Predictors for inpatient mortality during the first wave of the SARS-CoV-2 pandemic: A retrospective analysis
Daniel Sammartino, Farrukh Jafri, Brennan Cook, Lisa La, Hyemin Kim, John Cardasis, Joshua Raff
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.
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doi:10.1038/s41390-018-0071-3DOI record:
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"abstract": "<jats:sec id=\"sec001\">\n<jats:title>Background</jats:title>\n<jats:p>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.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods</jats:title>\n<jats:p>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.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results</jats:title>\n<jats:p>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].</jats:p>\n</jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions</jats:title>\n<jats:p>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 that institutional capacity for dynamic evaluation of process and outcome measures may benefit COVID-19 survival.</jats:p>\n</jats:sec>",
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