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2.
Preprint in English | EuropePMC | ID: ppcovidwho-295321

ABSTRACT

Importance Little is known about COVID vaccine breakthrough infections and their risk factors. Objective To identify risk factors associated with COVID-19 breakthrough infections among vaccinated individuals and to reassess the effectiveness of COVID-19 vaccination against severe outcomes using real-world data. Design, Setting, and Participants We conducted a series of observational retrospective analyses using the electronic health records (EHRs) of Columbia University Irving Medical Center/New York Presbyterian (CUIMC/NYP) up to September 21, 2021. New York adult residence with PCR test records were included in this analysis. Main Outcomes and Measures Poisson regression was used to assess the association between breakthrough infection rate in vaccinated individuals and multiple risk factors – including vaccine brand, demographics, and underlying conditions – while adjusting for calendar month, prior number of visits and observational days. Logistic regression was used to assess the association between vaccine administration and infection rate by comparing a vaccinated cohort to a historically matched cohort in the pre-vaccinated period. Infection incident rate was also compared between vaccinated individuals and longitudinally matched unvaccinated individuals. Cox regression was used to estimate the association of the vaccine and COVID-19 associated severe outcomes by comparing breakthrough cohort and two matched unvaccinated infection cohorts. Results Individuals vaccinated with Pfizer/BNT162b2 (IRR against Moderna/mRNA-1273 [95% CI]: 1.66 [1.17 – 2.35]);were male (1.47 [1.11 – 1.94%]);and had compromised immune systems (1.48 [1.09 – 2.00]) were at the highest risk for breakthrough infections. Vaccinated individuals had a significant lower infection rate among all subgroups. An increased incidence rate was found in both vaccines over the time. Among individuals infected with COVID-19, vaccination significantly reduced the risk of death (adj. HR: 0.20 [0.08 - 0.49]). Conclusion and Relevance While we found both mRNA vaccines were effective, Moderna/mRNA-1273 had a lower incidence rate of breakthrough infections. Both vaccines had increased incidence rates over the time. Immunocompromised individuals were among the highest risk groups experiencing breakthrough infections. Given the rapidly changing nature of the SARS-CoV-2, continued monitoring and a generalizable analysis pipeline are warranted to inform quick updates on vaccine effectiveness in real time. Key Points Question What risk factors contribute to COVID-19 breakthrough infections among mRNA vaccinated individuals? How do clinical outcomes differ between vaccinated but still SARS-CoV-2 infected individuals and non-vaccinated, infected individuals? Findings This retrospective study uses CUIMC/NYP EHR data up to September 21, 2021. Individuals who were vaccinated with Pfizer/BNT162b2, male, and had compromised immune systems had significantly higher incidence rate ratios of breakthrough infections. Comparing demographically matched pre-vaccinated and unvaccinated individuals, vaccinated individuals had a lower incidence rate of SARS-CoV-2 infection among all subgroups. Meaning Leveraging real-world EHR data provides insight on who may optimally benefit from a booster COVID-19 vaccination.

4.
MMWR Morb Mortal Wkly Rep ; 70(44): 1553-1559, 2021 Nov 05.
Article in English | MEDLINE | ID: covidwho-1502903

ABSTRACT

Immunocompromised persons, defined as those with suppressed humoral or cellular immunity resulting from health conditions or medications, account for approximately 3% of the U.S. adult population (1). Immunocompromised adults are at increased risk for severe COVID-19 outcomes (2) and might not acquire the same level of protection from COVID-19 mRNA vaccines as do immunocompetent adults (3,4). To evaluate vaccine effectiveness (VE) among immunocompromised adults, data from the VISION Network* on hospitalizations among persons aged ≥18 years with COVID-19-like illness from 187 hospitals in nine states during January 17-September 5, 2021 were analyzed. Using selected discharge diagnoses,† VE against COVID-19-associated hospitalization conferred by completing a 2-dose series of an mRNA COVID-19 vaccine ≥14 days before the index hospitalization date§ (i.e., being fully vaccinated) was evaluated using a test-negative design comparing 20,101 immunocompromised adults (10,564 [53%] of whom were fully vaccinated) and 69,116 immunocompetent adults (29,456 [43%] of whom were fully vaccinated). VE of 2 doses of mRNA COVID-19 vaccine against COVID-19-associated hospitalization was lower among immunocompromised patients (77%; 95% confidence interval [CI] = 74%-80%) than among immunocompetent patients (90%; 95% CI = 89%-91%). This difference persisted irrespective of mRNA vaccine product, age group, and timing of hospitalization relative to SARS-CoV-2 (the virus that causes COVID-19) B.1.617.2 (Delta) variant predominance in the state of hospitalization. VE varied across immunocompromising condition subgroups, ranging from 59% (organ or stem cell transplant recipients) to 81% (persons with a rheumatologic or inflammatory disorder). Immunocompromised persons benefit from mRNA COVID-19 vaccination but are less protected from severe COVID-19 outcomes than are immunocompetent persons, and VE varies among immunocompromised subgroups. Immunocompromised persons receiving mRNA COVID-19 vaccines should receive 3 doses and a booster, consistent with CDC recommendations (5), practice nonpharmaceutical interventions, and, if infected, be monitored closely and considered early for proven therapies that can prevent severe outcomes.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Hospitalization/statistics & numerical data , Immunocompromised Host/immunology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/immunology , COVID-19/therapy , COVID-19 Vaccines/immunology , Female , Humans , Immunization Schedule , Laboratories , Male , Middle Aged , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purification , United States/epidemiology , Vaccines, Synthetic/administration & dosage , Young Adult
5.
MMWR Morb Mortal Wkly Rep ; 70(44): 1539-1544, 2021 Nov 05.
Article in English | MEDLINE | ID: covidwho-1502901

