Publications by authors named "Jason Zucker"

64 Publications

Placental response to maternal SARS-CoV-2 infection.

Sci Rep 2021 07 13;11(1):14390. Epub 2021 Jul 13.

Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 204 Craft Avenue, Pittsburgh, PA, 15213, USA.

The coronavirus disease 2019 (COVID-19) pandemic affected people at all ages. Whereas pregnant women seemed to have a worse course of disease than age-matched non-pregnant women, the risk of feto-placental infection is low. Using a cohort of 66 COVID-19-positive women in late pregnancy, we correlated clinical parameters with disease severity, placental histopathology, and the expression of viral entry and Interferon-induced transmembrane (IFITM) antiviral transcripts. All newborns were negative for SARS-CoV-2. None of the demographic parameters or placental histopathological characteristics were associated with disease severity. The fetal-maternal transfer ratio for IgG against the N or S viral proteins was commonly less than one, as recently reported. We found that the expression level of placental ACE2, but not TMPRSS2 or Furin, was higher in women with severe COVID-19. Placental expression of IFITM1 and IFITM3, which have been implicated in antiviral response, was higher in participants with severe disease. We also showed that IFITM3 protein expression, which localized to early and late endosomes, was enhanced in severe COVID-19. Our data suggest an association between disease severity and placental SARS-CoV-2 processing and antiviral pathways, implying a role for these proteins in placental response to SARS-CoV-2.
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http://dx.doi.org/10.1038/s41598-021-93931-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277865PMC
July 2021

What's in a Summary? Laying the Groundwork for Advances in Hospital-Course Summarization.

Proc Conf 2021 Jun;2021:4794-4811

Columbia University, New York, NY.

Summarization of clinical narratives is a long-standing research problem. Here, we introduce the task of hospital-course summarization. Given the documentation authored throughout a patient's hospitalization, generate a paragraph that tells the story of the patient admission. We construct an English, text-to-text dataset of 109,000 hospitalizations (2M source notes) and their corresponding summary proxy: the clinician-authored "Brief Hospital Course" paragraph written as part of a discharge note. Exploratory analyses reveal that the BHC paragraphs are highly abstractive with some long extracted fragments; are concise yet comprehensive; differ in style and content organization from the source notes; exhibit minimal lexical cohesion; and represent silver-standard references. Our analysis identifies multiple implications for modeling this complex, multi-document summarization task.
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http://dx.doi.org/10.18653/v1/2021.naacl-main.382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225248PMC
June 2021

Attitudes and Perceived Barriers to Sexually Transmitted Infection Screening Among Graduate Medical Trainees.

Sex Transm Dis 2021 Feb 11. Epub 2021 Feb 11.

1 Department of Medicine, Division of Infectious Disease, Columbia University Irving Medical Center 2New York-Presbyterian Hospital 3Aaron Diamond AIDS Research Center at Vagelos College of Physicians and Surgeons 4 Department of Internal Medicine, Columbia University Irving Medical Center 5Department of Pediatrics, Columbia University Irving Medical Center 6HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute.

Graduate medical training is an opportune time to improve provider delivery of STI screening. A survey of trainees found that the majority feel sexually transmitted infection screening is their job but identified barriers to successful screening. Training that intentionally address service-specific barriers will be valuable in ending the STI epidemic.
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http://dx.doi.org/10.1097/OLQ.0000000000001396DOI Listing
February 2021

Characterization of Bacterial and Fungal Infections in Hospitalized Patients With Coronavirus Disease 2019 and Factors Associated With Health Care-Associated Infections.

Open Forum Infect Dis 2021 Jun 5;8(6):ofab201. Epub 2021 May 5.

Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA.

Background: Patients hospitalized with coronavirus disease 2019 (COVID-19) are at increased risk of health care-associated infections (HAIs), especially with prolonged hospital stays. We sought to identify incidence, antimicrobial susceptibilities, and outcomes associated with bacterial/fungal secondary infections in a large cohort of patients with COVID-19.

Methods: We evaluated adult patients diagnosed with COVID-19 between 2 March and 31 May 2020 and hospitalized >24 hours. Data extracted from medical records included diagnoses, vital signs, laboratory results, microbiological data, and antibiotic use. Microbiologically confirmed bacterial and fungal pathogens from clinical cultures were evaluated to characterize community- and health care-associated infections, including describing temporal changes in predominant organisms on presentation and throughout hospitalization. Univariable and multivariable logistic regression analyses were performed to investigate risk factors for HAIs.

Results: A total of 3028 patients were included and accounted for 899 positive clinical cultures. Overall, 516 (17%) patients with positive cultures met criteria for infection. Community-associated coinfections were identified in 183 (6%) patients, whereas HAIs occurred in 350 (12%) patients. Fifty-seven percent of HAIs were caused by gram-negative bacteria and 19% by fungi. Antibiotic resistance increased with longer hospital stays, with incremental increases in the proportion of vancomycin resistance among enterococci and ceftriaxone and carbapenem resistance among Enterobacterales. Intensive care unit stay, invasive mechanical ventilation, and steroids were associated with HAIs.

Conclusions: HAIs occur in a small proportion of patients hospitalized with COVID-19 and are most often caused by gram-negative and fungal pathogens. Antibiotic resistance is more prevalent with prolonged hospital stays. Antimicrobial stewardship is imperative in this population to minimize unnecessary broad-spectrum antibiotic use.
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http://dx.doi.org/10.1093/ofid/ofab201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135866PMC
June 2021

Clinical Significance of Positive Results of the BioFire Cerebrospinal Fluid FilmArray Meningitis/Encephalitis Panel at a Tertiary Medical Center in the United States.

Arch Pathol Lab Med 2021 Jun 4. Epub 2021 Jun 4.

From the Division of Critical Care and Hospitalist Neurology, Department of Neurology (Waldrop, Radmard, Thakur), Columbia University Irving Medical Center, New York, New York.

Context.—: The FilmArray Meningitis/Encephalitis (ME) panel is the first US Food and Drug Administration-cleared multiplex polymerase chain reaction panel for the detection of central nervous system infections. While the assay's performance characteristics have been described, the real-world significance of positive results has not been fully characterized.

