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1.
Cureus ; 14(6): e25824, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1934578

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has been associated with a plethora of symptoms weeks after the acute infection. While many reports have investigated the novel syndrome of post-acute sequelae of COVID-19, fewer studies have examined post-COVID-19 secondary infections, which may be distinct from typical post-viral bacterial infections due to the multiorgan involvement of COVID-19. This case report aims to highlight a presentation in which a 65-year-old man had COVID-19 and subsequently developed methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia with widespread seeding of secondary infections, including abscesses in the hand and paravertebral regions as well as discitis/osteomyelitis of the cervical spine. Further studies are needed to investigate whether an increased susceptibility to unusual secondary bacterial infections is present in post-COVID-19 patients.

2.
Am J Hosp Palliat Care ; : 10499091221084653, 2022 May 05.
Article in English | MEDLINE | ID: covidwho-1820074

ABSTRACT

The role of early Do Not Resuscitate (DNR) in hospitalized older adults (OAs) with SARS-CoV-2 infection is unknown. The objective of the study was to identify characteristics and outcomes associated with early DNR in hospitalized OAs with SARS-CoV-2. We conducted a retrospective chart review of older adults (65+) hospitalized with COVID-19 in New York, USA, between March 1, 2020, and April 20, 2020. Patient characteristics and hospital outcomes were collected. Early DNR (within 24 hours of admission) was compared to non-early DNR (late DNR, after 24 hours of admission, or no DNR). Outcomes included hospital morbidity and mortality. Of 4961 patients, early DNR prevalence was 5.7% (n = 283). Compared to non-early DNR, the early DNR group was older (85.0 vs 76.8, P < .001), women (51.2% vs 43.6%, P = .012), with higher comorbidity index (3.88 vs 3.36, P < .001), facility-based (49.1% vs 19.1%, P < .001), with dementia (13.3% vs 4.6%, P < .001), and severely ill on presentation (57.9% vs 32.3%, P < .001). In multivariable analyses, the early DNR group had higher mortality risk (OR: 2.94, 95% CI: 2.10-4.11), less hospital delirium (OR: 0.55, 95% CI: 0.40-.77), lower use of invasive mechanical ventilation (IMV, OR: 0.37, 95% CI: .21-.67), and shorter length of stay (LOS, 4.8 vs 10.3 days, P < .001), compared to non-early DNR. Regarding early vs late DNR, while there was no difference in mortality (OR: 1.12, 95% CI: 0.85-1.62), the early DNR group experienced less delirium (OR: 0.55, 95% CI: .40-.75), IMV (OR: 0.53, 95% CI: 0.29-.96), and shorter LOS (4.82 vs 10.63 days, OR: 0.35, 95% CI: 0.30-.41). In conclusion, early DNR prevalence in hospitalized OAs with COVID-19 was low, and compared to non-early DNR is associated with higher mortality but lower morbidity.

3.
Front Med (Lausanne) ; 9: 841326, 2022.
Article in English | MEDLINE | ID: covidwho-1775704

ABSTRACT

Background: COVID-19 has been associated with an increased risk of incident dementia (post-COVID dementia). Establishing additional risk markers may help identify at-risk individuals and guide clinical decision-making. Methods: We investigated pre-COVID psychotropic medication use (exposure) and 1-year incidence of dementia (outcome) in 1,755 patients (≥65 years) hospitalized with COVID-19. Logistic regression models were used to examine the association, adjusting for demographic and clinical variables. For further confirmation, we applied the Least Absolute Shrinkage and Selection Operator (LASSO) regression and a machine learning (Random Forest) algorithm. Results: One-year incidence rate of post-COVID dementia was 12.7% (N = 223). Pre-COVID psychotropic medications (OR = 2.7, 95% CI: 1.8-4.0, P < 0.001) and delirium (OR = 3.0, 95% CI: 1.9-4.6, P < 0.001) were significantly associated with greater 1-year incidence of post-COVID dementia. The association between psychotropic medications and incident dementia remained robust when the analysis was restricted to the 423 patients with at least one documented neurological or psychiatric diagnosis at the time of COVID-19 admission (OR = 3.09, 95% CI: 1.5-6.6, P = 0.002). Across different drug classes, antipsychotics (OR = 2.8, 95% CI: 1.7-4.4, P < 0.001) and mood stabilizers/anticonvulsants (OR = 2.4, 95% CI: 1.39-4.02, P = 0.001) displayed the greatest association with post-COVID dementia. The association of psychotropic medication with dementia was further confirmed with Random Forest and LASSO analysis. Conclusion: Confirming prior studies we observed a high dementia incidence in older patients after COVID-19 hospitalization. Pre-COVID psychotropic medications were associated with higher risk of incident dementia. Psychotropic medications may be risk markers that signify neuropsychiatric symptoms during prodromal dementia, and not mutually exclusive, contribute to post-COVID dementia.

