Acute Kidney Injury in Admitted COVID-19 Patients

Sam Butler, MD • Tyler Heist, PhD
Original Article: Data Analysis
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COVID-19 is primarily a respiratory infection; however, there are multiple examples of multi-organ and systemic dysfunction associated with this infection.1 In addition to lung damage, it appears that the virus affects the lining of blood vessels, potentially leading to clotting, embolization, and organ damage. In a recent study by Hirsch et al,2 acute kidney injury (AKI) was reported to occur at a high rate in hospitalized COVID-19 patients. Our examination of EHR data confirmed these findings and also revealed an increased incidence of AKI in COVID-19 patients with hypertension, diabetes, or COPD, as well as in patients on mechanical ventilation.

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Figure 1. Percent of patients who developed AKI during a COVID-19 admission, broken down by age and sex. Note: Two patients with a documented sex of “Other” were excluded from analysis.
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Figure 1. Percent of patients who developed AKI during a COVID-19 admission, broken down by age and sex. Note: Two patients with a documented sex of “Other” were excluded from analysis.
Figure 1. Percent of patients who developed AKI during a COVID-19 admission, broken down by age and sex. Note: Two patients with a documented sex of “Other” were excluded from analysis.
Innovators
InnovatorsNYU Langone Health
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NYU Langone Health: Telemedicine Growth at An Epicenter of COVID-19

Tiffany Martinez, and Others
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Figure 1. Visit volumes increase in telemedicine urgent care (VUC) and non-urgent care (non-VUC) and decrease in in-person care. Each bar represents 1 day. Key dates are annotated above corresponding bars. COVID-19: coronavirus disease 2019; ED: emergency department.
Figure 1. Visit volumes increase in telemedicine urgent care (VUC) and non-urgent care (non-VUC) and decrease in in-person care. Each bar represents 1 day. Key dates are annotated above corresponding bars. COVID-19: coronavirus disease 2019; ED: emergency department.
Tiffany Martinez, and Others

Evidence from one large health system—NYU Langone Health—at an epicenter of the coronavirus disease 2019 outbreak in the United States shows possibility of sharp and…

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Figure 1. Visit volumes increase in telemedicine urgent care (VUC) and non-urgent care (non-VUC) and decrease in in-person care. Each bar represents 1 day. Key dates are annotated above corresponding bars. COVID-19: coronavirus disease 2019; ED: emergency department.
Figure 1. Visit volumes increase in telemedicine urgent care (VUC) and non-urgent care (non-VUC) and decrease in in-person care. Each bar represents 1 day. Key dates are annotated above corresponding bars. COVID-19: coronavirus disease 2019; ED: emergency department.
InnovatorsMount Sinai
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Mount Sinai Studies COVID-19 and Blood Clots

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A preliminary case series at Mt. Sinai studies the use of anticoagulation therapies for COVID-19
A preliminary case series at Mt. Sinai studies the use of anticoagulation therapies for COVID-19.

Physicians at Mount Sinai are exploring new avenues of clinical investigation, based on the beneficial response of patients to tPA in a small, preliminary case…

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A preliminary case series at Mt. Sinai studies the use of anticoagulation therapies for COVID-19
A preliminary case series at Mt. Sinai studies the use of anticoagulation therapies for COVID-19.
InnovatorsOchsner Health System
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Learning from New Orleans’ COVID-19 Gene Sequence

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Ochsner in Louisiana
An Ochsner team is using gene sequencing to investigate interactions between COVID-19 and underlying conditions.

Researchers from Ochsner and local lab BioInfoExperts have sequenced the genetic code of samples from their COVID-19 patients to learn more about the virus’s spread…

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Ochsner in Louisiana
An Ochsner team is using gene sequencing to investigate interactions between COVID-19 and underlying conditions.
Original Article: Data Analysis
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Patients on OUD Medications for the First Time All
Figure 1. First-time MOUD, buprenorphine, and naltrexone patients over time. Solid colored capsules show the last observed value. Dashed outline capsules show the predicted value for May 2020.