ABSTRACT

Previous infection with SARS-CoV-2 (the virus that causes COVID-19) or COVID-19 vaccination can provide immunity and protection from subsequent SARS-CoV-2 infection and illness. CDC used data from the VISION Network* to examine hospitalizations in adults with COVID-19-like illness and compared the odds of receiving a positive SARS-CoV-2 test result, and thus having laboratory-confirmed COVID-19, between unvaccinated patients with a previous SARS-CoV-2 infection occurring 90-179 days before COVID-19-like illness hospitalization, and patients who were fully vaccinated with an mRNA COVID-19 vaccine 90-179 days before hospitalization with no previous documented SARS-CoV-2 infection. Hospitalized adults aged ≥18 years with COVID-19-like illness were included if they had received testing at least twice: once associated with a COVID-19-like illness hospitalization during January-September 2021 and at least once earlier (since February 1, 2020, and ≥14 days before that hospitalization). Among COVID-19-like illness hospitalizations in persons whose previous infection or vaccination occurred 90-179 days earlier, the odds of laboratory-confirmed COVID-19 (adjusted for sociodemographic and health characteristics) among unvaccinated, previously infected adults were higher than the odds among fully vaccinated recipients of an mRNA COVID-19 vaccine with no previous documented infection (adjusted odds ratio [aOR] = 5.49; 95% confidence interval [CI] = 2.75-10.99). These findings suggest that among hospitalized adults with COVID-19-like illness whose previous infection or vaccination occurred 90-179 days earlier, vaccine-induced immunity was more protective than infection-induced immunity against laboratory-confirmed COVID-19. All eligible persons should be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2.


Subject(s)
COVID-19/diagnosis , COVID-19/immunology , SARS-CoV-2/isolation & purification , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/therapy , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/immunology , Female , Hospitalization/statistics & numerical data , Humans , Laboratories , Male , Middle Aged , SARS-CoV-2/immunology , Vaccines, Synthetic/administration & dosage , Vaccines, Synthetic/immunology , Young Adult
6.
J Med Internet Res ; 23(9): e31122, 2021 09 30.
Article in English | MEDLINE | ID: covidwho-1459209

ABSTRACT

BACKGROUND: COVID-19 has threatened the health of tens of millions of people all over the world. Massive research efforts have been made in response to the COVID-19 pandemic. Utilization of clinical data can accelerate these research efforts to combat the pandemic since important characteristics of the patients are often found by examining the clinical data. Publicly accessible clinical data on COVID-19, however, remain limited despite the immediate need. OBJECTIVE: To provide shareable clinical data to catalyze COVID-19 research, we present Columbia Open Health Data for COVID-19 Research (COHD-COVID), a publicly accessible database providing clinical concept prevalence, clinical concept co-occurrence, and clinical symptom prevalence for hospitalized patients with COVID-19. COHD-COVID also provides data on hospitalized patients with influenza and general hospitalized patients as comparator cohorts. METHODS: The data used in COHD-COVID were obtained from NewYork-Presbyterian/Columbia University Irving Medical Center's electronic health records database. Condition, drug, and procedure concepts were obtained from the visits of identified patients from the cohorts. Rare concepts were excluded, and the true concept counts were perturbed using Poisson randomization to protect patient privacy. Concept prevalence, concept prevalence ratio, concept co-occurrence, and symptom prevalence were calculated using the obtained concepts. RESULTS: Concept prevalence and concept prevalence ratio analyses showed the clinical characteristics of the COVID-19 cohorts, confirming the well-known characteristics of COVID-19 (eg, acute lower respiratory tract infection and cough). The concepts related to the well-known characteristics of COVID-19 recorded high prevalence and high prevalence ratio in the COVID-19 cohort compared to the hospitalized influenza cohort and general hospitalized cohort. Concept co-occurrence analyses showed potential associations between specific concepts. In case of acute lower respiratory tract infection in the COVID-19 cohort, a high co-occurrence ratio was obtained with COVID-19-related concepts and commonly used drugs (eg, disease due to coronavirus and acetaminophen). Symptom prevalence analysis indicated symptom-level characteristics of the cohorts and confirmed that well-known symptoms of COVID-19 (eg, fever, cough, and dyspnea) showed higher prevalence than the hospitalized influenza cohort and the general hospitalized cohort. CONCLUSIONS: We present COHD-COVID, a publicly accessible database providing useful clinical data for hospitalized patients with COVID-19, hospitalized patients with influenza, and general hospitalized patients. We expect COHD-COVID to provide researchers and clinicians quantitative measures of COVID-19-related clinical features to better understand and combat the pandemic.