4.
Am J Med Qual ; 37(4): 327-334, 2022.
Article in English | MEDLINE | ID: covidwho-1741052

ABSTRACT

Accurate determinations of the time of intubation (TOI) are critical for retrospective electronic health record (EHR) data analyses. In a retrospective study, the authors developed and validated an improved query (Ti) to identify TOI across numerous settings in a large health system, using EHR data, during the COVID-19 pandemic. Further, they evaluated the affect of Ti on peri-intubation patient parameters compared to a previous method-ventilator parameters (Tv). Ti identified an earlier TOI for 84.8% (n = 1666) of cases with a mean (SD) of 3.5 hours (15.5), resulting in alternate values for: partial pressure of arterial oxygen (PaO 2 ) in 18.4% of patients (mean 43.95 mmHg [54.24]); PaO 2 /fractional inspired oxygen (FiO 2 ) in 17.8% of patients (mean 48.29 [69.81]), and oxygen saturation/FiO 2 in 62.7% (mean 16.75 [34.14]), using the absolute difference in mean values within the first 4 hours of intubation. Differences in PaO 2 /FiO 2 using Ti versus Tv resulted in the reclassification of 7.3% of patients into different acute respiratory distress syndrome (ARDS) severity categories.


Subject(s)
COVID-19 , Respiration, Artificial , Data Analysis , Electronic Health Records , Humans , Intubation, Intratracheal , Oxygen , Pandemics , Respiration, Artificial/methods , Retrospective Studies
5.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-313137

ABSTRACT

Background:  Understanding heterogeneity seen in patients with COVIDARDS and comparing to non-COVIDARDS may inform tailored treatments.  Methods:  A multidisciplinary team of frontline clinicians and data scientists worked to create the Northwell COVIDARDS dataset (NorthCARDS) leveraging over 11,542 COVID-19 hospital admissions. The data was then summarized to examine descriptive differences based on clinically meaningful categories of lung compliance, and to examine trends in oxygenation. Findings:  Of the 1595 COVIDARDS patients in the NorthCARDS dataset, there were 538 (34·6%) who had very low lung compliance (<20ml/cmH 2 O), 982 (63·2%) with low-normal compliance (20-50ml/cmH 2 O), and 34 (2·2%) with high lung compliance (>50ml/cmH 2 O). The very low compliance group had double the median time to intubation compared to the low-normal group (107 hours (IQR 26·3, 238·3) vs. 37·9 hours (IQR 4·8, 90·7)). Overall, 67·5% (n=1049) of the patients died during the hospitalization. In comparison to non-COVIDARDS reports, there were less patients in the high compliance category (2.2%vs.12%, compliance ≥50mL/cmH20), and more patients with P/F ≤ 150 (57·8% vs. 45.6%). No correlation was apparent between lung compliance and P/F ratio. The Oxygenation Index was similar, (11·12(SD 5·67) vs.12·8(SD 10·8)). 1  

6.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-321698

ABSTRACT

Background: Age has been implicated as the main risk factor for COVID-19-related mortality. Our objective was to determine patient factors associated with mortality in hospitalized older adults with COVID-19. Methods: : Retrospective cohort study of adults age 65+ (N=4,949) hospitalized with COVID-19 in the greater New York metropolitan area between 3/1/20-4/20/20. Data included patient demographics and clinical presentation. Multivariate logistic regression was used to evaluate associations. Results: : Average age 77.3 (SD=8.4), 56.0% male, 20.8% African American, 15.1% Hispanic. In a multivariate analysis, male gender (OR=1.47), higher comorbidity index (OR=1.10), admission from a facility (lower baseline function;OR=1.71), early DNR (declining life-sustaining treatments, OR=2.45), and higher illness severity (higher MEWS, OR=6.26, and higher oxygen requirements, OR=15.00) were associated with mortality, while age was not (p = 0.22). Conclusion: Our findings highlight the need to look beyond age in hospitalized older adults with COVID-19 when considering prognosis and treatment decisions.

