Association Between COVID-19 Outcomes and Patient Characteristics: A Study in an Inner-City Community Hospital

Abstract

BackgroundIt has been shown that certain hematological conditions, such as lymphopenia and thrombocytopenia, are associated with increased severity and mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, a majority of the previous data came from large institutional centers with high academic output. We aimed to explore the association between patient's characteristics, hematological parameters, and outcomes in admitted persons with coronavirus disease 2019 (COVID-19) at our community hospital in an inner city. MethodsThis study is a retrospective chart review designed to evaluate the potential associations between demographic and clinical characteristics of our patient population and their outcomes when testing positive for SARS-CoV-2. The study population included patients hospitalized in the Saint Francis Medical Center from January 2020 to September 2020. This pilot study included 50 out of the 275 hospitalized patients with a confirmed SARS-CoV-2 infection during this timeframe. Data collection from the patient's chart included age, sex, comorbidities, admission complete blood cell count, and use of Remdesivir, steroids, and plasma. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included the need for mechanical ventilation and ICU admission. ResultsIn this pilot study, there was an overall mortality rate of 32% (16 out of 50 patients). Charlson Comorbidity Index (CCI) of 3 points or above was present in 87.5% of the patients in the mortality group versus 41.1% in patients who survived (p = 0.0021). There was no statistically significant difference in mortality between males and females after adjusting for other variables with an odds ratio (OR) of 0.19 (95% CI 0.02-1.80, p = 0.09). There were no statically significant differences in mortality between Caucasians, non-Hispanic, Black, and Latinx patients (p = 0.466). Admission platelets were lower in the mortality group with a mean of 157.7 ± 43.23 (Thou/ul) versus 250.06 ± 93.95 (Thou/ul) in the survivors (p = 0.0005). Admission white blood cell count in the mortality group was lower than the survivor group with an average of 5.93 ± 2.58 (Thou/ul) versus 9.3 ± 4.14 (Thou/ul) (p = 0.0039), respectively. The plasma D-dimer level of 3 mg/L fibrinogen equivalent unit (FEU) or higher was associated with increased mortality. There was no association of Creactive protein (CRP) with mortality (p = 0.93 and p = 0.54, respectively); however, the CRP level revealed an association with ICU admission (p = 0.03). The use of steroids, Remdesivir, and plasma did not have a statistically significant effect on mortality, ICU admission, or sepsis in our study. ConclusionIn this study, older age, higher CCI, and plasma D-dimer level of 3 mg/L FEU or higher were associated with higher mortality among COVID-19 patients. White blood cell count and platelet count were significantly lower in the mortality group in comparison to the survivor group. However, there was no statistical difference in lymphocyte count b...

Molecular and Clinical Epidemiology of SARS-CoV-2 Infection among Vaccinated and Unvaccinated Individuals in a Large Healthcare Organization from New Jersey

“…Thyroid disease was likewise suggestive of inferior outcomes in prior studies [ 91 , 93 ], but was not found to be significant in this study. Figure 6 depicts increasing risk in individuals with greater numbers of comorbidities, similar to an earlier report which utilized the Charlson Comorbidity Index Score (CCIS) to address similar questions [ 94 ].…”

Characterization of persons with reported SARS-CoV-2 infection in the Oklahoma City tri-county area: Evidence from the first 12 months of transmission

“…For each confirmed case, we extracted the following: 1 date of notification in the system, 2 symptom onset date, 3 age, 4 gender, 5 ethnic group, 6 location (county, city/town, and zip code), 7 occupation, 8 presence of various symptoms at the time of testing, 9 information on chronic comorbidities and 10 whether the person was hospitalized and/or died following their diagnosis. All data on symptom onset, presence of symptoms, and presence of comorbidities were self-reported by the patient and covered symptoms/comorbidities as defined in a simple questionnaire without ICD codes.…”

“…The majority of these studies were based on data from large cities or selected population groups such as veterans, hospitalized patients or specific ethnic groups. Only a limited number of publications have used routinely collected surveillance data from smaller urban areas focusing on both hospitalized and non-hospitalized SARS-CoV-2 positive individuals 2 , 5 , 6 , 7 , 8 , 9 , 10 , 11 . In general, published evidence suggests that males are more likely to be infected, hospitalized and die from severe COVID-19 than females 12 , 13 .…”