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1.
Chest ; 2020.
Artículo | WHO COVID | ID: covidwho-866577

RESUMEN

Background Cytokine storm is a marker of COVID-19 illness severity and increased mortality Immunomodulatory treatments have been repurposed to improve mortality outcomes Research Question To identify if immunomodulatory therapies improve survival in patients with COVID-19 cytokine storm Study Design and Methods We conducted a retrospective analysis of electronic health records across the Northwell Health system COVID-19 patients hospitalized between March 1, 2020 and April 24, 2020 were included Cytokine storm was defined by inflammatory markers: ferritin >700ng/mL, C-reactive protein >30mg/dL or lactate dehydrogenase >300U/L Patients were subdivided into six groups—no immunomodulatory treatment (standard of care) and five groups that received either corticosteroids, anti-interleukin 6 antibody (tocilizumab) or anti-interleukin-1 therapy (anakinra) alone or in combination with corticosteroids The primary outcome was hospital mortality Results 5,776 patients met the inclusion criteria The most common comorbidities were hypertension (44-59%), diabetes (32-46%) and cardiovascular disease (5-14%) Patients most frequently met criteria with high lactate dehydrogenase (76 2%) alone or in combination, followed by ferritin (63 2%) and C-reactive protein (8 4%) More than 80% of patients had an elevated D-dimer Patients treated with corticosteroids and tocilizumab combination had lower mortality compared to standard of care (Hazard Ratio (HR):0 44, 95% confidence interval (CI): 0 35-0 55;p<0 0001) and when compared to corticosteroids alone (HR:0 66, 95%CI: 0 53-0 83;p-value=0 004), or in combination with anakinra (HR:0 64, 95%CI:0 50-0 81;p-value=0 003) Corticosteroids when administered alone (HR:0 66, 95%CI:0 57-0 76;p<0 0001) or in combination with tocilizumab (HR:0 43, 95%CI:0 35-0 55;p<0 0001) or anakinra (HR:0 68, 95%CI:0 57-0 81;p<0 0001) improved hospital survival compared to standard of care Interpretation The combination of corticosteroids with tocilizumab had superior survival outcome when compared to standard of care and corticosteroids alone or in combination with anakinra Furthermore, corticosteroid use either alone or in combination with tocilizumab or anakinra was associated with reduced hospital mortality for patients with COVID-19 cytokine storm compared to standard of care

2.
Abdom Radiol (NY) ; 2020 Oct 12.
Artículo en Inglés | MEDLINE | ID: covidwho-843955

RESUMEN

PURPOSE: Manifestations of COVID-19 are primarily respiratory based, however, gastrointestinal symptoms are now recognized as an important component of the disease. The purpose of this study is to evaluate differences in abdominal pelvic CT findings in the emergency department by COVID-19 test result. METHODS: This retrospective study identified patients tested by PCR for COVID-19 infection who underwent abdominal pelvic CT scan in the ED across an academic health system from March 15 to April 15, 2020. Radiology reports were reviewed for the presence of ground glass opacity in the lungs and acute abdominal pathology. A subset of patients with acute abdominal pathology were identified with inflammatory pathology in organs with high ACE2 receptor expression including bowel, pancreas, urinary bladder, and kidney. CT findings for COVID positive versus negative patients were compared with Chi-square test. RESULTS: 597 patients tested by PCR for COVID-19 infection underwent abdominal pelvic CT scan, 44% were COVID-19 positive. COVID-19 positive patients demonstrated significantly more ground glass opacity at the lung bases, 65.1%, (222/341) versus 12.4% (33/266), p < 0.001), and significantly less acute abdominal findings, 23.8% (81/341) versus 45.5% (121/266), p ≤ 0.001). When abdominal pathology was present, COVID-19 positive patients had higher rate of inflammatory pathology 58% (47/81) versus 29.8% (36/121). CONCLUSIONS: In patients undergoing abdominopelvic CT from the ED, COVID-19 positive patients are more likely to have ground glass opacities at the lung bases and less likely to have acute abdominal pathology compared with COVID-19 negative patients. Further, COVID-19 positive patients are more likely to have inflammation of organs with high expression of ACE2 receptors than other types of acute abdominal pathology.