Objective.—: To evaluate the clinical significance of positive ME panel results in a tertiary care medical center in New York, New York.

Design.—: Four physicians independently performed retrospective clinical assessments of all positive ME panel results at Columbia University Irving Medical Center, including the Children's Hospital of New York, during an 18-month period. Each reviewer determined the likelihood of central nervous system infection for all cases and whether cases fit Brighton diagnostic criteria for meningitis, encephalitis, or meningoencephalitis.

Results.—: Among 119 cases, there was 75% positive agreement (95% CI, 54%-89%) between ME panel results and clinical consensus, which varied among panel targets.

Conclusions.—: The ME panel showed good agreement with expert clinical consensus for patients presenting with acute meningitis/encephalitis. Factors contributing to clinically insignificant ME positive results included low pretest probability, traumatic lumbar puncture, specimen contamination, and detection of incidental viral targets such as human herpesvirus 6. Notably, the ME panel detected more than twice the number of cases of bacterial meningitis detected by culture alone, particularly among patients receiving empiric antimicrobial therapy before lumbar puncture. Appropriate test use and contextual interpretation of results are critical to leveraging the advantages of the platform while avoiding potential pitfalls.
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http://dx.doi.org/10.5858/arpa.2020-0380-OADOI Listing
June 2021

Characterising the long-term clinical outcomes of 1190 hospitalised patients with COVID-19 in New York City: a retrospective case series.

BMJ Open 2021 06 2;11(6):e049488. Epub 2021 Jun 2.

Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA.

Objective: To characterise the long-term outcomes of patients with COVID-19 admitted to a large New York City medical centre at 3 and 6 months after hospitalisation and describe their healthcare usage, symptoms, morbidity and mortality.

Design: Retrospective cohort through manual chart review of the electronic medical record.

Setting: NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical centre in New York City.

Participants: The first 1190 consecutive patients with symptoms of COVID-19 who presented to the hospital for care between 1 March and 8 April 2020 and tested positive for SARS-CoV-2 on reverse transcriptase PCR assay.

Main Outcome Measures: Type and frequency of follow-up encounters, self-reported symptoms, morbidity and mortality at 3 and 6 months after presentation, respectively; patient disposition information prior to admission, at discharge, and at 3 and 6 months after hospital presentation.

Results: Of the 1190 reviewed patients, 929 survived their initial hospitalisation and 261 died. Among survivors, 570 had follow-up encounters (488 at 3 months and 364 at 6 months). An additional 33 patients died in the follow-up period. In the first 3 months after admission, most encounters were telehealth visits (59%). Cardiopulmonary symptoms (35.7% and 28%), especially dyspnoea (22.1% and 15.9%), were the most common reported symptoms at 3-month and 6-month encounters, respectively. Additionally, a large number of patients reported generalised (26.4%) or neuropsychiatric (24.2%) symptoms 6 months after hospitalisation. Patients with severe COVID-19 were more likely to have reduced mobility, reduced independence or a new dialysis requirement in the 6 months after hospitalisation.

Conclusions: Patients hospitalised with SARS-CoV-2 infection reported persistent symptoms up to 6 months after diagnosis. These results highlight the long-term morbidity of COVID-19 and its burden on patients and healthcare resources.
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http://dx.doi.org/10.1136/bmjopen-2021-049488DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182750PMC
June 2021

Outcomes of COVID-19 in solid organ transplant recipients: A matched cohort study.

Transpl Infect Dis 2021 May 16:e13637. Epub 2021 May 16.

Department of Medicine, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY, USA.

Whether solid organ transplant (SOT) recipients are at increased risk of poor outcomes due to COVID-19 in comparison to the general population remains uncertain. In this study, we compared outcomes of SOT recipients and non-SOT patients hospitalized with COVID-19 in a propensity score matched analysis based on age, race, ethnicity, BMI, diabetes, and hypertension. After propensity matching, 117 SOT recipients and 350 non-SOT patients were evaluated. The median age of SOT recipients was 61 years, with a median time from transplant of 5.68 years. The most common transplanted organs were kidney (48%), followed by lung (21%), heart (19%), and liver (10%). Overall, SOT recipients were more likely to receive COVID-19 specific therapies and to require ICU admission. However, mortality (23.08% in SOT recipients vs. 23.14% in controls, P = .21) and highest level of supplemental oxygen (P = .32) required during hospitalization did not significantly differ between groups. In this propensity matched cohort study, SOT recipients hospitalized with COVID-19 had similar overall outcomes as non-SOT recipients, suggesting that chronic immunosuppression may not be an independent risk factor for poor outcomes in COVID-19.
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http://dx.doi.org/10.1111/tid.13637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209880PMC
May 2021

Attitudes and Perceived Barriers to Routine HIV Screening and Provision and Linkage of Postexposure Prophylaxis and Pre-Exposure Prophylaxis Among Graduate Medical Trainees.

AIDS Patient Care STDS 2021 05 23;35(5):180-187. Epub 2021 Apr 23.

Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.

New York City is the metropolitan area in the United States with the highest number of new HIV diagnoses nationwide. The End-The-Epidemic (EtE) initiative calls for identifying persons with HIV who remain undiagnosed, linking and retaining persons living with HIV to maximize viral suppression, and facilitate access to pre-exposure prophylaxis (PrEP) for patients at increased risk of HIV. HIV screening represents the first step to both the primary and secondary HIV prevention cascades. We conducted an online, anonymous, cross-sectional survey of residents at all stages of training within four residency programs at one institution in Northern Manhattan between August 2017 and August 2018. All internal medicine, emergency medicine, obstetrics and gynecology trainees, and pediatrics were invited to complete the survey via email. Of 298 eligible trainees, 142 (48%) completed the survey. Most trainees were aware of the HIV testing law and agreed that HIV testing was their responsibility, but few successfully screened most of their patients. Most trainees were not knowledgeable about non-occupational post-exposure prophylaxis (nPEP) or PrEP, but felt that it was important to provide these services across settings. Barriers to HIV, nPEP, and PrEP varied across specialties. Ending the HIV epidemic will require efforts across clinical specialties. In this survey from an EtE jurisdiction, most trainees felt that it is important to provide HIV prevention services in most settings; however, their knowledge and comfort with HIV prevention services other than testing were low. Barriers varied across specialties, and developing specialty-specific materials for trainees may be beneficial.
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http://dx.doi.org/10.1089/apc.2021.0029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106251PMC
May 2021

Cardiac Corrected QT Interval Changes Among Patients Treated for COVID-19 Infection During the Early Phase of the Pandemic.