Subject(s)
COVID-19 , Influenza, Human , Databases, Factual , Humans , Influenza, Human/epidemiology , Pandemics , SARS-CoV-2
7.
Cancer Epidemiol Biomarkers Prev ; 30(10): 1884-1894, 2021 10.
Article in English | MEDLINE | ID: covidwho-1450633

ABSTRACT

BACKGROUND: We described the demographics, cancer subtypes, comorbidities, and outcomes of patients with a history of cancer and coronavirus disease 2019 (COVID-19). Second, we compared patients hospitalized with COVID-19 to patients diagnosed with COVID-19 and patients hospitalized with influenza. METHODS: We conducted a cohort study using eight routinely collected health care databases from Spain and the United States, standardized to the Observational Medical Outcome Partnership common data model. Three cohorts of patients with a history of cancer were included: (i) diagnosed with COVID-19, (ii) hospitalized with COVID-19, and (iii) hospitalized with influenza in 2017 to 2018. Patients were followed from index date to 30 days or death. We reported demographics, cancer subtypes, comorbidities, and 30-day outcomes. RESULTS: We included 366,050 and 119,597 patients diagnosed and hospitalized with COVID-19, respectively. Prostate and breast cancers were the most frequent cancers (range: 5%-18% and 1%-14% in the diagnosed cohort, respectively). Hematologic malignancies were also frequent, with non-Hodgkin's lymphoma being among the five most common cancer subtypes in the diagnosed cohort. Overall, patients were aged above 65 years and had multiple comorbidities. Occurrence of death ranged from 2% to 14% and from 6% to 26% in the diagnosed and hospitalized COVID-19 cohorts, respectively. Patients hospitalized with influenza (n = 67,743) had a similar distribution of cancer subtypes, sex, age, and comorbidities but lower occurrence of adverse events. CONCLUSIONS: Patients with a history of cancer and COVID-19 had multiple comorbidities and a high occurrence of COVID-19-related events. Hematologic malignancies were frequent. IMPACT: This study provides epidemiologic characteristics that can inform clinical care and etiologic studies.


Subject(s)
COVID-19/mortality , Neoplasms/epidemiology , Outcome Assessment, Health Care/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Child , Cohort Studies , Comorbidity , Databases, Factual , Female , Hospitalization/statistics & numerical data , Humans , Influenza, Human/epidemiology , Male , Middle Aged , Pandemics , Prevalence , Risk Factors , SARS-CoV-2 , Spain/epidemiology , United States/epidemiology , Young Adult
8.
MMWR Morb Mortal Wkly Rep ; 70(37): 1291-1293, 2021 Sep 17.
Article in English | MEDLINE | ID: covidwho-1441399

ABSTRACT

Data on COVID-19 vaccine effectiveness (VE) since the B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, became the predominant circulating strain in the United States are limited (1-3). CDC used the VISION Network* to examine medical encounters (32,867) from 187 hospitals and 221 emergency departments (EDs) and urgent care (UC) clinics across nine states during June-August 2021, beginning on the date the Delta variant accounted for >50% of sequenced isolates in each medical facility's state. VISION Network methods have been published (4).


Subject(s)
COVID-19 Vaccines/immunology , COVID-19/prevention & control , SARS-CoV-2 , Adolescent , Adult , Aged , Ambulatory Care Facilities/statistics & numerical data , COVID-19/epidemiology , COVID-19/therapy , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Emergency Service, Hospital/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Middle Aged , United States/epidemiology , Young Adult
9.
N Engl J Med ; 385(15): 1355-1371, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1397961

