was a retrospective cohort study of adult patients referred to the post-acute COVID-19 pulmonary clinic after a diagnosis of COVID-19 pneumonia. The study period was after the initial peak of the pandemic in New York City, from June to December 2020. RESULTS: 111 patients were included. The average interval time between COVID-19 pneumonia and initial clinic evaluation was 12 weeks. 48.2% of patients had moderate and 22.3% had severe infection. Dyspnea and cough was the most common respiratory symptoms post infection. Radiographic abnormalities improved in majority of patients with ground glass opacities been the common residual abnormal finding. Restrictive airway disease and decreased diffusion capacity were the most common findings in pulmonary function test. CONCLUSION: Our study suggests the needs for close and serial monitoring of functional and radiological abnormalities during the post COVID-19 period. Considering that many of the clinical-radiological and functional abnormalities are reversible, we suggest a "wait and watch"approach to avoid unnecessary invasive work up.