Predictors for inpatient mortality during the first wave of the SARS-CoV-2 pandemic: A retrospective analysis

Abstract

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 that institutional capacity for dynamic evaluation of process and outcome measures may benefit COVID-19 survival.

Antirheumatic Drug Intake Influence on Occurrence of COVID-19 Infection in Ambulatory Patients with Immune-Mediated Inflammatory Diseases: A Cohort Study

“…Hydroxychloroquine oral chemoprophylaxis has been described as effective in young and healthy men in a randomized trial [ 6 ]. Conversely, hydroxychloroquine intake with or without azithromycin has been found to be ineffective against COVID-19 infection in multiple observational [ 7 – 14 ], intent-to-treat [ 15 ], and randomized controlled [ 16 – 24 ] studies. Recently published meta-analysis found that hydroxychloroquine had no efficacy as a prophylaxis for COVID-19 infections [ 25 ], and no clinical benefit in patients hospitalized for COVID-19 [ 26 – 30 ].…”

A randomized controlled trial to evaluate outcomes with Aggrenox in patients with SARS-CoV-2 infection

“…While we believe that it was clinically evident which patients indeed required high flow oxygen or some form of non-invasive/invasive ventilation therapy, and therefore did not likely interfere with our results, it is possible that our sample represented a different group of patients compared to that of the general population. Other studies have reported much higher mortality rates during similar study periods [ 45 ], and therefore Aggrenox could have resulted in larger benefits or complications in other patient samples. Lastly, our study predated the introduction of modern vaccines which are now globally available, and therefore it is unclear how Aggrenox may work in patients with previous antibodies, as is for most trials for our study period.…”

In Situ Simulation as a Tool to Longitudinally Identify and Track Latent Safety Threats in a Structured Quality Improvement Initiative for SARS-CoV-2 Airway Management

“…1,2 Our community hospital had a median 22.9% mortality rate among admitted patients between March -June 2020 with a decrease in risk of mortality by 49% each month attributed to the institution's ability to respond dynamically to a novel viral illness. [2][3][4] Debriefs held by the Emergency Department (ED) leadership with interprofessional staff identified systems-based latent safety threats (LST) particularly among newly developed SARS-CoV-2 clinical areas related to infection control precautions, equipment availability, and interdisciplinary team communication. 2 The simulation department at the hospital had a successful history of running quality improvement-based simulation programs 3,[5][6][7] and played a critical role in preparing the hospital during the first wave of the pandemic.…”

“…2 The simulation department at the hospital had a successful history of running quality improvement-based simulation programs 3,[5][6][7] and played a critical role in preparing the hospital during the first wave of the pandemic. 2,3 In June 2020, our hospital leadership provided prediction models to medical staff signaling an anticipated second wave in the early fall. Armed with this knowledge, the hospital's simulation team designed a program with the goal of improving hospital response elicited from concerns that surfaced during department-wide debriefs following the first wave to prepare and manage through the upcoming predicted second wave and beyond.…”

“…SARS-CoV-2 forced drastic changes in hospital workflows, including the transformation of nonclinical areas into clinical care spaces and medical staff working in unfamiliar units 1,2 . Our community hospital had a median 22.9% mortality rate among admitted patients between March – June 2020 with a decrease in risk of mortality by 49% each month attributed to the institution's ability to respond dynamically to a novel viral illness 2–4 . Debriefs held by the Emergency Department (ED) leadership with interprofessional staff identified systems-based latent safety threats (LST) particularly among newly developed SARS-CoV-2 clinical areas related to infection control precautions, equipment availability, and interdisciplinary team communication 2 .…”