ABSTRACT

BACKGROUND: There are limited data on the effectiveness of the vaccines against symptomatic coronavirus disease 2019 (Covid-19) currently authorized in the United States with respect to hospitalization, admission to an intensive care unit (ICU), or ambulatory care in an emergency department or urgent care clinic. METHODS: We conducted a study involving adults (≥50 years of age) with Covid-19-like illness who underwent molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed 41,552 admissions to 187 hospitals and 21,522 visits to 221 emergency departments or urgent care clinics during the period from January 1 through June 22, 2021, in multiple states. The patients' vaccination status was documented in electronic health records and immunization registries. We used a test-negative design to estimate vaccine effectiveness by comparing the odds of a positive test for SARS-CoV-2 infection among vaccinated patients with those among unvaccinated patients. Vaccine effectiveness was adjusted with weights based on propensity-for-vaccination scores and according to age, geographic region, calendar time (days from January 1, 2021, to the index date for each medical visit), and local virus circulation. RESULTS: The effectiveness of full messenger RNA (mRNA) vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization, 90% (95% CI, 86 to 93) against infection leading to an ICU admission, and 91% (95% CI, 89 to 93) against infection leading to an emergency department or urgent care clinic visit. The effectiveness of full vaccination with respect to a Covid-19-associated hospitalization or emergency department or urgent care clinic visit was similar with the BNT162b2 and mRNA-1273 vaccines and ranged from 81% to 95% among adults 85 years of age or older, persons with chronic medical conditions, and Black or Hispanic adults. The effectiveness of the Ad26.COV2.S vaccine was 68% (95% CI, 50 to 79) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization and 73% (95% CI, 59 to 82) against infection leading to an emergency department or urgent care clinic visit. CONCLUSIONS: Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARS-CoV-2 infection. (Funded by the Centers for Disease Control and Prevention.).


Subject(s)
Ambulatory Care/statistics & numerical data , COVID-19 Vaccines , COVID-19/prevention & control , Hospitalization/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19 Vaccines/immunology , Female , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Patient Readmission/statistics & numerical data , United States/epidemiology
10.
PLoS One ; 16(8): e0255811, 2021.
Article in English | MEDLINE | ID: covidwho-1354761

ABSTRACT

BACKGROUND: Obesity has emerged as a risk factor for severe coronavirus disease 2019 (COVID-19) infection. To inform treatment considerations the relationship between obesity and COVID-19 complications and the influence of race, ethnicity, and socioeconomic factors deserves continued attention. OBJECTIVE: To determine if obesity is an independent risk factor for severe COVID-19 complications and mortality and examine the relationship between BMI, race, ethnicity, distressed community index and COVID-19 complications and mortality. METHODS: A retrospective cohort study of 1,019 SARS-CoV-2 positive adult admitted to an academic medical center (n = 928) and its affiliated community hospital (n-91) in New York City from March 1 to April 18, 2020. RESULTS: Median age was 64 years (IQR 52-75), 58.7% were men, 23.0% were Black, and 52.8% were Hispanic. The prevalence of overweight and obesity was 75.2%; median BMI was 28.5 kg/m2 (25.1-33.0). Over the study period 23.7% patients died, 27.3% required invasive mechanical ventilation, 22.7% developed septic shock, and 9.1% required renal replacement therapy (RRT). In the multivariable logistic regression model, BMI was associated with complications including intubation (Odds Ratio [OR]1.03, 95% Confidence Interval [CI]1.01-1.05), septic shock (OR 1.04, CI 1.01-1.06), and RRT (OR1.07, CI 1.04-1.10), and mortality (OR 1.04, CI 1.01-1.06). The odds of death were highest among those with BMI ≥ 40 kg/m2 (OR 2.05, CI 1.04-4.04). Mortality did not differ by race, ethnicity, or socioeconomic distress score, though Black and Asian patients were more likely to require RRT. CONCLUSIONS AND RELEVANCE: Severe complications of COVID-19 and death are more likely in patients with obesity, independent of age and comorbidities. While race, ethnicity, and socioeconomic status did not impact COVID-19 related mortality, Black and Asian patients were more likely to require RRT. The presence of obesity, and in some instances race, should inform resource allocation and risk stratification in patients hospitalized with COVID-19.


Subject(s)
COVID-19/complications , Kidney Diseases/etiology , Obesity/complications , Shock, Septic/etiology , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Female , Hospital Mortality , Hospitalization , Humans , Kidney Diseases/mortality , Male , Middle Aged , New York City , Obesity/mortality , Retrospective Studies , Risk Factors , Shock, Septic/mortality , Survival Rate
11.
Cancer Epidemiol Biomarkers Prev ; 30(10): 1884-1894, 2021 10.
Article in English | MEDLINE | ID: covidwho-1317085