3.
Am J Transplant ; 20(7): 1819-1825, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-642184

RESUMEN

There is minimal information on coronavirus disease 2019 (COVID-19) in immunocompromised individuals. We have studied 10 patients treated at 12 adult care hospitals. Ten kidney transplant recipients tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction, and 9 were admitted. The median age was 57 (interquartile range [IQR] 47-67), 60% were male, 40% Caucasian, and 30% Black/African American. Median time from transplant to COVID-19 testing was 2822 days (IQR 1272-4592). The most common symptom was fever, followed by cough, myalgia, chills, and fatigue. The most common chest X-ray and computed tomography abnormality was multifocal patchy opacities. Three patients had no abnormal findings. Leukopenia was seen in 20% of patients, and allograft function was stable in 50% of patients. Nine patients were on tacrolimus and a mycophenolic antimetabolite, and 70% were on prednisone. Hospitalized patients had their antimetabolite agent stopped. All hospitalized patients received hydroxychloroquine and azithromycin. Three patients died (30%), and 5 (50%) developed acute kidney injury. Kidney transplant recipients infected with COVID-19 should be monitored closely in the setting of lowered immunosuppression. Most individuals required hospitalization and presenting symptoms were similar to those of nontransplant individuals.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Neumonía Viral/complicaciones , Receptores de Trasplantes , Anciano , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Cuidados Críticos , Registros Electrónicos de Salud , Femenino , Hospitalización , Humanos , Huésped Inmunocomprometido , Inmunosupresión/efectos adversos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/virología , Masculino , Persona de Mediana Edad , New York/epidemiología , Pandemias , Neumonía Viral/mortalidad
4.
Bioelectronic Medicine ; 6(1):14-14, 2020.
Artículo | WHO COVID | ID: covidwho-637250

RESUMEN

The number of cases from the coronavirus disease 2019 (COVID-19) global pandemic has overwhelmed existing medical facilities and forced clinicians, patients, and families to make pivotal decisions with limited time and information While machine learning (ML) methods have been previously used to augment clinical decisions, there is now a demand for “Emergency ML ” Throughout the patient care pathway, there are opportunities for ML-supported decisions based on collected vitals, laboratory results, medication orders, and comorbidities With rapidly growing datasets, there also remain important considerations when developing and validating ML models This perspective highlights the utility of evidence-based prediction tools in a number of clinical settings, and how similar models can be deployed during the COVID-19 pandemic to guide hospital frontlines and healthcare administrators to make informed decisions about patient care and managing hospital volume

5.
JAMA ; 323(20): 2052-2059, 2020 05 26.
Artículo en Inglés | MEDLINE | ID: covidwho-101977

RESUMEN

Importance: There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19). Objective: To describe the clinical characteristics and outcomes of patients with COVID-19 hospitalized in a US health care system. Design, Setting, and Participants: Case series of patients with COVID-19 admitted to 12 hospitals in New York City, Long Island, and Westchester County, New York, within the Northwell Health system. The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates. Exposures: Confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample among patients requiring admission. Main Outcomes and Measures: Clinical outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death. Demographics, baseline comorbidities, presenting vital signs, and test results were also collected. Results: A total of 5700 patients were included (median age, 63 years [interquartile range {IQR}, 52-75; range, 0-107 years]; 39.7% female). The most common comorbidities were hypertension (3026; 56.6%), obesity (1737; 41.7%), and diabetes (1808; 33.8%). At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/min, and 27.8% received supplemental oxygen. The rate of respiratory virus co-infection was 2.1%. Outcomes were assessed for 2634 patients who were discharged or had died at the study end point. During hospitalization, 373 patients (14.2%) (median age, 68 years [IQR, 56-78]; 33.5% female) were treated in the intensive care unit care, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died. As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital. The median postdischarge follow-up time was 4.4 days (IQR, 2.2-9.3). A total of 45 patients (2.2%) were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0-4.5) for readmitted patients. Among the 3066 patients who remained hospitalized at the final study follow-up date (median age, 65 years [IQR, 54-75]), the median follow-up at time of censoring was 4.5 days (IQR, 2.4-8.1). Conclusions and Relevance: This case series provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID-19 in the New York City area.


Asunto(s)
Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Complicaciones de la Diabetes , Femenino , Hospitalización , Humanos , Hipertensión/complicaciones , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Factores de Riesgo , Resultado del Tratamiento , Adulto Joven
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