7.
BMC Pulm Med ; 22(1): 51, 2022 Feb 04.
Article in English | MEDLINE | ID: covidwho-1666648

ABSTRACT

BACKGROUND: Understanding heterogeneity seen in patients with COVIDARDS and comparing to non-COVIDARDS may inform tailored treatments. METHODS: A multidisciplinary team of frontline clinicians and data scientists worked to create the Northwell COVIDARDS dataset (NorthCARDS) leveraging over 11,542 COVID-19 hospital admissions. The data was then summarized to examine descriptive differences based on clinically meaningful categories of lung compliance, and to examine trends in oxygenation. FINDINGS: Of the 1536 COVIDARDS patients in the NorthCARDS dataset, there were 531 (34.6%) who had very low lung compliance (< 20 ml/cmH2O), 970 (63.2%) with low-normal compliance (20-50 ml/cmH2O), and 35 (2.2%) with high lung compliance (> 50 ml/cmH2O). The very low compliance group had double the median time to intubation compared to the low-normal group (107.3 h (IQR 25.8, 239.2) vs. 39.5 h (IQR 5.4, 91.6)). Overall, 68.8% (n = 1057) of the patients died during hospitalization. In comparison to non-COVIDARDS reports, there were less patients in the high compliance category (2.2% vs. 12%, compliance ≥ 50 mL/cmH20), and more patients with P/F ≤ 150 (59.8% vs. 45.6%). There is a statistically significant correlation between compliance and P/F ratio. The Oxygenation Index is the highest in the very low compliance group (12.51, SD(6.15)), and lowest in high compliance group (8.78, SD(4.93)). CONCLUSIONS: The respiratory system compliance distribution of COVIDARDS is similar to non-COVIDARDS. In some patients, there may be a relation between time to intubation and duration of high levels of supplemental oxygen treatment on trajectory of lung compliance.


Subject(s)
COVID-19/physiopathology , Hypoxia/virology , Lung/physiopathology , Respiratory Distress Syndrome/virology , Adult , Aged , Aged, 80 and over , Biomechanical Phenomena , COVID-19/therapy , Case-Control Studies , Disease Progression , Female , Humans , Hypoxia/physiopathology , Hypoxia/therapy , Male , Middle Aged , Respiration, Artificial , Respiratory Distress Syndrome/physiopathology , Respiratory Distress Syndrome/therapy , Respiratory Function Tests , Retrospective Studies , Treatment Outcome
8.
J Thromb Thrombolysis ; 52(4): 1032-1035, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1525576

ABSTRACT

There is a need to discriminate which COVID-19 inpatients are at higher risk for venous thromboembolism (VTE) to inform prophylaxis strategies. The IMPROVE-DD VTE risk assessment model (RAM) has previously demonstrated good discrimination in non-COVID populations. We aimed to externally validate the IMPROVE-DD VTE RAM in medical patients hospitalized with COVID-19. This retrospective cohort study evaluated the IMPROVE-DD VTE RAM in adult patients with COVID-19 admitted to one of thirteen Northwell Health hospitals in the New York metropolitan area between March 1, 2020 and April 27, 2020. VTE was defined as new-onset symptomatic deep venous thrombosis or pulmonary embolism. To assess the predictive value of the RAM, the receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Of 9407 patients who met study criteria, 274 patients developed VTE with a prevalence of 2.91%. The VTE rate was 0.41% for IMPROVE-DD score 0-1 (low risk), 1.21% for score 2-3 (moderate risk), and 5.30% for score ≥ 4 (high risk). Approximately 45.7% of patients were classified as high VTE risk, 33.3% moderate risk, and 21.0% low risk. Discrimination of low versus moderate-high VTE risk demonstrated sensitivity 0.971, specificity 0.215, PPV 0.036, and NPV 0.996. ROC AUC was 0.703. In this external validation study, the IMPROVE-DD VTE RAM demonstrated very good discrimination to identify hospitalized COVID-19 patients at low, moderate, and high VTE risk.


Subject(s)
COVID-19 , Risk Assessment , Venous Thromboembolism , COVID-19/complications , Humans , Inpatients , New York City , Retrospective Studies , Risk Factors , Venous Thromboembolism/diagnosis , Venous Thromboembolism/epidemiology
9.
BMC Geriatr ; 21(1): 554, 2021 10 14.
Article in English | MEDLINE | ID: covidwho-1468047