ABSTRACT

BACKGROUND: We described the demographics, cancer subtypes, comorbidities, and outcomes of patients with a history of cancer and coronavirus disease 2019 (COVID-19). Second, we compared patients hospitalized with COVID-19 to patients diagnosed with COVID-19 and patients hospitalized with influenza. METHODS: We conducted a cohort study using eight routinely collected health care databases from Spain and the United States, standardized to the Observational Medical Outcome Partnership common data model. Three cohorts of patients with a history of cancer were included: (i) diagnosed with COVID-19, (ii) hospitalized with COVID-19, and (iii) hospitalized with influenza in 2017 to 2018. Patients were followed from index date to 30 days or death. We reported demographics, cancer subtypes, comorbidities, and 30-day outcomes. RESULTS: We included 366,050 and 119,597 patients diagnosed and hospitalized with COVID-19, respectively. Prostate and breast cancers were the most frequent cancers (range: 5%-18% and 1%-14% in the diagnosed cohort, respectively). Hematologic malignancies were also frequent, with non-Hodgkin's lymphoma being among the five most common cancer subtypes in the diagnosed cohort. Overall, patients were aged above 65 years and had multiple comorbidities. Occurrence of death ranged from 2% to 14% and from 6% to 26% in the diagnosed and hospitalized COVID-19 cohorts, respectively. Patients hospitalized with influenza (n = 67,743) had a similar distribution of cancer subtypes, sex, age, and comorbidities but lower occurrence of adverse events. CONCLUSIONS: Patients with a history of cancer and COVID-19 had multiple comorbidities and a high occurrence of COVID-19-related events. Hematologic malignancies were frequent. IMPACT: This study provides epidemiologic characteristics that can inform clinical care and etiologic studies.


Subject(s)
COVID-19/mortality , Neoplasms/epidemiology , Outcome Assessment, Health Care/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Child , Cohort Studies , Comorbidity , Databases, Factual , Female , Hospitalization/statistics & numerical data , Humans , Influenza, Human/epidemiology , Male , Middle Aged , Pandemics , Prevalence , Risk Factors , SARS-CoV-2 , Spain/epidemiology , United States/epidemiology , Young Adult
12.
BMJ Open ; 11(6): e049488, 2021 06 02.
Article in English | MEDLINE | ID: covidwho-1255601

ABSTRACT

OBJECTIVE: To characterise the long-term outcomes of patients with COVID-19 admitted to a large New York City medical centre at 3 and 6 months after hospitalisation and describe their healthcare usage, symptoms, morbidity and mortality. DESIGN: Retrospective cohort through manual chart review of the electronic medical record. SETTING: NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical centre in New York City. PARTICIPANTS: The first 1190 consecutive patients with symptoms of COVID-19 who presented to the hospital for care between 1 March and 8 April 2020 and tested positive for SARS-CoV-2 on reverse transcriptase PCR assay. MAIN OUTCOME MEASURES: Type and frequency of follow-up encounters, self-reported symptoms, morbidity and mortality at 3 and 6 months after presentation, respectively; patient disposition information prior to admission, at discharge, and at 3 and 6 months after hospital presentation. RESULTS: Of the 1190 reviewed patients, 929 survived their initial hospitalisation and 261 died. Among survivors, 570 had follow-up encounters (488 at 3 months and 364 at 6 months). An additional 33 patients died in the follow-up period. In the first 3 months after admission, most encounters were telehealth visits (59%). Cardiopulmonary symptoms (35.7% and 28%), especially dyspnoea (22.1% and 15.9%), were the most common reported symptoms at 3-month and 6-month encounters, respectively. Additionally, a large number of patients reported generalised (26.4%) or neuropsychiatric (24.2%) symptoms 6 months after hospitalisation. Patients with severe COVID-19 were more likely to have reduced mobility, reduced independence or a new dialysis requirement in the 6 months after hospitalisation. CONCLUSIONS: Patients hospitalised with SARS-CoV-2 infection reported persistent symptoms up to 6 months after diagnosis. These results highlight the long-term morbidity of COVID-19 and its burden on patients and healthcare resources.


Subject(s)
COVID-19 , Hospitalization , Humans , New York City/epidemiology , Retrospective Studies , SARS-CoV-2
13.
J Alzheimers Dis ; 81(2): 679-690, 2021.
Article in English | MEDLINE | ID: covidwho-1145549

ABSTRACT

BACKGROUND: Patients with dementia are vulnerable during the coronavirus disease 2019 (COVID-19) pandemic, yet few studies describe their hospital course and outcomes. OBJECTIVE: To describe and compare the hospital course for COVID-19 patients with dementia to an aging cohort without dementia in a large New York City academic medical center. METHODS: This was a single-center retrospective cohort study describing all consecutive patients age 65 or older with confirmed COVID-19 who presented to the emergency department or were hospitalized at New York-Presbyterian/Columbia University Irving Medical Center between March 6 and April 7, 2020. RESULTS: A total of 531 patients were evaluated, including 116 (21.8%) with previously diagnosed dementia, and 415 without dementia. Patients with dementia had higher mortality (50.0%versus 35.4%, p = 0.006); despite similar comorbidities and complications, multivariate analysis indicated the association was dependent on age, sex, comorbidities, and code status. Patients with dementia more often presented with delirium (36.2%versus 11.6%, p < 0.001) but less often presented with multiple other COVID-19 symptoms, and these findings remained after adjusting for age and sex. CONCLUSION: Hospitalized COVID-19 patients with dementia had higher mortality, but dementia was not an independent risk factor for death. These patients were approximately 3 times more likely to present with delirium but less often manifested or communicated other common COVID-19 symptoms. For this high-risk population in a worsening pandemic, understanding the unique manifestations and course in dementia and aging populations may help guide earlier diagnosis and optimize medical management.