JAMA Netw Open 2021 04 1;4(4):e216842. Epub 2021 Apr 1.

Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.

Importance: Critical illness, a marked inflammatory response, and viruses such as SARS-CoV-2 may prolong corrected QT interval (QTc).

Objective: To evaluate baseline QTc interval on 12-lead electrocardiograms (ECGs) and ensuing changes among patients with and without COVID-19.

Design, Setting, And Participants: This cohort study included 3050 patients aged 18 years and older who underwent SARS-CoV-2 testing and had ECGs at Columbia University Irving Medical Center from March 1 through May 1, 2020. Patients were analyzed by treatment group over 5 days, as follows: hydroxychloroquine with azithromycin, hydroxychloroquine alone, azithromycin alone, and neither hydroxychloroquine nor azithromycin. ECGs were manually analyzed by electrophysiologists masked to COVID-19 status. Multivariable modeling evaluated clinical associations with QTc prolongation from baseline.

Exposures: COVID-19, hydroxychloroquine, azithromycin.

Main Outcomes And Measures: Mean QTc prolongation, percentage of patients with QTc of 500 milliseconds or greater.

Results: A total of 965 patients had more than 2 ECGs and were included in the study, with 561 (58.1%) men, 198 (26.2%) Black patients, and 191 (19.8%) aged 80 years and older. There were 733 patients (76.0%) with COVID-19 and 232 patients (24.0%) without COVID-19. COVID-19 infection was associated with significant mean QTc prolongation from baseline by both 5-day and 2-day multivariable models (5-day, patients with COVID-19: 20.81 [95% CI, 15.29 to 26.33] milliseconds; P < .001; patients without COVID-19: -2.01 [95% CI, -17.31 to 21.32] milliseconds; P = .93; 2-day, patients with COVID-19: 17.40 [95% CI, 12.65 to 22.16] milliseconds; P < .001; patients without COVID-19: 0.11 [95% CI, -12.60 to 12.81] milliseconds; P = .99). COVID-19 infection was independently associated with a modeled mean 27.32 (95% CI, 4.63-43.21) millisecond increase in QTc at 5 days compared with COVID-19-negative status (mean QTc, with COVID-19: 450.45 [95% CI, 441.6 to 459.3] milliseconds; without COVID-19: 423.13 [95% CI, 403.25 to 443.01] milliseconds; P = .01). More patients with COVID-19 not receiving hydroxychloroquine and azithromycin had QTc of 500 milliseconds or greater compared with patients without COVID-19 (34 of 136 [25.0%] vs 17 of 158 [10.8%], P = .002). Multivariable analysis revealed that age 80 years and older compared with those younger than 50 years (mean difference in QTc, 11.91 [SE, 4.69; 95% CI, 2.73 to 21.09]; P = .01), severe chronic kidney disease compared with no chronic kidney disease (mean difference in QTc, 12.20 [SE, 5.26; 95% CI, 1.89 to 22.51; P = .02]), elevated high-sensitivity troponin levels (mean difference in QTc, 5.05 [SE, 1.19; 95% CI, 2.72 to 7.38]; P < .001), and elevated lactate dehydrogenase levels (mean difference in QTc, 5.31 [SE, 2.68; 95% CI, 0.06 to 10.57]; P = .04) were associated with QTc prolongation. Torsades de pointes occurred in 1 patient (0.1%) with COVID-19.

Conclusions And Relevance: In this cohort study, COVID-19 infection was independently associated with significant mean QTc prolongation at days 5 and 2 of hospitalization compared with day 0. More patients with COVID-19 had QTc of 500 milliseconds or greater compared with patients without COVID-19.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.6842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065381PMC
April 2021

What about tocilizumab? A retrospective study from a NYC Hospital during the COVID-19 outbreak.

PLoS One 2021 8;16(4):e0249349. Epub 2021 Apr 8.

Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America.

Background: Tocilizumab, an interleukin-6 receptor blocker, has been used in the inflammatory phase of COVID-19, but its impact independent of corticosteroids remains unclear in patients with severe disease.

Methods: In this retrospective analysis of patients with COVID-19 admitted between March 2 and April 14, 2020 to a large academic medical center in New York City, we describe outcomes associated with tocilizumab 400 mg (without methylprednisolone) compared to a propensity-matched control. The primary endpoints were change in a 7-point ordinal scale of oxygenation and ventilator free survival, both at days 14 and 28. Secondary endpoints include incidence of bacterial superinfections and gastrointestinal perforation. Primary outcomes were evaluated using t-test.

Results: We identified 33 patients who received tocilizumab and matched 74 controls based on demographics and health measures upon admission. After adjusting for illness severity and baseline ordinal scale, we failed to find evidence of an improvement in hypoxemia based on an ordinal scale at hospital day 14 in the tocilizumab group (OR 2.2; 95% CI, 0.7-6.5; p = 0.157) or day 28 (OR 1.1; 95% CI, 0.4-3.6; p = 0.82). There also was no evidence of an improvement in ventilator-free survival at day 14 (OR 0.8; 95% CI, 0.18-3.5; p = 0.75) or day 28 (OR 1.1; 95% CI, 0.1-1.8; p = 0.23). There was no increase in secondary bacterial infection rates in the tocilizumab group compared to controls (OR 0.37; 95% CI, 0.09-1.53; p = 0.168).

Conclusions: There was no evidence to support an improvement in hypoxemia or ventilator-free survival with use of tocilizumab 400 mg in the absence of corticosteroids. No increase in secondary bacterial infections was observed in the group receiving tocilizumab.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249349PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8031323PMC
April 2021

A Novel and Expanding SARS-CoV-2 Variant, B.1.526, Identified in New York.

medRxiv 2021 Jun 12. Epub 2021 Jun 12.

Division of Infectious Diseases, Department of Internal Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.

