Predictors for inpatient mortality during the first wave of the SARS-CoV-2 pandemic: A retrospective analysis
Sammartino et al.
, 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
Retrospective 1,108 hospitalized patients in New York showing significantly higher mortality with HCQ treatment.
Time based confounding is very likely because HCQ became increasingly controversial and less used over the time covered (Mar - Jun 2020), while overall treatment protocols during this period improved dramatically, i.e., more control patients likely come later in the period when treatment protocols were greatly improved. Authors note that for every week or month later that a person was admitted, their risk of death dropped by 16% and 49%, respectively, yet they do not consider time based confounding.
This study is excluded in the after exclusion results of meta
substantial confounding by time
likely due to declining usage over the early stages of the pandemic when overall treatment protocols improved dramatically.
risk of death, 240.0% higher, OR 3.40, p = 0.002, treatment 137, control 191, PSM, model 1a, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Sammartino et al., 10 May 2021, retrospective, propensity score matching, USA, peer-reviewed, 7 authors.
Abstract: PLOS ONE
Predictors for inpatient mortality during the
first wave of the SARS-CoV-2 pandemic:
A retrospective analysis
Daniel Sammartino ID1☯*, Farrukh Jafri1☯, Brennan Cook2☯, Lisa La1☯, Hyemin Kim1☯,
John Cardasis1☯, Joshua Raff ID1☯
1 White Plains Hospital, White Plains, New York, United States of America, 2 Rutgers Robert Wood Johnson
School of Medicine, New Brunswick, New Jersey, United States of America
☯ These authors contributed equally to this work.
Citation: Sammartino D, Jafri F, Cook B, La L, Kim
H, Cardasis J, et al. (2021) Predictors for inpatient
mortality during the first wave of the SARS-CoV-2
pandemic: A retrospective analysis. PLoS ONE
16(5): e0251262. https://doi.org/10.1371/journal.
Editor: Aleksandar R. Zivkovic, Heidelberg
University Hospital, GERMANY
Received: January 14, 2021
The coronavirus disease 2019 (COVID-19) pandemic overwhelmed healthcare systems,
highlighting the need to better understand predictors of mortality and the impact of medical
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.
Accepted: April 23, 2021
Published: May 10, 2021
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication of
all of the content of peer review and author
responses alongside final, published articles. The
editorial history of this article is available here:
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].
Copyright: © 2021 Sammartino et al. This is an
open access article distributed under the terms of
the Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: All relevant data are
within the manuscript and its Supporting
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
PLOS ONE | https://doi.org/10.1371/journal.pone.0251262 May 10, 2021
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Funding: The authors received no specific funding
for this work.
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