ABSTRACT

BACKGROUND: Age has been implicated as the main risk factor for COVID-19-related mortality. Our objective was to utilize administrative data to build an explanatory model accounting for geriatrics-focused indicators to predict mortality in hospitalized older adults with COVID-19. METHODS: Retrospective cohort study of adults age 65 and older (N = 4783) hospitalized with COVID-19 in the greater New York metropolitan area between 3/1/20-4/20/20. Data included patient demographics and clinical presentation. Stepwise logistic regression with Akaike Information Criterion minimization was used. RESULTS: The average age was 77.4 (SD = 8.4), 55.9% were male, 20.3% were African American, and 15.0% were Hispanic. In multivariable analysis, male sex (adjusted odds ration (adjOR) = 1.06, 95% CI:1.03-1.09); Asian race (adjOR = 1.08, CI:1.03-1.13); history of chronic kidney disease (adjOR = 1.05, CI:1.01-1.09) and interstitial lung disease (adjOR = 1.35, CI:1.28-1.42); low or normal body mass index (adjOR:1.03, CI:1.00-1.07); higher comorbidity index (adjOR = 1.01, CI:1.01-1.02); admission from a facility (adjOR = 1.14, CI:1.09-1.20); and mechanical ventilation (adjOR = 1.52, CI:1.43-1.62) were associated with mortality. While age was not an independent predictor of mortality, increasing age (centered at 65) interacted with hypertension (adjOR = 1.02, CI:0.98-1.07, reducing by a factor of 0.96 every 10 years); early Do-Not-Resuscitate (DNR, life-sustaining treatment preferences) (adjOR = 1.38, CI:1.22-1.57, reducing by a factor of 0.92 every 10 years); and severe illness on admission (at 65, adjOR = 1.47, CI:1.40-1.54, reducing by a factor of 0.96 every 10 years). CONCLUSION: Our findings highlight that residence prior to admission, early DNR, and acute illness severity are important predictors of mortality in hospitalized older adults with COVID-19. Readily available administrative geriatrics-focused indicators that go beyond age can be utilized when considering prognosis.


Subject(s)
COVID-19 , Geriatrics , Aged , Comorbidity , Hospital Mortality , Hospitalization , Humans , Male , Retrospective Studies , Risk Factors , SARS-CoV-2
10.
Blood ; 136(Supplement 1):33-34, 2020.
Article in English | PMC | ID: covidwho-1339052

ABSTRACT

IntroductionThromboembolic outcomes have emerged as an important issue in sick hospitalized patients with COVID-19. Multiple pathogenetic mechanisms for thrombosis have been implicated, including endothelial dysfunction, increased von Willebrand factor (vWF), interleukin-6 release, and activation of/interaction between macrophages, monocytes, endothelial cells, platelets and lymphocytes. The actual rate of arterial and venous thromboembolic events (ATE and VTE) in hospitalized patients with COVID-19, especially in the immediate post-hospital discharge period, has not been fully elucidated, with most of the data derived from retrospective studies with small sample sizes.MethodsAgainst this background, we have designed and implemented an ongoing prospective registry (CORE-19) consisting of 11,249 consecutive hospitalized patients with COVID-19 from March 1st 2020 through May 31st 2020 using data derived from the Northwell Health System and the COVID-19 Research Consortium to study through 90-days post-discharge the rate of VTE and ATE, major bleeding, all-cause mortality, and other complications. We are capturing data of interest including demographic characteristics, co-morbidities, relevant medications, hospital setting, in-hospital treatment, thromboprophylaxis usage, key laboratory parameters, and 90-day thromboembolic and other key outcomes. A unified data repository (datamart) of hospitalized COVID-19 patients across multiple datasets from electronic health records, health informatics exchange, a dedicated radiology database, and a standardized data collection tool in REDCap, that includes telephonic calls up to 90 days post-discharge, is being implemented. A common data model (CDM) is utilized to ensure semantic interoperability between data originating from disparate sources. Northwell Health protocols stipulate the use of post-discharge low-molecular weight heparin, direct oral anticoagulants, or baby aspirin in hospitalized COVID-19 patients with high thrombotic risk features.ResultsOur cohort as of August 7, 2020 consists of complete follow up in 4,100 patients with a mean age of 61.0 years (SD: 17.0) with 54.7% males (Table 1). Preliminary data show an all-cause mortality rate of 4.29%, an overall thromboembolic rate of 3.51% (2.41% VTE and 1.10% ATE), a major bleeding rate of 1.61%, and a rehospitalization rate of 12.85%. Of patients with either DVT or PE post-discharge, 13.43% (9/67) died. The full dataset, including risk factors, comorbidities, key in-hospital and post-discharge medications including anticoagulant and antiplatelet agents, will be available at the time of presentation to the ASH congress.ConclusionOur ongoing registry is a large prospective study evaluating the rate of overall thromboembolic complications and all-cause mortality in hospitalized COVID-19 patients through 90 days post discharge. Current rates of thromboembolic events signify the importance of post-discharge surveillance and, potentially, post-discharge extended thromboprophylaxis, in this acutely ill medical population.