Recent months have seen surges of SARS-CoV-2 infection across the globe along with considerable viral evolution. Extensive mutations in the spike protein may threaten efficacy of vaccines and therapeutic monoclonal antibodies. Two signature mutations of concern are E484K, which plays a crucial role in the loss of neutralizing activity of antibodies, and N501Y, a driver of rapid worldwide transmission of the B.1.1.7 lineage. Here, we report the emergence of a novel variant lineage B.1.526 that contains E484K and its alarming rise to dominance in New York City in recent months. This variant is partially or completely resistant to two therapeutic monoclonal antibodies in clinical use. It is also less susceptible to neutralization by convalescent plasma or vaccinee sera, posing a modest antigenic challenge. The B.1.526 lineage has now been reported from all 50 states in the US and numerous other countries. B.1.526 has rapidly replaced non-variant lineages in New York, with an estimated transmission advantage of 35%. Although B.1.526 initially outpaced B.1.1.7 in the region, its growth has slowed concurrent with the rise of B.1.1.7. In states surrounding New York, B.1.526 continues to increase where B.1.1.7 has not yet reached dominance, persistently replacing non-variant lineages. Such transmission dynamics, together with the relative antibody resistance of its E484K sub-lineage, would warrant consideration of B.1.526 as a SARS-CoV-2 variant of concern.
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http://dx.doi.org/10.1101/2021.02.23.21252259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924303PMC
June 2021

Cycle Thresholds Among Solid Organ Transplant Recipients Testing Positive for SARS-CoV-2.

Transplantation 2021 07;105(7):1445-1448

Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY.

Background: The optimal duration of transmission-based precautions among immunocompromised patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown.

Methods: Retrospective review of patients with solid organ transplant with positive SARS-CoV-2 polymerase chain reaction result from nasopharyngeal specimens admitted to the hospital between March 13, 2020 and May 15, 2020.

Results: Twenty-one percent of solid organ transplant recipients with positive SARS-CoV-2 polymerase chain reaction detected ≥20 d after symptom onset (or after first positive test among asymptomatic individuals) had a low cycle threshold (ie, high viral load). The majority of these patients were asymptomatic or symptomatically improved.

Conclusions: Solid organ transplant recipients may have prolonged high viral burden of SARS-CoV-2. Further data are needed to understand whether cycle threshold data can help inform strategies for prevention of healthcare-associated transmission of SARS-CoV-2 and for appropriate discontinuation of transmission-based precautions.
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http://dx.doi.org/10.1097/TP.0000000000003695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8222146PMC
July 2021

HIV-1 Infection Does Not Change Disease Course or Inflammatory Pattern of SARS-CoV-2-Infected Patients Presenting at a Large Urban Medical Center in New York City.

Open Forum Infect Dis 2021 Feb 28;8(2):ofab029. Epub 2021 Jan 28.

Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA.

Background: The clinical impact of coronavirus disease 2019 (COVID-19) among people with HIV (PWH) remains unclear. In this retrospective cohort study of COVID-19, we compared clinical outcomes and laboratory parameters among PWH and controls.

Methods: Sixty-eight PWH diagnosed with COVID-19 were matched 1:4 to patients without known HIV diagnosis, drawn from a study population of all patients who were diagnosed with COVID-19 at an academic urban hospital. The primary outcome was death/discharge to hospice within 30 days of hospital presentation.

Results: PWH were more likely to be admitted from the emergency department than patients without HIV (91% vs 71%;  = .001). We observed no statistically significant difference between admitted PWH and patients without HIV in terms of 30-day mortality rate (19% vs 13%, respectively) or mechanical ventilation rate (18% vs 20%, respectively). PWH had higher erythrocyte sedimentation rates than controls on admission but did not differ in other inflammatory marker levels or nasopharyngeal/oropharyngeal severe acute respiratory syndrome coronavirus 2 viral load estimated by reverse transcriptase polymerase chain reaction cycle thresholds.

Conclusions: HIV infection status was associated with a higher admission rate; however, among hospitalized patients, PWH did not differ from HIV-uninfected controls by rate of mechanical ventilation or death/discharge to hospice.
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http://dx.doi.org/10.1093/ofid/ofab029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880266PMC
February 2021

Pretest Symptom Duration and Cycle Threshold Values for Severe Acute Respiratory Syndrome Coronavirus 2 Reverse-Transcription Polymerase Chain Reaction Predict Coronavirus Disease 2019 Mortality.

Open Forum Infect Dis 2021 Feb 4;8(2):ofab003. Epub 2021 Jan 4.

Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA.

Background: The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and patient symptom duration in both in- and outpatients, and the impact of these factors on patient outcomes, are currently unknown. Understanding these associations is important to clinicians caring for patients with coronavirus disease 2019 (COVID-19).

Methods: We conducted an observational study between March 10 and May 30, 2020 at a large quaternary academic medical center in New York City. Patient characteristics, laboratory values, and clinical outcomes were abstracted from the electronic medical records. Of all patients tested for SARS-CoV-2 during this time (N = 16 384), there were 5467 patients with positive tests, 4254 of which had available cycle threshold (Ct) values and were included in further analysis. Univariable and multivariable logistic regression models were used to test associations between Ct values, duration of symptoms before testing, patient characteristics, and mortality. The primary outcome is defined as death or discharge to hospice.

Results: Lower Ct values at diagnosis (ie, higher viral load) were associated with significantly higher mortality among both in- and outpatients. It is interesting to note that patients with a shorter time since the onset of symptoms to testing had a worse prognosis, with those presenting less than 3 days from symptom onset having 2-fold increased odds of death. After adjusting for time since symptom onset and other clinical covariates, Ct values remained a strong predictor of mortality.

Conclusions: Severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction Ct value and duration of symptoms are strongly associated with mortality. These 2 factors add useful information for clinicians to risk stratify patients presenting with COVID-19.
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http://dx.doi.org/10.1093/ofid/ofab003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7798567PMC
February 2021

Limited Utility of Procalcitonin in Identifying Community-Associated Bacterial Infections in Patients Presenting with Coronavirus Disease 2019.

Antimicrob Agents Chemother 2021 03 18;65(4). Epub 2021 Mar 18.

Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA

The role of procalcitonin in identifying community-associated bacterial infections among patients with coronavirus disease 2019 is not yet established. In 2,443 patients of whom 148 had bacterial coinfections, mean procalcitonin levels were significantly higher with any bacterial infection (13.16 ± 51.19 ng/ml; = 0.0091) and with bacteremia (34.25 ± 85.01 ng/ml; = 0.0125) than without infection (2.00 ± 15.26 ng/ml). Procalcitonin (cutoff, 0.25 or 0.50 ng/ml) did not reliably identify bacterial coinfections but may be useful in excluding bacterial infection.
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http://dx.doi.org/10.1128/AAC.02167-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097424PMC
March 2021

Prevalence of Clostridioides difficile and Other Gastrointestinal Pathogens in Patients with COVID-19.

Dig Dis Sci 2021 Jan 22. Epub 2021 Jan 22.

Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian Columbia University Medical Center, New York, NY, USA.

Background: Gastrointestinal symptoms are common in patients with COVID-19, but prevalence of co-infection with enteric pathogens is unknown.

Aims: This study assessed the prevalence of enteric infections among hospitalized patients with COVID-19.

Methods: We evaluated 4973 hospitalized patients ≥ 18 years of age tested for COVID-19 from March 11 through April 28, 2020, at two academic hospitals. The primary exposure was a positive COVID-19 test. The primary outcome was detection of a gastrointestinal pathogen by PCR stool testing.

Results: Among 4973 hospitalized individuals, 311 were tested for gastrointestinal infections (204 COVID-19 positive, 107 COVID-19 negative). Patients with COVID-19 were less likely to test positive compared to patients without COVID-19 (10% vs 22%, p < 0.01). This trend was driven by lower rates of non-C.difficile infections (11% vs 22% in COVID-19 positive vs. negative, respectively, p = 0.04), but not C. difficile infection (5.1% vs. 8.2%, p = 0.33). On multivariable analysis, infection with COVID-19 remained significantly associated with lower odds of concurrent GI infection (aOR 0.49, 95% CI 0.24-0.97), again driven by reduced non-C.difficile infection. Testing for both C.difficile and non-C.difficile enteric infection decreased dramatically during the pandemic.

Conclusions: Pathogens aside from C.difficile do not appear to be a significant contributor to diarrhea in COVID-19 positive patients.
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http://dx.doi.org/10.1007/s10620-020-06760-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819769PMC
January 2021

Clinical and Demographic Characteristics of HIV Post-Exposure Prophylaxis Users in New York City.

J Health Care Poor Underserved 2020 ;31(2):672-681

Incidence of HIV infection remains high in New York City and, while considerable attention has been paid to the scale-up of pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP) plays an important role in the HIV prevention continuum. We conducted a retrospective analysis of clinical and demographic characteristics of individuals receiving HIV post-exposure prophylaxis at a large academic medical center in northern Manhattan. Post-exposure prophylaxis users were predominantly Latinx (52.8%) and/or African American (33.7%) men who have sex with men (72%), representing the underserved groups at highest risk of HIV infection. Many individuals (20%) requiring PEP presented to their clinician seeking initiation of PrEP. Frequent PEP users may be good candidates for PrEP but psychosocial barriers such as home environment and recreational drug use must be addressed for successful transitions. Patient counseling for at-risk groups should involve both PEP and PrEP screening and must be sensitized to the needs and cultures of the communities they serve.
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http://dx.doi.org/10.1353/hpu.2020.0053DOI Listing
January 2020

Vitamin D Status and COVID-19 Clinical Outcomes in Hospitalized Patients.

Endocr Res 2021 Feb-May;46(2):66-73. Epub 2020 Dec 30.

Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, USA.

: Populations severely affected by COVID-19 are also at risk for vitamin D deficiency. Common risk factors include older age, chronic illness, obesity, and non-Caucasian race. Vitamin D deficiency has been associated with risk for respiratory infections and failure, susceptibility and response to therapy for enveloped virus infection, and immune-mediated inflammatory reaction.: To test the hypothesis that 25-hydroxyvitamin D[25(OH)D] deficiency is a risk factor for severity of COVID-19 respiratory and inflammatory complications.: We examined the relationship between prehospitalization 25(OH)D levels (obtained 1-365 days prior to admission) and COVID-19 clinical outcomes in 700 COVID-19 positive hospitalized patients.: Discharge status, mortality, length of stay, intubation status, renal replacement.: Inflammatory markers.: 25(OH)D levels were available in 93 patients [25(OH)D:25(IQR:17-33)ng/mL]. Compared to those without 25(OH)D levels, those with measurements did not differ in age, BMI or distribution of sex and race, but were more likely to have comorbidities. Those with 25(OH)D < 20 ng/mL (n = 35) did not differ from those with 25(OH)D ≥ 20 ng/mL in terms of age, sex, race, BMI, or comorbidities. Low 25(OH)D tended to be associated with younger age and lower frequency of preexisting pulmonary disease. There were no significant between-group differences in any outcome. Results were similar in those ≥50 years, in male/female-only cohorts, and when differing 25(OH)D thresholds were used (<15 ng/mL and <30 ng/mL). There was no relationship between 25(OH)D as a continuous variable and any outcome, even after controlling for age and pulmonary disease.: These preliminary data do not support a relationship between prehospitalization vitamin D status and COVID-19 clinical outcomes.
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http://dx.doi.org/10.1080/07435800.2020.1867162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784779PMC
April 2021

High rate of renal recovery in survivors of COVID-19 associated acute renal failure requiring renal replacement therapy.

PLoS One 2020 28;15(12):e0244131. Epub 2020 Dec 28.

Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.

Introduction: A large proportion of patients with COVID-19 develop acute kidney injury (AKI). While the most severe of these cases require renal replacement therapy (RRT), little is known about their clinical course.

Methods: We describe the clinical characteristics of COVID-19 patients in the ICU with AKI requiring RRT at an academic medical center in New York City and followed patients for outcomes of death and renal recovery using time-to-event analyses.