Subject(s)
COVID-19/epidemiology , Delirium/epidemiology , Dementia/epidemiology , Aged , Aged, 80 and over , COVID-19/mortality , Comorbidity , Delirium/mortality , Dementia/mortality , Female , Hospital Mortality , Hospitalization , Humans , Male , New York City/epidemiology , Pandemics , Retrospective Studies
14.
Rheumatology (Oxford) ; 60(SI): SI37-SI50, 2021 10 09.
Article in English | MEDLINE | ID: covidwho-1135892

ABSTRACT

OBJECTIVE: Patients with autoimmune diseases were advised to shield to avoid coronavirus disease 2019 (COVID-19), but information on their prognosis is lacking. We characterized 30-day outcomes and mortality after hospitalization with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza. METHODS: A multinational network cohort study was conducted using electronic health records data from Columbia University Irving Medical Center [USA, Optum (USA), Department of Veterans Affairs (USA), Information System for Research in Primary Care-Hospitalization Linked Data (Spain) and claims data from IQVIA Open Claims (USA) and Health Insurance and Review Assessment (South Korea). All patients with prevalent autoimmune diseases, diagnosed and/or hospitalized between January and June 2020 with COVID-19, and similar patients hospitalized with influenza in 2017-18 were included. Outcomes were death and complications within 30 days of hospitalization. RESULTS: We studied 133 589 patients diagnosed and 48 418 hospitalized with COVID-19 with prevalent autoimmune diseases. Most patients were female, aged ≥50 years with previous comorbidities. The prevalence of hypertension (45.5-93.2%), chronic kidney disease (14.0-52.7%) and heart disease (29.0-83.8%) was higher in hospitalized vs diagnosed patients with COVID-19. Compared with 70 660 hospitalized with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2-4.3% vs 6.32-24.6%). CONCLUSION: Compared with influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality.


Subject(s)
Autoimmune Diseases/mortality , Autoimmune Diseases/virology , COVID-19/mortality , Hospitalization/statistics & numerical data , Influenza, Human/mortality , Adult , Aged , Aged, 80 and over , COVID-19/immunology , Cohort Studies , Female , Humans , Influenza, Human/immunology , Male , Middle Aged , Prevalence , Prognosis , Republic of Korea/epidemiology , SARS-CoV-2 , Spain/epidemiology , United States/epidemiology , Young Adult
15.
J Am Med Inform Assoc ; 28(7): 1480-1488, 2021 07 14.
Article in English | MEDLINE | ID: covidwho-1127354

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) patients are at risk for resource-intensive outcomes including mechanical ventilation (MV), renal replacement therapy (RRT), and readmission. Accurate outcome prognostication could facilitate hospital resource allocation. We develop and validate predictive models for each outcome using retrospective electronic health record data for COVID-19 patients treated between March 2 and May 6, 2020. MATERIALS AND METHODS: For each outcome, we trained 3 classes of prediction models using clinical data for a cohort of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2)-positive patients (n = 2256). Cross-validation was used to select the best-performing models per the areas under the receiver-operating characteristic and precision-recall curves. Models were validated using a held-out cohort (n = 855). We measured each model's calibration and evaluated feature importances to interpret model output. RESULTS: The predictive performance for our selected models on the held-out cohort was as follows: area under the receiver-operating characteristic curve-MV 0.743 (95% CI, 0.682-0.812), RRT 0.847 (95% CI, 0.772-0.936), readmission 0.871 (95% CI, 0.830-0.917); area under the precision-recall curve-MV 0.137 (95% CI, 0.047-0.175), RRT 0.325 (95% CI, 0.117-0.497), readmission 0.504 (95% CI, 0.388-0.604). Predictions were well calibrated, and the most important features within each model were consistent with clinical intuition. DISCUSSION: Our models produce performant, well-calibrated, and interpretable predictions for COVID-19 patients at risk for the target outcomes. They demonstrate the potential to accurately estimate outcome prognosis in resource-constrained care sites managing COVID-19 patients. CONCLUSIONS: We develop and validate prognostic models targeting MV, RRT, and readmission for hospitalized COVID-19 patients which produce accurate, interpretable predictions. Additional external validation studies are needed to further verify the generalizability of our results.