11.
J Gerontol A Biol Sci Med Sci ; 77(4): e124-e132, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1316816

ABSTRACT

BACKGROUND: Literature indicates an atypical presentation of COVID-19 among older adults (OAs). Our purpose is to identify the frequency of atypical presentation and compare demographic and clinical factors, and short-term outcomes, between typical versus atypical presentations in OAs hospitalized with COVID-19 during the first surge of the pandemic. METHODS: Data from the inpatient electronic health record were extracted for patients aged 65 and older, admitted to our health systems' hospitals with COVID-19 between March 1 and April 20, 2020. Presentation as reported by the OA or his/her representative is documented by the admitting professional and includes both symptoms and signs. Natural language processing was used to code the presence/absence of each symptom or sign. Typical presentation was defined as words indicating fever, cough, or shortness of breath; atypical presentation was defined as words indicating functional decline or altered mental status. RESULTS: Of 4 961 unique OAs, atypical presentation characterized by functional decline or altered mental status was present in 24.9% and 11.3%, respectively. Atypical presentation was associated with older age, female gender, Black race, non-Hispanic ethnicity, higher comorbidity index, and the presence of dementia and diabetes mellitus. Those who presented typically were 1.39 times more likely than those who presented atypically to receive intensive care unit-level care. Hospital outcomes of mortality, length of stay, and 30-day readmission were similar between OAs with typical versus atypical presentations. CONCLUSION: Although atypical presentation in OAs is not associated with the same need for acute intervention as respiratory distress, it must not be dismissed.


Subject(s)
COVID-19 , Pandemics , Aged , COVID-19/epidemiology , Female , Hospitalization , Hospitals , Humans , Male , SARS-CoV-2
12.
FACE ; : 27325016211027610, 2021.
Article in English | Sage | ID: covidwho-1295407

ABSTRACT

Purpose: The COVID-19 pandemic resulted in the institution of strict public health measures aimed at reducing virus transmission. This coincided with a well-documented alteration to the frequency and characteristics of maxillofacial trauma presentations. The aim was to examine the incidence and characteristics of maxillofacial trauma at a large tertiary hospital in the United Kingdom to determine whether these previously reported changes persisted after the relaxation of COVID-19 ?lockdown? legislation. Method: This was a retrospective cohort study of patients who sustained a facial injury during the 8-week period of 16th March 2020 to 11th May 2020 (strict COVID lockdown) compared to the 11th May 2020 to 6th July 2020 (relaxation of COVID lockdown). Cohorts were compared on the incidence and characteristics of facial injury. Results: Compared to the peak of COVID-19 lockdown, the subsequent period during which these laws were eased saw an increase in the frequency of maxillofacial trauma presentations (n?=?78 vs n?=?37). Despite this absolute increase, the incidence remained statistically below seasonal expectation. Operative management remained persistently low (45% in 2020 vs 67% in 2019). Conclusion: This is the first study to report the characteristics of facial trauma after the easing of COVID-19 lockdown legislation. Compared to previously published reports from Australia, there has not yet been a clear return to baseline epidemiology in the UK, perhaps reflecting the severity of the pandemic in that region.