Results: Our cohort of 115 patients represented 23% of all ICU admissions at our center, with a peak prevalence of 29%. Patients were followed for a median of 29 days (2542 total patient-RRT-days; median 54 days for survivors). Mechanical ventilation and vasopressor use were common (99% and 84%, respectively), and the median Sequential Organ Function Assessment (SOFA) score was 14. By the end of follow-up 51% died, 41% recovered kidney function (84% of survivors), and 8% still needed RRT (survival probability at 60 days: 0.46 [95% CI: 0.36-0.56])). In an adjusted Cox model, coronary artery disease and chronic obstructive pulmonary disease were associated with increased mortality (HRs: 3.99 [95% CI 1.46-10.90] and 3.10 [95% CI 1.25-7.66]) as were angiotensin-converting-enzyme inhibitors (HR 2.33 [95% CI 1.21-4.47]) and a SOFA score >15 (HR 3.46 [95% CI 1.65-7.25).

Conclusions And Relevance: Our analysis demonstrates the high prevalence of AKI requiring RRT among critically ill patients with COVID-19 and is associated with a high mortality, however, the rate of renal recovery is high among survivors and should inform shared-decision making.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244131PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769434PMC
January 2021

Women Are Less Likely to Be Tested for HIV or Offered Preexposure Prophylaxis at the Time of Sexually Transmitted Infection Diagnosis.

Sex Transm Dis 2021 01;48(1):32-36

Department of Internal Medicine, Division of Infectious Diseases.

Background: Ending the HIV epidemic requires linkage of at-risk individuals from diverse health care settings to comprehensive HIV prevention services. Sexually transmitted infections (STIs) are significant biomarkers of HIV risk and should trigger preexposure prophylaxis (PrEP) discussion. We reviewed STI testing practices outside of sexual health clinics to identify opportunities for improvement in the provision of HIV prevention services.

Methods: An electronic sexual health dashboard was used to identify patient encounters with a positive gonorrhea, chlamydia, and/or rapid plasma reagin test result between January 1, 2019, and August 23, 2019, at a large urban academic medical center. A retrospective chart review was performed to assess HIV testing, completeness of STI screening, and HIV prevention discussion; inadequate screening was defined as no HIV test in 12 months before STI diagnosis.

Results: A total of 815 patients with 856 patient encounters were included. Patients were predominantly female (64.4%); median age was 24 years (range, 18-85 years). The most common test and most common positive test result was the genitourinary gonorrhea/chlamydia nucleic acid amplification test. Multisite testing was rare (7.5% of patient encounters) and performed more frequently in men than in women (20.3% vs. 0.36%). Women were also more likely to be inadequately screened for HIV (15.1% vs. 25.8%).Documentation of PrEP discussion was rare (4.7% of patient encounters) compared with safe sex (44.6%) and condoms (49.8%). Preexposure prophylaxis was discussed almost exclusively with men compared with women (17% vs. 1.1%).

Conclusions: In patients diagnosed with bacterial STI outside of sexual health clinics, gaps in HIV prevention exist. HIV screening, multisite STI screening, and discussion of PrEP were particularly infrequent among women.
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http://dx.doi.org/10.1097/OLQ.0000000000001265DOI Listing
January 2021

The Stairway to Antibiotic Heaven: A Scaffolded Video Series on Empiric Antibiotic Selection for Fourth-Year Medical Students.

MedEdPORTAL 2020 11 30;16:11036. Epub 2020 Nov 30.

Associate Professor, Department of Medicine and Epidemiology, Columbia University Irving Medical Center.

Introduction: Inappropriate antibiotic use and spread of resistance is a well-known problem, and medical students have indicated they want additional education on appropriate use of antimicrobials. We introduced a series of short whiteboard animation videos on empiric antibiotic selection as a supplemental resource for fourth-year medical students during a transition to residency course.

Methods: A total of eight whiteboard animation videos on empiric antibiotic selection were created using Camtasia. The video series started with the narrowest spectrum antibiotic discussed and progressed up an antibiotic ladder to broader spectrum antibiotics. Questions were embedded in each video. Students were offered a pretest prior to viewing the video series as well as a posttest after completing the video series. After each individual video, students were offered a postvideo survey with Likert-scaled questions evaluating student perceptions of the video. All tests and surveys were anonymous. Scores of pre- and posttests were compared with unpaired tests.

Results: We received 37 pretests and 14 posttests. The average score on the pretest was 66% compared with 93% on the posttest ( <.0001; 95% CI 16.78, 37.93). Seventy-two postvideo surveys were completed across all videos. Of student responses, 100% either agreed or strongly agreed that the evaluated module was an effective way to learn the material.

Discussion: Our results suggested that this scaffolded, interactive video animation series on antibiotic spectrum and selection was an effective learning activity.
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http://dx.doi.org/10.15766/mep_2374-8265.11036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703485PMC
November 2020

Cerebrospinal Analysis in Patients With COVID-19.

Open Forum Infect Dis 2020 Nov 18;7(11):ofaa501. Epub 2020 Oct 18.

Department of Neurology, Columbia University Irving Medical Center (CUIMC)/New York Presbyterian Hospital, New York, New York, USA.

Background: Assessment of the impact of cerebrospinal fluid (CSF) analysis including investigation for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for the optimization of patient care.

Methods: In this case series, we review patients diagnosed with SARS-CoV-2 undergoing lumbar puncture (LP) admitted to Columbia University Irving Medical Center (New York, NY, USA) from March 1 to May 26, 2020. In a subset of patients, CSF SARS-CoV-2 quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) testing is performed.

Results: The average age of 27 patients who underwent LP with definitive SARS-CoV-2 (SD) was 37.5 (28.7) years. CSF profiles showed elevated white blood cell counts and protein in 44% and 52% of patients, respectively. LP results impacted treatment decisions in 10 (37%) patients, either by change of antibiotics, influence in disposition decision, or by providing an alternative diagnosis. CSF SARS-CoV-2 qRT-PCR was performed on 8 (30%) patients, with negative results in all samples.

Conclusions: Among patients diagnosed with SARS-CoV-2, CSF results changed treatment decisions or disposition in over one-third of our patient cohort. CSF was frequently abnormal, though CSF SARS-CoV-2 qRT-PCR was negative in all samples. Further studies are required to define whether CSF SARS-CoV-2 testing is warranted in certain clinical contexts.
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http://dx.doi.org/10.1093/ofid/ofaa501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665724PMC
November 2020

Blood component utilization in COVID-19 patients in New York City: Transfusions do not follow the curve.