Subject(s)
COVID-19/therapy , Models, Statistical , Patient Readmission , Renal Replacement Therapy , Respiration, Artificial , Adolescent , Adult , Aged , Aged, 80 and over , Area Under Curve , COVID-19/complications , Electronic Health Records , Female , Humans , Logistic Models , Male , Middle Aged , Prognosis , ROC Curve , Retrospective Studies , Statistics, Nonparametric , Young Adult
16.
PLoS One ; 15(12): e0244131, 2020.
Article in English | MEDLINE | ID: covidwho-999832

ABSTRACT

INTRODUCTION: A large proportion of patients with COVID-19 develop acute kidney injury (AKI). While the most severe of these cases require renal replacement therapy (RRT), little is known about their clinical course. METHODS: We describe the clinical characteristics of COVID-19 patients in the ICU with AKI requiring RRT at an academic medical center in New York City and followed patients for outcomes of death and renal recovery using time-to-event analyses. RESULTS: Our cohort of 115 patients represented 23% of all ICU admissions at our center, with a peak prevalence of 29%. Patients were followed for a median of 29 days (2542 total patient-RRT-days; median 54 days for survivors). Mechanical ventilation and vasopressor use were common (99% and 84%, respectively), and the median Sequential Organ Function Assessment (SOFA) score was 14. By the end of follow-up 51% died, 41% recovered kidney function (84% of survivors), and 8% still needed RRT (survival probability at 60 days: 0.46 [95% CI: 0.36-0.56])). In an adjusted Cox model, coronary artery disease and chronic obstructive pulmonary disease were associated with increased mortality (HRs: 3.99 [95% CI 1.46-10.90] and 3.10 [95% CI 1.25-7.66]) as were angiotensin-converting-enzyme inhibitors (HR 2.33 [95% CI 1.21-4.47]) and a SOFA score >15 (HR 3.46 [95% CI 1.65-7.25). CONCLUSIONS AND RELEVANCE: Our analysis demonstrates the high prevalence of AKI requiring RRT among critically ill patients with COVID-19 and is associated with a high mortality, however, the rate of renal recovery is high among survivors and should inform shared-decision making.


Subject(s)
Acute Kidney Injury/etiology , Acute Kidney Injury/pathology , COVID-19/complications , Kidney/pathology , Acute Kidney Injury/virology , Aged , Critical Illness/mortality , Female , Humans , Intensive Care Units , Kidney/virology , Male , Middle Aged , New York City , Proportional Hazards Models , Renal Replacement Therapy/methods , Retrospective Studies , SARS-CoV-2/pathogenicity , Survivors
17.
medRxiv ; 2020 Nov 27.
Article in English | MEDLINE | ID: covidwho-955714

ABSTRACT

Objective: Patients with autoimmune diseases were advised to shield to avoid COVID-19, but information on their prognosis is lacking. We characterised 30-day outcomes and mortality after hospitalisation with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza. Design: Multinational network cohort study. Setting: Electronic health records data from Columbia University Irving Medical Center (CUIMC) (NYC, United States [US]), Optum [US], Department of Veterans Affairs (VA) (US), Information System for Research in Primary Care-Hospitalisation Linked Data (SIDIAP-H) (Spain), and claims data from IQVIA Open Claims (US) and Health Insurance and Review Assessment (HIRA) (South Korea). Participants: All patients with prevalent autoimmune diseases, diagnosed and/or hospitalised between January and June 2020 with COVID-19, and similar patients hospitalised with influenza in 2017-2018 were included. Main outcome measures: 30-day complications during hospitalisation and death. Results: We studied 133,589 patients diagnosed and 48,418 hospitalised with COVID-19 with prevalent autoimmune diseases. The majority of participants were female (60.5% to 65.9%) and aged ≥50 years. The most prevalent autoimmune conditions were psoriasis (3.5 to 32.5%), rheumatoid arthritis (3.9 to 18.9%), and vasculitis (3.3 to 17.6%). Amongst hospitalised patients, Type 1 diabetes was the most common autoimmune condition (4.8% to 7.5%) in US databases, rheumatoid arthritis in HIRA (18.9%), and psoriasis in SIDIAP-H (26.4%).Compared to 70,660 hospitalised with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2% to 4.3% versus 6.3% to 24.6%). Conclusions: Patients with autoimmune diseases had high rates of respiratory complications and 30-day mortality following a hospitalization with COVID-19. Compared to influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality. Future studies should investigate predictors of poor outcomes in COVID-19 patients with autoimmune diseases. What is already known about this topic: Patients with autoimmune conditions may be at increased risk of COVID-19 infection andcomplications.There is a paucity of evidence characterising the outcomes of hospitalised COVID-19 patients with prevalent autoimmune conditions. What this study adds: Most people with autoimmune diseases who required hospitalisation for COVID-19 were women, aged 50 years or older, and had substantial previous comorbidities.Patients who were hospitalised with COVID-19 and had prevalent autoimmune diseases had higher prevalence of hypertension, chronic kidney disease, heart disease, and Type 2 diabetes as compared to those with prevalent autoimmune diseases who were diagnosed with COVID-19.A variable proportion of 6% to 25% across data sources died within one month of hospitalisation with COVID-19 and prevalent autoimmune diseases.For people with autoimmune diseases, COVID-19 hospitalisation was associated with worse outcomes and 30-day mortality compared to admission with influenza in the 2017-2018 season.