The number of patients receiving first-time prescriptions for Medications for Opioid Use Disorder (MOUD) decreased by over 30% in the spring of 2020 when compared to trends observed in EHR data from January 2017 to May 2020. This finding suggests that patients at risk for opioid use disorder (OUD) and overdose are increasingly vulnerable during…

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Patients on OUD Medications for the First Time All
Figure 1. First-time MOUD, buprenorphine, and naltrexone patients over time. Solid colored capsules show the last observed value. Dashed outline capsules show the predicted value for May 2020.
Original Article: Data Analysis
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Ventilator survival by age and sex

This brief was updated on June 26, 2020, with data as of June 18, 2020. Overall findings remain consistent, but the percentage of patients with an unknown outcome has decreased from 34% to 6%. Here we examine the mortality of patients who received invasive mechanical ventilation as treatment for acute respiratory failure due to COVID-19. As of June 18, 2020, for COVID-19 positive patients age 19+ requiring invasive mechanical ventilation (n = 10,873), 4,989 (46%) were discharged from the hospital, 5,215 (48%) died, and 669 (6%) remain in the hospital.

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Ventilator survival by age and sex

Patients with Multiple Positive COVID-19 Tests

Jeff Trinkl, MD, Melissa Gaisser, MS
Original Article: Data Analysis
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Figure 1. COVID-19 tested patients, by test result. Callout graph shows subsequent testing information for patients who tested positive for COVID-19.
Figure 1. COVID-19 tested patients, by test result. Callout graph shows subsequent testing information for patients who tested positive for COVID-19.

For numerous reasons, some patients are tested for SARS-CoV-2 virus multiple times, and a small percentage of patients test positive more than once. We were interested in better understanding how often patients undergo multiple tests, and what the time frame is between the first and last positive results. We speculate that fewer days between repeat…

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Figure 1. COVID-19 tested patients, by test result. Callout graph shows subsequent testing information for patients who tested positive for COVID-19.
Figure 1. COVID-19 tested patients, by test result. Callout graph shows subsequent testing information for patients who tested positive for COVID-19.

As Office Visits Fall, Telehealth Takes Hold

Bradley Fox, MD, J. Owen Sizemore, PhD
Original Article: Data Analysis
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Telehealth by condition – v2

Recent data show that, while overall visit volumes have decreased dramatically since the beginning of the COVID-19 pandemic in the United States, telehealth visits overall have increased 300-fold.1 This brief describes the diagnoses and specialties that saw the largest visit volumes of telehealth, with the goal of informing future strategy around telehealth.

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Telehealth by condition – v2

No Association Seen Between Vitamin D Deficiency and COVID-19 Infection, Hospitalization, or Mortality

Bradley Fox, MD, J. Owen Sizemore, PhD
Original Article: Data Analysis
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COVID-19 infection rate, hospitalization rate, and mortality rate by vitamin D status
Figure 1. Percentages of COVID-19 positive patients, hospitalizations, and deaths by vitamin D deficiency status.

A recent publication suggested patients’ vitamin D levels may impact the severity of their COVID-19 symptoms. EHR data for 28,185 patients for whom both COVID-19 disease status and vitamin D deficiency status were known show no statistically significant…

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COVID-19 infection rate, hospitalization rate, and mortality rate by vitamin D status
Figure 1. Percentages of COVID-19 positive patients, hospitalizations, and deaths by vitamin D deficiency status.

Effect of Comorbidities on Hospitalization and Death in COVID-19 Patients

Kieran Gallagher, MPH, Alejandro Munoz del Rio, PhD, and Others
Report
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Effect of COVID-19 on hospitalization and death by comorbidity
Figure 1: The light blue bars show higher or lower risk of hospitalization and death (using hazard ratios) for each comorbidity, controlling for age group, sex, and other comorbidities. For example, diabetics have a hazard ratio of 1.6 for hospitalization, which means that patients with diabetes are 60 percent more likely to be hospitalized compared to patients with the same age group, sex, and combination of comorbidities who don’t have diabetes. The dark blue lines indicate 95% confidence intervals, or the range that contains the true value with 95% certainty.