13.
Blood ; 137(20): 2838-2847, 2021 05 20.
Article in English | MEDLINE | ID: covidwho-1236540

ABSTRACT

Thromboembolic events, including venous thromboembolism (VTE) and arterial thromboembolism (ATE), and mortality from subclinical thrombotic events occur frequently in coronavirus disease 2019 (COVID-19) inpatients. Whether the risk extends postdischarge has been controversial. Our prospective registry included consecutive patients with COVID-19 hospitalized within our multihospital system from 1 March to 31 May 2020. We captured demographics, comorbidities, laboratory parameters, medications, postdischarge thromboprophylaxis, and 90-day outcomes. Data from electronic health records, health informatics exchange, radiology database, and telephonic follow-up were merged. Primary outcome was a composite of adjudicated VTE, ATE, and all-cause mortality (ACM). Principal safety outcome was major bleeding (MB). Among 4906 patients (53.7% male), mean age was 61.7 years. Comorbidities included hypertension (38.6%), diabetes (25.1%), obesity (18.9%), and cancer history (13.1%). Postdischarge thromboprophylaxis was prescribed in 13.2%. VTE rate was 1.55%; ATE, 1.71%; ΑCM, 4.83%; and MB, 1.73%. Composite primary outcome rate was 7.13% and significantly associated with advanced age (odds ratio [OR], 3.66; 95% CI, 2.84-4.71), prior VTE (OR, 2.99; 95% CI, 2.00-4.47), intensive care unit (ICU) stay (OR, 2.22; 95% CI, 1.78-2.93), chronic kidney disease (CKD; OR, 2.10; 95% CI, 1.47-3.0), peripheral arterial disease (OR, 2.04; 95% CI, 1.10-3.80), carotid occlusive disease (OR, 2.02; 95% CI, 1.30-3.14), IMPROVE-DD VTE score ≥4 (OR, 1.51; 95% CI, 1.06-2.14), and coronary artery disease (OR, 1.50; 95% CI, 1.04-2.17). Postdischarge anticoagulation was significantly associated with reduction in primary outcome (OR, 0.54; 95% CI, 0.47-0.81). Postdischarge VTE, ATE, and ACM occurred frequently after COVID-19 hospitalization. Advanced age, cardiovascular risk factors, CKD, IMPROVE-DD VTE score ≥4, and ICU stay increased risk. Postdischarge anticoagulation reduced risk by 46%.


Subject(s)
COVID-19/complications , Thromboembolism/epidemiology , Thromboembolism/etiology , Aged , Anticoagulants/therapeutic use , Female , Humans , Male , Middle Aged , Patient Discharge , Registries , Risk Factors , SARS-CoV-2 , Thromboembolism/prevention & control
14.
FACE ; : 27325016211015405, 2021.
Article in English | Sage | ID: covidwho-1223756

ABSTRACT

The imposition of COVID-19 social distancing laws serendipitously decreased the frequency and altered the characteristics of facial injury presentation. The purpose of this study was to determine whether the devolution of social distancing laws had the opposite effect. Materials and methods: The authors undertook a retrospective study of the clinical records of a cohort of patients who sustained a facial injury during COVID-19 social distancing devolution. The primary predictor valuable was the 8?week devolution of social distancing. Other variables consisted of a heterogeneous set of factors grouped into logical categories: demographic, injury specifics, and treatment. A descriptive statistical analysis was undertaken on the assembled results. Results: The study found that the absolute numbers of facial injury presentation rose from 73 to 120;a 64% increase. The study also found that there was an alteration to the characteristics of facial injury presentation across the study variables. Conclusion: The initial imposition and subsequent devolution of COVID-19 social distancing measures had a serendipitous public health benefit. Initially there was a decrease in the frequency of facial injury presentation followed by an increase upon cessation of social distancing restrictions

15.
Blood ; 137(20): 2838-2847, 2021 05 20.
Article in English | MEDLINE | ID: covidwho-1172063

ABSTRACT

Thromboembolic events, including venous thromboembolism (VTE) and arterial thromboembolism (ATE), and mortality from subclinical thrombotic events occur frequently in coronavirus disease 2019 (COVID-19) inpatients. Whether the risk extends postdischarge has been controversial. Our prospective registry included consecutive patients with COVID-19 hospitalized within our multihospital system from 1 March to 31 May 2020. We captured demographics, comorbidities, laboratory parameters, medications, postdischarge thromboprophylaxis, and 90-day outcomes. Data from electronic health records, health informatics exchange, radiology database, and telephonic follow-up were merged. Primary outcome was a composite of adjudicated VTE, ATE, and all-cause mortality (ACM). Principal safety outcome was major bleeding (MB). Among 4906 patients (53.7% male), mean age was 61.7 years. Comorbidities included hypertension (38.6%), diabetes (25.1%), obesity (18.9%), and cancer history (13.1%). Postdischarge thromboprophylaxis was prescribed in 13.2%. VTE rate was 1.55%; ATE, 1.71%; ΑCM, 4.83%; and MB, 1.73%. Composite primary outcome rate was 7.13% and significantly associated with advanced age (odds ratio [OR], 3.66; 95% CI, 2.84-4.71), prior VTE (OR, 2.99; 95% CI, 2.00-4.47), intensive care unit (ICU) stay (OR, 2.22; 95% CI, 1.78-2.93), chronic kidney disease (CKD; OR, 2.10; 95% CI, 1.47-3.0), peripheral arterial disease (OR, 2.04; 95% CI, 1.10-3.80), carotid occlusive disease (OR, 2.02; 95% CI, 1.30-3.14), IMPROVE-DD VTE score ≥4 (OR, 1.51; 95% CI, 1.06-2.14), and coronary artery disease (OR, 1.50; 95% CI, 1.04-2.17). Postdischarge anticoagulation was significantly associated with reduction in primary outcome (OR, 0.54; 95% CI, 0.47-0.81). Postdischarge VTE, ATE, and ACM occurred frequently after COVID-19 hospitalization. Advanced age, cardiovascular risk factors, CKD, IMPROVE-DD VTE score ≥4, and ICU stay increased risk. Postdischarge anticoagulation reduced risk by 46%.


