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Mallipattu SK, Jawa R, Moffitt R, Hajagos J, Fries B, Nachman S, Gan TJ, Saltz M, Saltz J, Kaushansky K, Skopicki H, Abell-Hart K, Chaudhri I, Deng J, Garcia V, Gayen S, Kurc T, Bolotova O, Yoo J, Dhaliwal S, Nataraj N, Sun S, Tsai C, Wang Y, Abbasi S, Abdullah R, Ahmad S, Bai K, Bennett-Guerrero E, Chua A, Gomes C, Griffel M, Kalogeropoulos A, Kiamanesh D, Kim N, Koraishy F, Lingham V, Mansour M, Marcos L, Miller J, Poovathor S, Rubano J, Rutigliano D, Sands M, Santora C, Schwartz J, Shroyer K, Spitzer S, Stopeck A, Talamini M, Tharakan M, Vosswinkel J, Wertheim W, Mallipattu SK, Jawa R, Moffitt R, Hajagos J, Fries B, Nachman S, Gan TJ, Saltz M, Saltz J, Kaushansky K, Skopicki H, Abell-Hart K, Chaudhri I, Deng J, Garcia V, Gayen S, Kurc T, Bolotova O, Yoo J, Dhaliwal S, Nataraj N, Sun S, Tsai C, Wang Y, Abbasi S, Abdullah R, Ahmad S, Bai K, Bennett-Guerrero E, Chua A, Gomes C, Griffel M, Kalogeropoulos A, Kiamanesh D, Kim N, Koraishy F, Lingham V, Mansour M, Marcos L, Miller J, Poovathor S, Rubano J, Rutigliano D, Sands M, Santora C, Schwartz J, Shroyer K, Spitzer S, Stopeck A, Talamini M, Tharakan M, Vosswinkel J, Wertheim W. Geospatial Distribution and Predictors of Mortality in Hospitalized Patients With COVID-19: A Cohort Study. Open Forum Infect Dis 2020;7:ofaa436. [PMID: 33117852 PMCID: PMC7543608 DOI: 10.1093/ofid/ofaa436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/09/2020] [Indexed: 01/20/2023] Open

Abstract

BACKGROUND

The global coronavirus disease 2019 (COVID-19) pandemic offers the opportunity to assess how hospitals manage the care of hospitalized patients with varying demographics and clinical presentations. The goal of this study was to demonstrate the impact of densely populated residential areas on hospitalization and to identify predictors of length of stay and mortality in hospitalized patients with COVID-19 in one of the hardest hit counties internationally.

METHODS

This was a single-center cohort study of 1325 sequentially hospitalized patients with COVID-19 in New York between March 2, 2020, to May 11, 2020. Geospatial distribution of study patients' residences relative to population density in the region were mapped, and data analysis included hospital length of stay, need and duration of invasive mechanical ventilation (IMV), and mortality. Logistic regression models were constructed to predict discharge dispositions in the remaining active study patients.

RESULTS

The median age of the study cohort (interquartile range [IQR]) was 62 (49-75) years, and more than half were male (57%) with history of hypertension (60%), obesity (41%), and diabetes (42%). Geographic residence of the study patients was disproportionately associated with areas of higher population density (r s = 0.235; P = .004), with noted "hot spots" in the region. Study patients were predominantly hypertensive (MAP > 90 mmHg; 670, 51%) on presentation with lymphopenia (590, 55%), hyponatremia (411, 31%), and kidney dysfunction (estimated glomerular filtration rate < 60 mL/min/1.73 m2; 381, 29%). Of the patients with a disposition (1188/1325), 15% (182/1188) required IMV and 21% (250/1188) developed acute kidney injury. In patients on IMV, the median (IQR) hospital length of stay in survivors (22 [16.5-29.5] days) was significantly longer than that of nonsurvivors (15 [10-23.75] days), but this was not due to prolonged time on the ventilator. The overall mortality in all hospitalized patients was 15%, and in patients receiving IMV it was 48%, which is predicted to minimally rise from 48% to 49% based on logistic regression models constructed to project disposition in the remaining patients on ventilators. Acute kidney injury during hospitalization (odds ratioE, 3.23) was the strongest predictor of mortality in patients requiring IMV.

CONCLUSIONS

This is the first study to collectively utilize the demographics, clinical characteristics, and hospital course of COVID-19 patients to identify predictors of poor outcomes that can be used for resource allocation in future waves of the pandemic.

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Affiliation(s)

Stony Brook COVID-19 Research Consortium
S K Mallipattu Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
R Jawa Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
R Moffitt Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Hajagos Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
B Fries Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Nachman Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
T J Gan Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
M Saltz Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Saltz Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
K Kaushansky Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
H Skopicki Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
K Abell-Hart Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
I Chaudhri Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Deng Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
V Garcia Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Gayen Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
T Kurc Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
O Bolotova Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Yoo Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Dhaliwal Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
N Nataraj Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Sun Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
C Tsai Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
Y Wang Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Abbasi Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
R Abdullah Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Ahmad Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
K Bai Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
E Bennett-Guerrero Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
A Chua Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
C Gomes Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
M Griffel Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
A Kalogeropoulos Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
D Kiamanesh Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
N Kim Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
F Koraishy Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
V Lingham Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
M Mansour Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
L Marcos Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Miller Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Poovathor Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Rubano Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
D Rutigliano Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
M Sands Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
C Santora Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Schwartz Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
K Shroyer Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Spitzer Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
A Stopeck Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
M Talamini Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
M Tharakan Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Vosswinkel Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
W Wertheim Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S K Mallipattu Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
R Jawa Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
R Moffitt Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Hajagos Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
B Fries Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Nachman Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
T J Gan Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
M Saltz Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Saltz Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
K Kaushansky Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
H Skopicki Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
K Abell-Hart Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
I Chaudhri Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Deng Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
V Garcia Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Gayen Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
T Kurc Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
O Bolotova Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Yoo Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Dhaliwal Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
N Nataraj Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Sun Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
C Tsai Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
Y Wang Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Abbasi Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
R Abdullah Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Ahmad Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
K Bai Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
E Bennett-Guerrero Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
A Chua Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
C Gomes Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
M Griffel Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
A Kalogeropoulos Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
D Kiamanesh Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
N Kim Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
F Koraishy Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
V Lingham Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
M Mansour Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
L Marcos Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Miller Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Poovathor Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Rubano Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
D Rutigliano Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
M Sands Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
C Santora Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Schwartz Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
K Shroyer Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
S Spitzer Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
A Stopeck Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
M Talamini Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
M Tharakan Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
J Vosswinkel Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA
W Wertheim Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, New York, USA

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Viccellio A, Santora C, Singer A, Thode H, Henry M. 6: Transfer of Emergency Department Boarders to Inpatient Hallways: A Four-Year Experience. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]

Pikitch EK, Santora C, Babcock EA, Bakun A, Bonfil R, Conover DO, Dayton P, Doukakis P, Fluharty D, Heneman B, Houde ED, Link J, Livingston PA, Mangel M, McAllister MK, Pope J, Sainsbury KJ. ECOLOGY: Ecosystem-Based Fishery Management. Science 2004;305:346-7. [PMID: 15256658 DOI: 10.1126/science.1098222] [Citation(s) in RCA: 1399] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]