Events of Immune Thrombocytopenic Purpura (ITP) Among COVID-19-positive Adults in the United States; an Analysis via the National Inpatient Sample for Cases Between April to November 2020 (preprint)

Various cases of immune thrombocytopenic purpura (ITP) were reported among COVID-19-positive patients in the literature. We used the National Inpatient Sample (NIS) to evaluate the odds of ITP among COVID-19 patients in the United States between April and November 2020. Females (vs. Males), Whites (vs. other races), and the presence of multiple comorbidities such as chronic kidney disease, cirrhosis, prior stroke, HIV, obesity, cachexia, neoplasms, and autoimmune conditions showed higher odds of ITP. Meanwhile, those with diabetes and peripheral vascular disease and covered by private insurance (vs. Medicare) were less likely to experience ITP while being positive for the virus. Events of ITP also led to a higher mortality risk in COVID-19-positive patients.

Characteristics and outcomes of 7620 Multiple Sclerosis patients admitted with COVID-19 in the United States (preprint)

Background At the start of the COVID-19 pandemic, several experts raised concerns about its impact on Multiple Sclerosis (MS) patients. Several small sample studies were published throughout the pandemic highlighting certain risk factors and outcomes. This study aims to provide a perspective using the biggest inpatient database from the United States. Method We screened for COVID-19 cases between April to December 2020, via the 2020 National Inpatient Sample (NIS). Characteristics of COVID-19 patients with and without MS were studied. The odds of mortality, mechanical ventilation and non-invasive ventilation were also analyzed. Finally, we investigated the risk factors of various outcomes among MS patients. Results We identified 1,628,110 hospitalizations with COVID-19, including 7620 (0.5%) MS patients. 68.6% of MS cases were Whites, and 63.3% were covered by Medicare. Compared to non-MS patients, MS patients with COVID-19 were mostly Females, had depression, peripheral vascular disease, and smoked. However, MS patients had lower cases of alcohol abuse, obesity, hyperlipidemia, diabetes, hypertension, CKD, or maintenance dialysis. MS patients with COVID-19 were also younger (mean age 60.65 years vs. 62.60 years, p<0.01). 8.9% of MS patients with COVID-19 did not survive their hospitalization, and it was lower than non-MS cases (12.9%, aOR 0.783, 95% CI 0.721-0.852, p<0.01). Less MS patients with COVID-19 needed non-invasive ventilation (4.5% vs. 6.4%, aOR 0.790, 95% CI 0.706-0.883, p<0.01) and mechanical ventilation (9.0% vs. 11.2%, aOR 1.017, 95% CI 0.937-1.104, p=0.687). Furthermore, MS patients with COVID-19 reported higher odds of non-invasive ventilation if they were of ages 60 and above (aOR 2.124, p<0.01), had chronic pulmonary disease (aOR 1.691, p<0.01), obesity (aOR 1.69, p<0.01), and diabetes (aOR 1.573, p<0.01). Private insurance beneficiaries showed reduced risk compared to Medicare (aOR 0.523, p<0.01). Similarly, for mechanical ventilation, those ages 60 and above (aOR 1.404, p<0.01), alcohol abuse (aOR 6.404, p<0.01), obesity (aOR 1.417, p<0.01), diabetes (aOR 1.992, p<0.01), hypertension (aOR 1.269, p=0.016), or dialysis (aOR 3.003, p<0.01) had higher odds, while females (aOR 0.700, p<0.01), smokers (aOR 0.588, p<0.01), and those with depression (aOR 0.698, p<0.01) or hyperlipidemia (aOR 0.711, p<0.01) showed reduced odds. Our study further found higher odds of mortality among those of age 60 and above (aOR 3.813, p<0.01), chronic pulmonary disease (aOR 1.739, p<0.01), obesity (aOR 1.425, p<0.01), CKD (aOR 1.982, p<0.01), or a history of old MI (aOR 1.864, p<0.01) while females (aOR 0.610, p<0.01), smokers (aOR 0.770, p<0.01), as well as those with depression (aOR 0.695, p<0.01), and hyperlipidemia (aOR 0.769, p<0.01) showed better outcomes. Blacks had lower odds of dying (aOR 0.636, p<0.01), whereas Hispanics had higher odds of dying (aOR 1.674, p<0.01), compared to Whites. Medicaid and Privately insured patients had lower odds of dying compared to Medicare i.e. (aOR 0.435, p<0.01), and (aOR 0.488, p<0.01), respectively. Conclusion We found several differences in patient characteristics among MS and non-MS patients with COVID-19. MS patients were also less likely to die or require non-invasive ventilation than non-MS patients. Further risk factors influencing the different outcomes among MS patients were also identified.

Characteristics of COVID-19 in children and potential risk factors for requiring mechanical ventilation; an analysis of 22,490 cases from the United States (preprint)

The pandemic of Coronavirus disease 2019 (COVID-19) has lasted more than two years and caused millions of deaths. While the characteristics and outcomes have been more widely studied in the adult population, we conducted an in-depth analysis via the 2020 National Inpatient Sample to understand the characteristics and predictors for the use of mechanical ventilation in patients of ages 18 and less in the United States. Twenty-two thousand four hundred ninety hospitalizations involving COVID-19-positive children were found. 52.7% (11850 cases) were females, 37.0% were Hispanics, 38.0% (8555 cases) were in the first percentile 0-25th of Median household income, and 66.9% used Medicaid. In total, 1140 cases (5.1%) needed mechanical ventilation. Among factors such as obesity (aOR 1.662, 95%CI 1.368-2.019, p<0.001), Blacks (vs. White) (aOR 1.472, 95%CI 1.23-1.761, p<0.001), private insurances (aOR 1.241, 95%CI 1.06-1.453, p=0.007) or remaining forms of payment other than Medicaid or private insurances (aOR 1.763, 95%CI 1.428-2.177, p<0.001, vs. Medicaid), ages 6 to 10 years (aOR 1.531, 95%CI 1.259-1.862, p<0.001, vs. ages 0-5) showed higher odds of needing mechanical ventilation. On the contrary, Females (aOR 0.54, 95%CI 0.472-0.617, p<0.001, vs. Males), hospitalized patients in November (aOR 0.542, 95%CI 0.399-0.736, p<0.001) and December (aOR 0.446, 95%CI 0.329-0.606, p<0.001) (vs. April), Hispanics (aOR 0.832, 95%CI 0.699-0.99, p=0.038, vs. White), ages 16-18 years (aOR 0.804, 95%CI 0.673-0.96, p=0.016, vs. 0-5years), and in the 76th-100th median household income percentile (aOR 0.783, 95%CI 0.628-0.976, p=0.03, vs. 0-25th percentile) showed reduced odds. 9.6% of patients on mechanical ventilation died.