Subject(s)
COVID-19/complications , Thromboembolism/epidemiology , Thromboembolism/etiology , Aged , Anticoagulants/therapeutic use , Female , Humans , Male , Middle Aged , Patient Discharge , Registries , Risk Factors , SARS-CoV-2 , Thromboembolism/prevention & control
16.
J Diabetes ; 2021 Jan 23.
Article in English | MEDLINE | ID: covidwho-1112184

ABSTRACT

BACKGROUND: Diabetes has been identified as a risk factor for intubation and mortality in patients with coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We seek to examine the impact of clinical variables such as glycosylated hemoglobin (HbA1c) on mortality and need for intubation, as well as demographic variables such as age, sex, and race on persons with type 2 diabetes and COVID-19. METHODS: Analyses were conducted on 4413 patients with an International Classification of Diseases and Related Health Problems (ICD-10) diagnosis of type 2 diabetes and COVID-19. Survival analysis was conducted using Kaplan-Meier curves and the log-rank test to compare subgroup analyses. RESULTS: In this multivariate analysis, male gender, older age, and hyperglycemia at admission were associated with increased mortality and intubation, but this was not seen for race, ethnicity, insurance type, or HbA1c. Based on Kaplan-Meier analysis, having comorbid conditions such as hypertension, chronic kidney disease, and coronary artery disease was associated with a statistically significant increased risk of mortality. CONCLUSIONS: Glycemic levels at admission have a greater impact on health outcomes than HbA1c. Older men and those with comorbid disease are also at greater risk for mortality. Further longitudinal studies need to be done to evaluate the impact of COVID-19 on type 2 diabetes.

17.
Heart Rhythm ; 18(4): 501-507, 2021 04.
Article in English | MEDLINE | ID: covidwho-1046413

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) is the most encountered arrhythmia and has been associated with worse in-hospital outcomes. OBJECTIVE: This study was to determine the incidence of AF in patients hospitalized with coronavirus disease 2019 (COVID-19) as well as its impact on in-hospital mortality. METHODS: Patients hospitalized with a positive COVID-19 polymerase chain reaction test between March 1 and April 27, 2020, were identified from the common medical record system of 13 Northwell Health hospitals. Natural language processing search algorithms were used to identify and classify AF. Patients were classified as having AF or not. AF was further classified as new-onset AF vs history of AF. RESULTS: AF occurred in 1687 of 9564 patients (17.6%). Of those, 1109 patients (65.7%) had new-onset AF. Propensity score matching of 1238 pairs of patients with AF and without AF showed higher in-hospital mortality in the AF group (54.3% vs 37.2%; P < .0001). Within the AF group, propensity score matching of 500 pairs showed higher in-hospital mortality in patients with new-onset AF as compared with those with a history of AF (55.2% vs 46.8%; P = .009). The risk ratio of in-hospital mortality for new-onset AF in patients with sinus rhythm was 1.56 (95% confidence interval 1.42-1.71; P < .0001). The presence of cardiac disease was not associated with a higher risk of in-hospital mortality in patients with AF (P = .1). CONCLUSION: In patients hospitalized with COVID-19, 17.6% experienced AF. AF, particularly new-onset, was an independent predictor of in-hospital mortality.


Subject(s)
Atrial Fibrillation/epidemiology , COVID-19/complications , COVID-19/mortality , Aged , Aged, 80 and over , Atrial Fibrillation/diagnosis , Atrial Fibrillation/virology , COVID-19/diagnosis , Female , Hospital Mortality , Hospitalization , Humans , Incidence , Male , Middle Aged , Propensity Score , Retrospective Studies
18.
J Am Acad Dermatol ; 84(4): 946-952, 2021 04.
Article in English | MEDLINE | ID: covidwho-988149

