Predictors for inpatient mortality during the first wave of the SARS-CoV-2 pandemic: A retrospective analysis
PLOS ONE, doi:10.1371/journal.pone.0251262
Background The coronavirus disease 2019 (COVID-19) pandemic overwhelmed healthcare systems, highlighting the need to better understand predictors of mortality and the impact of medical interventions.
Methods This retrospective cohort study examined data from every patient who tested positive for COVID-19 and was admitted to White Plains Hospital between March 9, 2020, and June 3, 2020. We used binomial logistic regression to analyze data for all patients, and propensity score matching for those treated with hydroxychloroquine and convalescent plasma (CP). The primary outcome of interest was inpatient mortality.
Results 1,108 admitted patients with COVID-19 were available for analysis, of which 124 (11.2%) were excluded due to incomplete data. Of the 984 patients included, 225 (22.9%) died. Risk for death decreased for each day later a patient was admitted [OR 0.970, CI 0.955 to 0.985; p < 0.001]. Elevated initial C-reactive protein (CRP) value was associated with a higher risk for death at 96 hours [OR 1.007, 1.002 to 1.012; p = 0.006]. Hydroxychloroquine and CP administration were each associated with increased mortality [OR 3.4, CI 1.614 to 7.396; p = 0.002, OR 2.8560, CI 1.361 to 6.160; p = 0.006 respectively].
Conclusions Elevated CRP carried significant odds of early death. Hydroxychloroquine and CP were each associated with higher risk for death, although CP was without titers and was administered at a median of five days from admission. Randomized or controlled studies will better describe the impact of CP. Mortality decreased as the pandemic progressed, suggesting
Author Contributions Conceptualization: Daniel Sammartino, Farrukh Jafri, Lisa La, Hyemin Kim, John Cardasis. Data curation: Daniel Sammartino, Brennan Cook, Lisa La, Hyemin Kim, Joshua Raff. Formal analysis: Daniel Sammartino, Farrukh Jafri, Brennan Cook, Lisa La, Hyemin Kim, John Cardasis, Joshua Raff. Investigation: Daniel Sammartino. Methodology: Daniel Sammartino, Lisa La, Joshua Raff. Project administration: Daniel Sammartino, Farrukh Jafri, Lisa La, John Cardasis, Joshua Raff. Supervision: Farrukh Jafri, John Cardasis, Joshua Raff. Validation: Brennan Cook, Joshua Raff. Visualization: Joshua Raff. Writing -original draft: Daniel Sammartino, Farrukh Jafri, Brennan Cook, Hyemin Kim, Joshua Raff. Writing -review & editing: Daniel Sammartino, Farrukh Jafri, Brennan Cook, Hyemin Kim, Joshua Raff.
Ashish, Unsworth, Martindale, CPAP management of COVID-19 respiratory failure: A first quantitative analysis from an inpatient service evaluation, BMJ Open Respir Res, doi:10.1136/bmjresp-2020-000692
Binder, Torres, Elwell, Use of the Donabedian Model as a Framework for COVID-19 Response at a Hospital in Suburban Westchester County, New York: A Facility-level Case Report, J Emerg Nurs, doi:10.1016/j.jen.2020.10.008
Calligaro, Lalla, Audley, The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study, EClinicalMedicine
Cardasis, Rasamny, Berzofsky, Bello, Multz, Outcomes After Tracheostomy for Patients With Respiratory Failure due to COVID-19, Ear, Nose Throat J, doi:10.1177/0145561321993567
Cavalcanti, Zampieri, Rosa, Hydroxychloroquine with or without Azithromycin in Mildto-Moderate Covid-19, N Engl J Med, doi:10.1056/NEJMoa2019014
Ciceri, Castagna, Rovere-Querini, Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy, Clin Immunol, doi:10.1016/j.clim.2020.108509
Gautret, Lagier, Parola, Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, Int J Antimicrob Agents, doi:10.1016/j.ijantimicag.2020.105949
Gude, Riveiro, Rodrı ´guez-Nu ´ñez, Development and validation of a clinical score to estimate progression to severe or critical state in COVID-19 pneumonia hospitalized patients, Sci Rep, doi:10.1038/s41598-020-75651-z
Holshue, Debolt, Lindquist, First Case of 2019 Novel Coronavirus in the United States, N Engl J Med, doi:10.1056/NEJMoa2001191
Horby, Mafham, Linsell, Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19, N Engl J Med, doi:10.1056/NEJMoa2022926
Joyner, Effect of Convalescent Plasma on Mortality among Hospitalized Patients with COVID-19: Initial Three-Month Experience, medRxiv, doi:10.1101/2020.08.12.20169359
Marano, Vaglio, Pupella, Convalescent plasma: New evidence for an old therapeutic tool?, Blood Transfus, doi:10.2450/2015.0131-15
Million, Lagier, Gautret, Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France, Travel Med Infect Dis, doi:10.1016/j.tmaid.2020.101738
Richardson, Hirsch, Narasimhan, Presenting Characteristics, Comorbidities, and Outcomes among 5700 Patients Hospitalized with COVID-19 in the New York City Area, JAMA-J Am Med Assoc, doi:10.1001/jama.2020.6775
Rochwerg, Solo, Darzi, Chen, Khamis, Update Alert: Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19, Ann Intern Med, doi:10.7326/L20-0944
Rogers, Shehadeh, Mylona, Convalescent plasma for patients with severe COVID-19: a matched cohort study, Clin Infect Dis an Off Publ Infect Dis Soc Am, doi:10.1093/cid/ciaa1548
Shen, Wang, Zhao, Treatment of 5 Critically Ill Patients with COVID-19 with Convalescent Plasma, JAMA-J Am Med Assoc, doi:10.1001/jama.2020.4783
Simonovich, Pratx, Scibona, A Randomized Trial of Convalescent Plasma in Covid-19 Severe Pneumonia, N Engl J Med, doi:10.1056/NEJMoa2031304
Williams, Bach, Matthiesen, Henriksen, Gagliardi, Directed acyclic graphs: a tool for causal studies in paediatrics, Pediatr. Res, doi:10.1038/s41390-018-0071-3