Using data from 190,194 COVID-19 patients, the following conditions were found to be most strongly associated with a higher risk of hospitalization and death: Heart failure, diabetes, a weakened immune system, COPD, and a BMI of 40 or higher…

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Effect of COVID-19 on hospitalization and death by comorbidity
Figure 1: The light blue bars show higher or lower risk of hospitalization and death (using hazard ratios) for each comorbidity, controlling for age group, sex, and other comorbidities. For example, diabetics have a hazard ratio of 1.6 for hospitalization, which means that patients with diabetes are 60 percent more likely to be hospitalized compared to patients with the same age group, sex, and combination of comorbidities who don’t have diabetes. The dark blue lines indicate 95% confidence intervals, or the range that contains the true value with 95% certainty.

Pediatric Immunizations Drop in the Wake of COVID-19

Original Article: Data Analysis
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Estimated missed or delayed immunizations during COVID-19 pandemic by patient age group

Recent EHR data show that immunization administrations for pediatric patients have decreased by 42% in the spring of 2020 compared to prior years. It is estimated that 260,000 immunizations expected for March 8-May 9 were missed or delayed across all age groups at sampled organizations. Patients under 6 months of age showed the smallest reduction…

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Estimated missed or delayed immunizations during COVID-19 pandemic by patient age group

Trends in Acute MI and Stroke in the ED During COVID-19

Original Article: Data Analysis
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Weekly Trend in AMI Presentation

As the COVID-19 pandemic continues, there are growing concerns that patients with urgent conditions are not seeking the care they need for fear of exposure to COVID-19. Recent EHR data show that the weekly incidence of acute myocardial infarctions (AMI), commonly known as heart attacks, has decreased by 45% since the United States declared a…

Race, Comorbidities, and COVID-19

Original Article: Data Analysis
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Comorbidities in COVID-19 hospitalizations and deaths: Aged 19-64 years, by race, compared to studied population
Table 1: Distribution of comorbidities by race for all sampled patients, COVID-19 positive hospitalized patients, and COVID-19 related deaths for patients aged 19-64 years. The “other” category contains the following groups: patients with a race documented as “other” in the EHR; patients without a documented race; and patients with a documented race that is not white or black, which have low sample sizes.

As coronavirus cases mount, racial minorities appear to be disproportionately affected by the pandemic. Across a sample population of 23 million patients across 16 states, 12% were black and 65% were white, but among the 108,000 of those patients who are documented COVID-19 positive, 22% were black and 46% were white. The root causes of…

Obesity and COVID-19 Severity

Original Article: Data Analysis
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Worst severity in COVID-19 patients by obesity class and age group

Severe obesity, defined as having a body mass index (BMI) of 40 kg/m2 or higher, has been identified by the CDC as a risk factor for more severe COVID-19 illness. This brief examines the relationship between obesity and severity of illness for adult COVID-19 positive patients. In this sample of 119,582 COVID-19 positive patients, 79% have a BMI documented in their electronic medical record…

COVID-19 Severity by Smoking Status

Original Article: Data Analysis
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COVID-19 outcomes by smoking status and age
Figure 1. COVID-19 worst severity by smoking status and age group. Some rows may not add to 100% due to rounding.

There has been recent conversation about the role that smoking status may play in severity of COVID-19 disease. To investigate this role, we examined the relationship between smoking status, as documented in the electronic health record, and general outcome severity of COVID-19 in a large national cohort of adult COVID-19 positive patients…

Prevalence of Comorbidities in COVID-19 Related Hospitalizations and Deaths

Original Article: Data Analysis
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Condition prevalence in adults in active patient population compared to adult national baselines
Table 1. Prevalence of examined conditions in adults in the active patient population as compared to national baselines.