Transfusion 2021 03 20;61(3):692-698. Epub 2020 Nov 20.

Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA.

Background: Blood suppliers and transfusion services have worked diligently to maintain an adequate blood supply during the COVID-19 pandemic. Our experience has shown that some COVID-19 inpatients require transfusion support; understanding this need is critical to blood product inventory management.

Study Design And Methods: Hospital-wide and COVID-19 specific inpatient blood product utilization data were collected retrospectively for our network's two tertiary academic medical centers over a 9-week period (March 1, 2020-May 2, 2020), when most inpatients had COVID-19. Utilization data were merged with a COVID-19 patient database to investigate clinical demographic characteristics of transfused COVID-19 inpatients relative to non-transfused ones.

Results: Overall, 11 041 COVID-19 patients were admitted and 364 received blood product transfusions for an overall transfusion rate of 3.3%. COVID-19 patients received 1746 blood components in total, the majority of which were red blood cells. COVID-19 patients' weekly transfusion rate increased as the pandemic progressed, possibly reflecting their increased severity of illness. Transfusion was significantly associated with several indicators of severe disease, including mortality, intubation, thrombosis, longer hospital admission, lower hemoglobin and platelet nadirs, and longer prothrombin and activated partial thromboplastin times. As the pandemic progressed, institutional adherence to transfusion guidelines improved for RBC transfusions compared to prior year trends but did not improve for platelets or plasma.

Conclusion: There is a need to closely monitor the blood product inventory and demand throughout the COVID-19 pandemic as patients' transfusion needs may increase over time. Daily or weekly trending of patients' clinical status and laboratory values may assist blood banks in inventory management.
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http://dx.doi.org/10.1111/trf.16202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753518PMC
March 2021

Associations between blood type and COVID-19 infection, intubation, and death.

Nat Commun 2020 11 13;11(1):5761. Epub 2020 Nov 13.

Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA.

The rapid global spread of the novel coronavirus SARS-CoV-2 has strained healthcare and testing resources, making the identification and prioritization of individuals most at-risk a critical challenge. Recent evidence suggests blood type may affect risk of severe COVID-19. Here, we use observational healthcare data on 14,112 individuals tested for SARS-CoV-2 with known blood type in the New York Presbyterian (NYP) hospital system to assess the association between ABO and Rh blood types and infection, intubation, and death. We find slightly increased infection prevalence among non-O types. Risk of intubation was decreased among A and increased among AB and B types, compared with type O, while risk of death was increased for type AB and decreased for types A and B. We estimate Rh-negative blood type to have a protective effect for all three outcomes. Our results add to the growing body of evidence suggesting blood type may play a role in COVID-19.
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http://dx.doi.org/10.1038/s41467-020-19623-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666188PMC
November 2020

Melatonin is significantly associated with survival of intubated COVID-19 patients.

medRxiv 2020 Oct 18. Epub 2020 Oct 18.


Respiratory distress requiring intubation is the most serious complication associated with coronavirus disease 2019 (COVID-19).
In this retrospective study, we used survival analysis to determine whether or not mortality following intubation was associated with hormone exposure in patients treated at New York Presbyterian/ Columbia University Irving Medical Center. Here, we report the overall hazards ratio for each hormone for exposure before and after intubation for intubated and mechanically ventilated patients.
Among the 189,987 patients, we identified 948 intubation periods across 791 patients who were diagnosed with COVID-19 or infected with SARS-CoV2 and 3,497 intubation periods across 2,981 patients who were not. Melatonin exposure after intubation was statistically associated with a positive outcome in COVID-19 (demographics and comorbidities adjusted HR: 0.131, 95% CI: 7.76E-02 - 0.223, -value = 8.19E-14) and non-COVID-19 (demographics and comorbidities adjusted HR: 0.278, 95% CI: 0.142 - 0.542, -value = 1.72E-04) intubated patients. Additionally, melatonin exposure after intubation was statically associated with a positive outcome in COVID-19 patients (demographics and comorbidities adjusted HR: 0.127, 95% CI: 6.01E-02 - 0.269, -value = 7.15E-08).
Melatonin exposure after intubation is significantly associated with a positive outcome in COVID-19 and non-COVID-19 patients. Additionally, melatonin exposure after intubation is significantly associated with a positive outcome in COVID-19 patients requiring mechanical ventilation. While our models account for many covariates, including clinical history and demographics, it is impossible to rule out confounding or collider biases within our population. Further study into the possible mechanism of this observation is warranted.
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http://dx.doi.org/10.1101/2020.10.15.20213546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574268PMC
October 2020

Immediate Antiretroviral Therapy: The Need for a Health Equity Approach.

Int J Environ Res Public Health 2020 10 8;17(19). Epub 2020 Oct 8.

HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY 10032, USA.

Immediate antiretroviral therapy (iART), defined as same-day initiation of ART or as soon as possible after diagnosis, has recently been recommended by global and national clinical care guidelines for patients newly diagnosed with human immunodeficiency virus (HIV). Based on San Francisco's Rapid ART Program Initiative for HIV Diagnoses (RAPID) model, most iART programs in the US condense ART initiation, insurance acquisition, housing assessment, and mental health and substance use evaluation into an initial visit. However, the RAPID model does not explicitly address structural racism and homophobia, HIV-related stigma, medical mistrust, and other important factors at the time of diagnosis experienced more poignantly by African American, Latinx, men who have sex with men (MSM), and transgender patient populations. These factors negatively impact initial and subsequent HIV care engagement and exacerbate significant health disparities along the HIV care continuum. While iART has improved time to viral suppression and linkage to care rates, its association with retention in care and viral suppression, particularly in vulnerable populations, remains controversial. Considering that in the US the HIV epidemic is sharply defined by healthcare disparities, we argue that incorporating an explicit health equity approach into the RAPID model is vital to ensure those who disproportionately bear the burden of HIV are not left behind.
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http://dx.doi.org/10.3390/ijerph17197345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579579PMC
October 2020

At-Home Testing for Sexually Transmitted Infections During the COVID-19 Pandemic.

