Geospatial Distribution and Predictors of Mortality in Hospitalized Patients With COVID-19: A Cohort Study

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.

Experimental study and modelling of zinc and lead migration in sandy soils due to stormwater infiltration

Heavy metals emitted by road traffic are contaminants of roadside soils and can potentially migrate through the soils down to groundwater during runoff water infiltration. Stormwater management requires a better understanding of the mechanisms involved in the transport and particularly chemical interactions between heavy metals and the solid matrix. Experiments with open dynamic systems and modelling with a mixing-cells-in-series model have been performed to identify the main reactions which govern the migration of zinc and lead in sandy soils. Binary and ternary exchange experiments have been performed and a numerical modelling was proposed to describe zinc and lead mobility in column experiments.

[The factors related to the research activities of primary care physicians]

OBJECTIVE

To find the factors related with the research activities of primary care (PC) doctors in Catalonia, especially their motivation and the obstacles to research perceived by the doctors themselves.

DESIGN

An observational, crossover study.

SETTING

Primary care doctors in Catalonia.

PARTICIPANTS

The number of doctors (1,286) was divided into two: a) doctors who had published between 1989 and 1994 (n = 146), b) doctors who had not published.

INTERVENTIONS

A survey concerning personal and workplace variables was carried out by post.

RESULTS

The reply percentage was 49.5% (63.7% among those who had published and 44.85% among those who had not). The multivariant analysis showed a significant link between publishing and postgraduate residence training (MIR), the fact of working in a teaching centre and working in a centre with more than ten doctors.

CONCLUSIONS

Research is close related to postgraduate residence training (MIR), work in a teaching unit and PC centres with over ten doctors. Care load, lack of time and difficulty in getting financing were the main obstacles to research given by the doctors polled.

[Value of the technique of intravenous infusion of contrast media for the diagnosis of fluid processes (author's transl)]

The study covered 50 patients suffering from hepatic effusions; a solution used in contrast intravenous psychography was administered to them by the intravenous route, at similar doses to those used in intravenous psychography with infusions. This process which we have called Intravenous Viscerogramme, because of the similarity of the images obtained with those of the viscerographic phase of arteriography, has enabled the diagnosis of 35 hydatidiform cysts, one case of cholangiolar hamartoma and an abscess. Owing to the ease with which it can be carried out, we think that it can be used in the diagnosis of tumoral lesions of the liver. When the result is positive, radiological signs are obtained which enable identification of the lesion, thus avoiding resorting to more complex investigations such as angiography.