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Together, chronic obstructive pulmonary disease (COPD) and asthma account for the most common non-infectious respiratory pathologies. Conflicting preliminary studies have shown varied effect for COPD and asthma as prognostic factors for mortality in coronavirus disease 2019 (COVID-19). The aim of this study was to explore the association of COPD and asthma with in-hospital mortality in patients with COVID-19 by systematically reviewing and synthesizing with a meta-analysis the available observational studies. MEDLINE, Scopus, and medRxiv databases were reviewed. A random-effects model meta-analysis was used, and I-square was utilized to assess for heterogeneity. In-hospital mortality was defined as the primary endpoint. Sensitivity and meta-regression analyses were performed. Thirty studies with 21,309 patients were included in this meta-analysis (1465 with COPD and 633 with asthma). Hospitalized COVID-19 patients with COPD had higher risk of death compared to those without COPD (OR: 2.29; 95% CI: 1.79–2.93; I2 59.6%). No significant difference in in-hospital mortality was seen in patients with and without asthma (OR: 0.87; 95% CI: 0.68–1.10; I2 0.0%). The likelihood of death was significantly higher in patients with COPD that were hospitalized with COVID-19 compared to patients without COPD. Further studies are needed to assess whether this association is independent or not. No significant difference was demonstrated in COVID-19-related mortality between patients with and without asthma.

Background and Aims Initial reports on US COVID-19 showed different outcomes in different races. In this study we use a diverse large cohort of hospitalized COVID-19 patients to determine predictors of mortality. Methods We analyzed data from hospitalized COVID-19 patients (n = 5852) between March 2020- August 2020 from 8 hospitals across the US. Demographics, comorbidities, symptoms and laboratory data were collected. Results The cohort contained 3,662 (61.7%) African Americans (AA), 286 (5%) American Latinx (LAT), 1,407 (23.9%), European Americans (EA), and 93 (1.5%) American Asians (AS). Survivors and non-survivors mean ages in years were 58 and 68 for AA, 58 and 77 for EA, 44 and 61 for LAT, and 51 and 63 for AS. Mortality rates for AA, LAT, EA and AS were 14.8, 7.3, 16.3 and 2.2%. Mortality increased among patients with the following characteristics: age, male gender, New York region, cardiac disease, COPD, diabetes mellitus, hypertension, history of cancer, immunosuppression, elevated lymphocytes, CRP, ferritin, D-Dimer, creatinine, troponin, and procalcitonin. Use of mechanical ventilation (p = 0.001), shortness of breath (SOB) (p < 0.01), fatigue (p = 0.04), diarrhea (p = 0.02), and increased AST (p < 0.01), significantly correlated with death in multivariate analysis. Male sex and EA and AA race/ethnicity had higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables among the demographics of study population were age (over 45 years old), male sex, EA, and patients hospitalized in New York. When adjusting for disease severity, significant variables were age over 65 years old, male sex, EA as well as having SOB, elevated CRP and D-dimer. Glucocorticoid usage was associated with an increased risk of COVID-19 death in our cohort. Conclusion Among this large cohort of hospitalized COVID-19 patients enriched for African Americans, our study findings may reflect the extent of systemic organ involvement by SARS-CoV-2 and subsequent progression to multi-system organ failure. High mortality in AA in comparison with LAT is likely related to high frequency of comorbidities and older age among AA. Glucocorticoids should be used carefully considering the poor outcomes associated with it. Special focus in treating patients with elevated liver enzymes and other inflammatory biomarkers such as CRP, troponin, ferritin, procalcitonin, and D-dimer are required to prevent poor outcomes.

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Introduction: Computed tomography with pulmonary angiography (CTPA) is the gold standard for diagnosis of pulmonary embolism (PE). A nearly five-fold increase in the use of CTPA was observed from 2004 to 2016 in the United States. Hypothesis: Suboptimal utilization of validated diagnostic predictive tools with D-dimer might have led to excessive use of CTPA in a large public hospital in Bronx, New York. Methods: We conducted a retrospective review of patients who underwent CTPA from January to October 2021. Two independent reviewers, blinded to each other and to the CTPA and D-dimer results, estimated the clinical probability for PE using the Well’s criteria, YEARS criteria, and the revised Geneva score. Patients were classified based on the presence or absence of PE in the CTPA. Chi-square and Fischer's exact test were used to compare discrete variables. Results: 504 patients were included in the analysis (median age: 56 years, female: 59.1%). The clinical probability for PE was considered to be low by both independent reviewers in 303 (60.2%), 250 (49.7%), and 108 (21.5%) patients based on Well’s criteria, YEARS criteria, and the revised Geneva score, respectively. D-dimer testing was conducted in less than half of patients with low clinical probability [Well’s:(43.2%), YEARS:(49.7%), Geneva:(46.3%)]. Based on Well’s criteria, of 69/131 patients (52.7%) with a D-dimer < 500 ng/ml, 3/69 (4.3%) were diagnosed with PE. As per YEARS criteria, of 51/100 patients (51%) with a D-dimer < 500 ng/ml, 3/51 (5.9%) were diagnosed with PE. Based on the revised Geneva score, of 26/50 (52%) patients with a D-dimer of < 500 ng/ml, 1/26 (3.8%) patient was diagnosed with PE. All PEs were subsegmental. Conclusion: Many patients underwent CTPA despite having a low probability of PE due to suboptimal utilization of validated diagnostic predictive tools with D-dimer. Using a D-dimer cut-off of <500 ng/ml in patients with a low probability of PE would have missed only a small number of subsegmental PE.

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