ABSTRACT

BACKGROUND: Limited information exists on mucocutaneous disease and its relation to course of COVID-19. OBJECTIVE: To estimate prevalence of mucocutaneous findings, characterize morphologic patterns, and describe relationship to course in hospitalized adults with COVID-19. METHODS: Prospective cohort study at 2 tertiary hospitals (Northwell Health) between May 11, 2020 and June 15, 2020. RESULTS: Among 296 hospitalized adults with COVID-19, 35 (11.8%) had at least 1 disease-related eruption. Patterns included ulcer (13/35, 37.1%), purpura (9/35, 25.7%), necrosis (5/35, 14.3%), nonspecific erythema (4/35, 11.4%), morbilliform eruption (4/35, 11.4%), pernio-like lesions (4/35, 11.4%), and vesicles (1/35, 2.9%). Patterns also showed anatomic site specificity. A greater proportion of patients with mucocutaneous findings used mechanical ventilation (61% vs 30%), used vasopressors (77% vs 33%), initiated dialysis (31% vs 9%), had thrombosis (17% vs 11%), and had in-hospital mortality (34% vs 12%) compared with those without mucocutaneous findings. Patients with mucocutaneous disease were more likely to use mechanical ventilation (adjusted prevalence ratio, 1.98; 95% confidence interval, 1.37-2.86); P < .001). Differences for other outcomes were attenuated after covariate adjustment and did not reach statistical significance. LIMITATIONS: Skin biopsies were not performed. CONCLUSIONS: Distinct mucocutaneous patterns were identified in hospitalized adults with COVID-19. Mucocutaneous disease may be linked to more severe clinical course.


Subject(s)
COVID-19/complications , Skin Diseases/virology , Skin/pathology , Acute Kidney Injury/therapy , Acute Kidney Injury/virology , Aged , Blister/virology , COVID-19/therapy , Chilblains/virology , Erythema/virology , Exanthema/virology , Female , Hospital Mortality , Hospitalization , Humans , Male , Middle Aged , Mucous Membrane , Necrosis/virology , Prospective Studies , Purpura/virology , Renal Dialysis , Respiration, Artificial , SARS-CoV-2 , Skin Ulcer/virology , Thrombosis/virology , Vasoconstrictor Agents/therapeutic use
19.
Circ Arrhythm Electrophysiol ; 13(11): e008937, 2020 11.
Article in English | MEDLINE | ID: covidwho-945067

ABSTRACT

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2) has resulted in a global pandemic. Hydroxychloroquine±azithromycin have been widely used to treat coronavirus disease 2019 (COVID-19) despite a paucity of evidence regarding efficacy. The incidence of torsade de pointes remains unknown. Widespread use of these medications forced overwhelmed health care systems to search for ways to effectively monitor these patients while simultaneously trying to minimize health care provider exposure and use of personal protective equipment. METHODS: Patients with COVID-19 positive who received hydroxychloroquine±azithromycin across 13 hospitals between March 1 and April 15 were included in this study. A comprehensive search of the electronic medical records was performed using a proprietary python script to identify any mention of QT prolongation, ventricular tachy-arrhythmias and cardiac arrest. RESULTS: The primary outcome of torsade de pointes was observed in 1 (0.015%) out of 6476 hospitalized patients with COVID-19 receiving hydroxychloroquine±azithromycin. Sixty-seven (1.03%) had hydroxychloroquine±azithromycin held or discontinued due to an average QT prolongation of 60.5±40.5 ms from a baseline QTc of 473.7±35.9 ms to a peak QTc of 532.6±31.6 ms. Of these patients, hydroxychloroquine±azithromycin were discontinued in 58 patients (86.6%), while one or more doses of therapy were held in the remaining nine (13.4%). A simplified approach to monitoring for QT prolongation and arrythmia was implemented on April 5. There were no deaths related to the medications with the simplified monitoring approach and health care provider exposure was reduced. CONCLUSIONS: The risk of torsade de pointes is low in hospitalized patients with COVID-19 receiving hydroxychloroquine±azithromycin therapy.


Subject(s)
Antiviral Agents/adverse effects , Azithromycin/adverse effects , COVID-19/drug therapy , Delivery of Health Care , Heart Conduction System/drug effects , Hydroxychloroquine/adverse effects , Torsades de Pointes/chemically induced , Action Potentials/drug effects , Adolescent , Adult , Aged , Antiviral Agents/administration & dosage , Azithromycin/administration & dosage , COVID-19/diagnosis , Cardiotoxicity , Female , Heart Conduction System/physiopathology , Heart Rate/drug effects , Hospitalization , Humans , Hydroxychloroquine/administration & dosage , Male , Middle Aged , New York , Patient Safety , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Torsades de Pointes/diagnosis , Torsades de Pointes/physiopathology , Treatment Outcome , Young Adult
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