18.
medRxiv ; 2021 Feb 12.
Article in English | MEDLINE | ID: covidwho-955711

ABSTRACT

Objective: To estimate the proportion of patients hospitalized with COVID-19 who undergo dialysis, tracheostomy, and extracorporeal membrane oxygenation (ECMO). Design: A network cohort study. Setting: Seven databases from the United States containing routinely-collected patient data: HealthVerity, Premier, IQVIA Hospital CDM, IQVIA Open Claims, Optum EHR, Optum SES, and VA-OMOP. Patients: Patients hospitalized with a clinical diagnosis or a positive test result for COVID-19. Interventions: Dialysis, tracheostomy, and ECMO. Measurements and Main Results: 842,928 patients hospitalized with COVID-19 were included (22,887 from HealthVerity, 77,853 from IQVIA Hospital CDM, 533,997 from IQVIA Open Claims, 36,717 from Optum EHR, 4,336 from OPTUM SES, 156,187 from Premier, and 10,951 from VA-OMOP). Across the six databases, 35,192 (4.17% [95% CI: 4.13% to 4.22%]) patients received dialysis, 6,950 (0.82% [0.81% to 0.84%]) had a tracheostomy, and 1,568 (0.19% [95% CI: 0.18% to 0.20%]) patients underwent ECMO over the 30 days following hospitalization. Use of ECMO was more common among patients who were younger, male, and with fewer comorbidities. Tracheostomy was broadly used for a similar proportion of patients regardless of age, sex, or comorbidity. While dialysis was generally used for a similar proportion among younger and older patients, it was more frequent among male patients and among those with chronic kidney disease. Conclusion: Use of dialysis among those hospitalized with COVID-19 is high at around 4%. Although less than one percent of patients undergo tracheostomy and ECMO, the absolute numbers of patients who have undergone these interventions is substantial.

19.
medRxiv ; 2020 Oct 27.
Article in English | MEDLINE | ID: covidwho-915971

ABSTRACT

Early identification of symptoms and comorbidities most predictive of COVID-19 is critical to identify infection, guide policies to effectively contain the pandemic, and improve health systems' response. Here, we characterised socio-demographics and comorbidity in 3,316,107persons tested and 219,072 persons tested positive for SARS-CoV-2 since January 2020, and their key health outcomes in the month following the first positive test. Routine care data from primary care electronic health records (EHR) from Spain, hospital EHR from the United States (US), and claims data from South Korea and the US were used. The majority of study participants were women aged 18-65 years old. Positive/tested ratio varied greatly geographically (2.2:100 to 31.2:100) and over time (from 50:100 in February-April to 6.8:100 in May-June). Fever, cough and dyspnoea were the most common symptoms at presentation. Between 4%-38% required admission and 1-10.5% died within a month from their first positive test. Observed disparity in testing practices led to variable baseline characteristics and outcomes, both nationally (US) and internationally. Our findings highlight the importance of large scale characterization of COVID-19 international cohorts to inform planning and resource allocation including testing as countries face a second wave.

20.
Nat Commun ; 11(1): 5009, 2020 10 06.
Article in English | MEDLINE | ID: covidwho-834880

ABSTRACT

Comorbid conditions appear to be common among individuals hospitalised with coronavirus disease 2019 (COVID-19) but estimates of prevalence vary and little is known about the prior medication use of patients. Here, we describe the characteristics of adults hospitalised with COVID-19 and compare them with influenza patients. We include 34,128 (US: 8362, South Korea: 7341, Spain: 18,425) COVID-19 patients, summarising between 4811 and 11,643 unique aggregate characteristics. COVID-19 patients have been majority male in the US and Spain, but predominantly female in South Korea. Age profiles vary across data sources. Compared to 84,585 individuals hospitalised with influenza in 2014-19, COVID-19 patients have more typically been male, younger, and with fewer comorbidities and lower medication use. While protecting groups vulnerable to influenza is likely a useful starting point in the response to COVID-19, strategies will likely need to be broadened to reflect the particular characteristics of individuals being hospitalised with COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Hospitalization , Influenza, Human/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19 , Cohort Studies , Comorbidity , Coronavirus Infections/drug therapy , Female , Humans , Influenza, Human/drug therapy , Male , Middle Aged , Pneumonia, Viral/drug therapy , Prevalence , Republic of Korea/epidemiology , Sex Factors , Spain/epidemiology , United States/epidemiology , Young Adult
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