OBJECTIVES: To define the current incidence, epidemiology, and mortality of older adult patients hospitalized with community-acquired pneumonia (CAP) in Louisville, KY and thus estimate the burden of CAP in the older adult population of the United States. To define risk factors associated with early and late outcomes. DESIGN: This was a secondary analysis of older adults (aged ≥65 years) from the University of Louisville Pneumonia Study, a prospective population-based cohort study of all hospitalized adults with CAP between June 1, 2014, and May 31, 2016. SETTING: The study took place in all nine acute care hospitals for adults in Louisville, KY. PARTICIPANTS: Residents in the city of Louisville, KY, who were diagnosed with CAP between the inclusion dates were included and who were aged 65 years or older. MEASUREMENTS: Incidence of CAP and outcomes were measured. A total of nine risk factors were also assessed for any potential association with time to clinical stability, length of stay (LOS), and mortality. RESULTS: During the 2-year study, from a Louisville population of 102 264 adults aged 65 years or older, 4760 were hospitalized with CAP. The incidence of older adults hospitalized with CAP was 2093 per 100 000 population. This corresponds to 967 470 older adults in the United States hospitalized per year with CAP. The median time to clinical stability was 2 days, and the median LOS was 6 days. The 30-day allcause mortality was 17%. The 1-year all-cause mortality was 38% (829 patients), which corresponds to 361 982 deaths in the United States with CAP in older adults. CONCLUSION: The estimated burden of CAP in older adults is substantial in the United States. Nearly 1 million older adults are hospitalized for CAP, and over a third of those die within 1 year.
Objectives: This systematic review attempts to retrieve and report the findings of postmortem studies including the histopathologic data of deceased coronavirus disease 2019 patients and to review the manifestations of coronavirus disease 2019–associated thrombotic pathologies reported in the recent literature. Data Sources: PubMed, Excerpta Medica Database, and Cochrane library between December 1, 2019, and August 26, 2020. Study Selection: Investigators screened 360 unique references, retrieved published autopsy series, and report on the postmortem histopathologic information on patients who had died of coronavirus disease 2019. Data Extraction: Investigators independently abstracted all available data including study design, participant demographics, key histopathologic findings, disease severity markers, duration of hospital stay, and cause of death. Data Synthesis: From the 65 eligible studies, 691 total completed autopsies were included in evidence synthesis. Histopathologic evaluation of the lungs revealed presence of diffuse alveolar damage in 323 of 443 patients and pulmonary microthrombi in 242 of 326 patients. Deep venous thrombosis and pulmonary embolism were found in 41% and ~15%, respectively, of the cadavers examined for thromboembolic events. d -dimer levels were generally higher in patients with severe clinical course of coronavirus disease 2019. Plasma levels of ferritin, lactate dehydrogenase, interleukin-6, and C-reactive protein were higher in nonsurvivors when compared with survivors. Overall, microthrombi and extensive angiogenesis of lung vasculature were the most common pathologic findings in the lungs and microthrombi in most of the assessed organ-tissue. Conclusions: Diffuse alveolar damage was the most predominant feature in the lungs of coronavirus disease 2019 patients who underwent postmortem assessment. Widespread pulmonary microthrombosis and extensive pulmonary angiogenesis, in addition to frequent pulmonary and extrapulmonary microthrombotic and thromboembolic findings in patients with coronavirus disease 2019, appear to be consistent with the disease-specific hypercoagulability. Further discovery efforts in assessing the link between coronavirus disease 2019, hypercoagulable state, and immunothrombosis are warranted. In the interim, increased attention to anticoagulant treatment approaches in coronavirus disease 2019 patients is needed.
Objective To analyze outcomes and risk factors of cardiovascular events in a metropolitan COVID-19 database, and to perform a subgroup analysis in African American populations to determine whether outcomes and risk factors are influenced by race. Design Retrospective cohort analysis from March 9, 2020 to June 20, 2020. Setting Population-based study in Louisville, KY, USA Participants 700 adult inpatients hospitalized with COVID-19. Interventions N/A Measurements and Main Results: Our cohort consisted of 126 patients (18%) with cardiovascular events and 574 patients without cardiovascular events. Patients with cardiovascular events had a much higher mortality rate than those without cardiovascular events (45.2% vs. 8.7%, p <0.001). There was no difference between African Americans and Whites regarding mortality (43.9% vs 46.3%, p =1) and length of stay for survivors (11 days vs. 9.5 days, p =0.301). Multiple logistics regression analysis suggested that male, race, lower SaO2/FiO2, higher serum potassium, lower serum albumin, and number of cardiovascular co-morbidities were highly associated with the occurrence of cardiovascular events in COVID-19 patients. Lower serum albumin and neoplastic/immune compromised diseases were highly associated with cardiovascular events for African American COVID-19 patients. SaO2/FiO2 ratio and cardiovascular comorbidity count were significantly associated with cardiovascular events in white patients. Conclusions : Cardiovascular events were prevalent and associated with worse outcomes in hospitalized patients with COVID-19. Outcomes of cardiovascular events in African American and white COVID-19 patients were similar after propensity score matching analysis. There were common and unique risk factors for cardiovascular events in African American COVID-19 patients when compared with white patients.
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