COVID-19 hospitalization and mortality information were assessed in a sample of 36 million active patients.1 Nearly 10 million of those patients have documented hypertension, diabetes, chronic obstructive pulmonary disease (COPD), or moderate/severe asthma as of April 30, 2020. The summarized data were contributed by 31 health systems (300 hospitals) across 18 states. Table 1 shows…

Delayed Cancer Screenings

Original Article: Data Analysis
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Cancer screenings in the U.S. - Mean weekly screening volume for breast, colon, and cervical cancer
Figure 1. Weekly cancer screening volume vs. time for each type of cancer screening. Colored capsules show the last observed volume.

EHR data show a recent abrupt drop – between 86% and 94% – in preventive cancer screenings performed across the United States, presumably due to access disruptions caused by COVID-19. The data set includes 2.7 million patient records from 39 organizations that represent 190 hospitals spanning 23 states. If the trend continues, the data suggest that many cancer cases could go undiagnosed or be diagnosed at a later stage with a poorer prognosis…

Prior Outpatient Medications and Subsequent COVID-19 Positive Status

Original Article: Data Analysis
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Prior Outpatient Medications and Subsequent COVID-19 Positive Status
Figure 1: COVID-19 Positive Rate by Medication. See footnote for details.

As the COVID-19 pandemic sweeps the globe, there is a rush to find medications that, if taken before COVID-19 is acquired, may be protective against infection. Clinical trials are currently examining drugs in many different classes. Figure 1 shows the percentage of patients who acquire COVID-19 after taking each medication chronically…

COVID-19 Home Monitoring: The Role of Technology

Eric Boose, MD, Christopher Babiuch, MD, and Others
InnovatorsCleveland Clinic
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Cleveland Clinic Miller Family Pavillion
Cleveland Clinic Miller Family Pavillion

Story contributed by Cleveland Clinic. Never before has the need to leverage technology for population health management been more apparent. With the outbreak of COVID-19, consistent outreach and prompt intervention are necessary to prevent negative outcomes. Although patients with COVID-19 often experience mild symptoms, deterioration can be rapid, even in patients considered low risk. That’s…

NYU Langone Scientists Track Evolution of Virus

InnovatorsNYU Langone Health
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Genome sequencing holds clues about the progression of COVID-19 in New York City and offers hints about where to look next.
NYU Langone researchers are using the gene codes from COVID-19 samples to track the pandemic’s spread. This map uses color to represent countries, circle size to show the number of infections, and lines to illustrate transmission. (Photo courtesy of nextstrain.org)

Researchers at NYU Langone have sequenced the genetic code of samples from 91 COVID-19 patients in New York City, seeking clues to its origin and evolution in this region. Early data suggest that the virus has been spreading in the city for two months, before testing started. The findings also indicate the New York City…

COVID-19 Population Characteristics: Age and Sex

Original Article: Data Analysis
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COVID-19 testing rates by age and sex, compared to the overall population
Figure 1. COVID-19 testing rates by age group and sex

Investigators examined which patient populations are most likely to be tested for COVID-19, test positive for COVID-19, and have the most severe outcomes. The analysis below includes 165,359 patients tested for COVID-19 and 66,017 COVID-19 positive patients as of April 17, 2020. Data are pooled from 22 health systems that represent 140 hospitals, spanning 11…

Ibuprofen and COVID-19 Severity

Original Article: Data Analysis
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Worst severity probability by prior ibuprofen prescription by age and sex

Investigators examined whether patients who were prescribed ibuprofen before they were infected with COVID-19 showed a difference in disease severity. Patients who were prescribed ibuprofen before infection had less severe outcomes. This appeared to be the case regardless of sex or age group. We include patients in the “prescribed ibuprofen” group if they had a…