Sex Transm Dis 2021 01;48(1):e11-e14

Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY.

During the COVID-19 pandemic in New York City, NewYork-Presbyterian Hospital provided HIV prevention patients with gonorrhea/chlamydia testing kits at home. This report describes the program implementation to provide other sexual health clinics with a roadmap in adapting to a "new normal" in providing comprehensive sexual health care virtually to patients.
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http://dx.doi.org/10.1097/OLQ.0000000000001313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130547PMC
January 2021

Disease Course and Outcomes of COVID-19 Among Hospitalized Patients With Gastrointestinal Manifestations.

Clin Gastroenterol Hepatol 2021 07 30;19(7):1402-1409.e1. Epub 2020 Sep 30.

Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York; Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.

Background & Aims: Our understanding of outcomes and disease time course of COVID-19 in patients with gastrointestinal (GI) symptoms remains limited. In this study we characterize the disease course and severity of COVID-19 among hospitalized patients with gastrointestinal manifestations in a large, diverse cohort from the Unites States.

Methods: This retrospective study evaluated hospitalized individuals with COVID-19 between March 11 and April 28, 2020 at two affiliated hospitals in New York City. We evaluated the association between GI symptoms and death, and also explored disease duration, from symptom onset to death or discharge.

Results: Of 2804 patients hospitalized with COVID-19, the 1,084 (38.7%) patients with GI symptoms were younger (aOR for age ≥75, 0.59; 95% CI, 0.45-0.77) and had more co-morbidities (aOR for modified Charlson comorbidity score ≥2, 1.22; 95% CI, 1.01-1.48) compared to those without GI symptoms. Individuals with GI symptoms had better outcomes, with a lower likelihood of intubation (aHR, 0.66; 95% CI, 0.55-0.79) and death (aHR, 0.71; 95% CI, 0.59-0.87), after adjusting for clinical factors. These patients had a longer median disease course from symptom onset to discharge (13.8 vs 10.8 days, log-rank p = .048; among 769 survivors with available symptom onset time), which was driven by longer time from symptom onset to hospitalization (7.4 vs 5.4 days, log-rank P < .01).

Conclusion: Hospitalized patients with GI manifestations of COVID-19 have a reduced risk of intubation and death, but may have a longer overall disease course driven by duration of symptoms prior to hospitalization.
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http://dx.doi.org/10.1016/j.cgh.2020.09.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525451PMC
July 2021

Clinical Outcomes Associated With Methylprednisolone in Mechanically Ventilated Patients With COVID-19.

Clin Infect Dis 2021 05;72(9):e367-e372

Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA.

Background: The efficacy and safety of methylprednisolone in mechanically ventilated patients with acute respiratory distress syndrome resulting from coronavirus disease 2019 (COVID-19) are unclear. In this study, we evaluated the association between use of methylprednisolone and key clinical outcomes.

Methods: Clinical outcomes associated with the use of methylprednisolone were assessed in an unmatched, case-control study; a subset of patients also underwent propensity-score matching. Patients were admitted between 1 March and 12 April, 2020. The primary outcome was ventilator-free days by 28 days after admission. Secondary outcomes included extubation, mortality, discharge, positive cultures, and hyperglycemia.

Results: A total of 117 patients met inclusion criteria. Propensity matching yielded a cohort of 42 well-matched pairs. Groups were similar except for hydroxychloroquine and azithromycin use, which were more common in patients who did not receive methylprednisolone. Mean ventilator-free days were significantly higher in patients treated with methylprednisolone (6.21 ± 7.45 vs 3.14 ± 6.22; P = .044). The probability of extubation was also increased in patients receiving methylprednisolone (45% vs 21%; P = .021), and there were no significant differences in mortality (19% vs 36%; P = .087). In a multivariable linear regression analysis, only methylprednisolone use was associated with a higher number of ventilator-free days (P = .045). The incidence of positive cultures and hyperglycemia were similar between groups.

Conclusions: Methylprednisolone was associated with increased ventilator-free days and higher probability of extubation in a propensity-score matched cohort. Randomized, controlled studies are needed to further define methylprednisolone use in patients with COVID-19.
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http://dx.doi.org/10.1093/cid/ciaa1163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454332PMC
May 2021

Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection : A Retrospective Cohort Study.

Ann Intern Med 2020 11 29;173(10):782-790. Epub 2020 Jul 29.

Columbia University Irving Medical Center, New York, New York (M.R.A., J.G., J.Z., Y.R.N., D.F., J.S., K.N.R., S.C., K.N., D.R., E.E., A.P., A.W.F., M.R.B.).

Background: Obesity is a risk factor for pneumonia and acute respiratory distress syndrome.

Objective: To determine whether obesity is associated with intubation or death, inflammation, cardiac injury, or fibrinolysis in coronavirus disease 2019 (COVID-19).

Design: Retrospective cohort study.

Setting: A quaternary academic medical center and community hospital in New York City.

Participants: 2466 adults hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection over a 45-day period with at least 47 days of in-hospital observation.

Measurements: Body mass index (BMI), admission biomarkers of inflammation (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), cardiac injury (troponin level), and fibrinolysis (D-dimer level). The primary end point was a composite of intubation or death in time-to-event analysis.

Results: Over a median hospital length of stay of 7 days (interquartile range, 3 to 14 days), 533 patients (22%) were intubated, 627 (25%) died, and 59 (2%) remained hospitalized. Compared with overweight patients, patients with obesity had higher risk for intubation or death, with the highest risk among those with class 3 obesity (hazard ratio, 1.6 [95% CI, 1.1 to 2.1]). This association was primarily observed among patients younger than 65 years and not in older patients ( for interaction by age = 0.042). Body mass index was not associated with admission levels of biomarkers of inflammation, cardiac injury, or fibrinolysis.

Limitations: Body mass index was missing for 28% of patients. The primary analyses were conducted with multiple imputation for missing BMI. Upper bounding factor analysis suggested that the results are robust to possible selection bias.

Conclusion: Obesity is associated with increased risk for intubation or death from COVID-19 in adults younger than 65 years, but not in adults aged 65 years or older.

Primary Funding Source: National Institutes of Health.
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http://dx.doi.org/10.7326/M20-3214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7397550PMC
November 2020
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