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J Am Heart Assoc ; 10(16): e021204, 2021 08 17.
Article in English | MEDLINE | ID: covidwho-1352600

ABSTRACT

Background Limited information is available regarding in-hospital cardiac arrest (IHCA) in patients with COVID-19. Methods and Results We leveraged the American Heart Association COVID-19 Cardiovascular Disease (AHA COVID-19 CVD) Registry to conduct a cohort study of adults hospitalized for COVID-19. IHCA was defined as those with documentation of cardiac arrest requiring medication or electrical shock for resuscitation. Mixed effects models with random intercepts were used to identify independent predictors of IHCA and mortality while accounting for clustering at the hospital level. The study cohort included 8518 patients (6080 not in the intensive care unit [ICU]) with mean age of 61.5 years (SD 17.5). IHCA occurred in 509 (5.9%) patients overall with 375 (73.7%) in the ICU and 134 (26.3%) patients not in the ICU. The majority of patients at the time of ICHA were not in a shockable rhythm (76.5%). Independent predictors of IHCA included older age, Hispanic ethnicity (odds ratio [OR], 1.9; CI, 1.4-2.4; P<0.001), and non-Hispanic Black race (OR, 1.5; CI, 1.1-1.9; P=0.004). Other predictors included oxygen use on admission, quick Sequential Organ Failure Assessment score on admission, and hypertension. Overall, 35 (6.9%) patients with IHCA survived to discharge, with 9.1% for ICU and 0.7% for non-ICU patients. Conclusions Older age, Black race, and Hispanic ethnicity are independent predictors of IHCA in patients with COVID-19. Although the incidence is much lower than in ICU patients, approximately one-quarter of IHCA events in patients with COVID-19 occur in non-ICU settings, with the latter having a substantially lower survival to discharge rate.


Subject(s)
African Americans , COVID-19 , Heart Arrest/ethnology , Inpatients , Intensive Care Units , Patient Admission , Age Factors , Aged , Aged, 80 and over , Death, Sudden, Cardiac/ethnology , Death, Sudden, Cardiac/prevention & control , Female , Heart Arrest/diagnosis , Heart Arrest/mortality , Heart Arrest/therapy , Hospital Mortality/ethnology , Humans , Incidence , Male , Middle Aged , Prognosis , Race Factors , Registries , Risk Assessment , Risk Factors , Time Factors , United States/epidemiology
2.
J Am Heart Assoc ; 10(12): e020910, 2021 06 15.
Article in English | MEDLINE | ID: covidwho-1263974

ABSTRACT

Background Emerging evidence links acute kidney injury (AKI) in patients with COVID-19 with higher mortality and respiratory morbidity, but the relationship of AKI with cardiovascular disease outcomes has not been reported in this population. We sought to evaluate associations between chronic kidney disease (CKD), AKI, and mortality and cardiovascular outcomes in patients hospitalized with COVID-19. Methods and Results In a large multicenter registry including 8574 patients with COVID-19 from 88 US hospitals, data were collected on baseline characteristics and serial laboratory data during index hospitalization. Primary exposure variables were CKD (categorized as no CKD, CKD, and end-stage kidney disease) and AKI (classified into no AKI or stages 1, 2, or 3 using a modification of the Kidney Disease Improving Global Outcomes guideline definition). The primary outcome was all-cause mortality. The key secondary outcome was major adverse cardiac events, defined as cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, new-onset nonfatal heart failure, and nonfatal cardiogenic shock. CKD and end-stage kidney disease were not associated with mortality or major adverse cardiac events after multivariate adjustment. In contrast, AKI was significantly associated with mortality (stage 1 hazard ratio [HR], 1.72 [95% CI, 1.46-2.03]; stage 2 HR, 1.83 [95% CI, 1.52-2.20]; stage 3 HR, 1.69 [95% CI, 1.44-1.98]; versus no AKI) and major adverse cardiac events (stage 1 HR, 2.17 [95% CI, 1.74-2.71]; stage 2 HR, 2.70 [95% CI, 2.07-3.51]; stage 3 HR, 3.06 [95% CI, 2.52-3.72]; versus no AKI). Conclusions This large study demonstrates a significant association between AKI and all-cause mortality and, for the first time, major adverse cardiovascular events in patients hospitalized with COVID-19.


Subject(s)
COVID-19/mortality , Cardiovascular Diseases/mortality , Renal Insufficiency, Chronic/mortality , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/therapy , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Cause of Death , Female , Hospitalization , Humans , Male , Middle Aged , Prognosis , Registries , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/therapy , Risk Assessment , Risk Factors , Time Factors , United States
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