Clinical risk factors for mortality in an analysis of 1375 patients admitted for COVID treatment
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Abstract
The goal of the present work was to examine clinical risk factors for mortality in 1375 COVID + patients admitted to a hospital in Suffolk County, NY. Data were collated by the hospital epidemiological service for patients admitted from 3/7/2020 to 9/1/2020. Time until final discharge or death was the outcome. Cox proportional hazards models were used to estimate time until death among admitted patients. In total, all cases had resolved leading to 207 deaths. Length of stay was significantly longer in those who died as compared to those who did not (p = 0.007). Of patients who had been discharged, 54 were readmitted and nine subsequently died. Multivariable-adjusted Cox proportional hazards regression revealed that in addition to older age, male sex, and a history of chronic heart failure, chronic obstructive pulmonary disease, and diabetes, that a history of premorbid depression was a risk factors for COVID-19 mortality (aHR = 2.42 [1.38–4.23] P = 0.002), and that this association remained after adjusting for age and for neuropsychiatric conditions as well as medical comorbidities including cardiovascular disease and pulmonary conditions. Sex-stratified analyses revealed that associations between mortality and depression was strongest in males (aHR = 4.45 [2.04–9.72], P < 0.001), and that the association between heart failure and mortality was strongest in participants aged < 65 years old (aHR = 30.50 [9.17–101.48], P < 0.001). While an increasing number of studies have identified several comorbid medical conditions including chronic heart failure and age of patient as risk factors for mortality in COVID + patients, this study confirmed several prior reports and also noted that a history of depression is an independent risk factor for COVID-19 mortality.
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SciScore for 10.1101/2020.12.17.20248362: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Ethics: The Internal Review Board at Stony Brook University approved this study (IRB#1586703). Randomization not detected. Blinding not detected. Power Analysis Power simulations determined that at least 1,300 patients were required to achieve multivariable-adjusted power estimates (α=0.05, power=0.80); a priori projections completed in April indicated May 15th as study closing date. Sex as a biological variable Patients who died prior to admission ranged in age from 46-101 years, none were depressed, six were female, and had on average 1.75 comorbidities including COPD and atrial fibrillation but not depression or chronic heart failure. Table 2: Resources
… SciScore for 10.1101/2020.12.17.20248362: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Ethics: The Internal Review Board at Stony Brook University approved this study (IRB#1586703). Randomization not detected. Blinding not detected. Power Analysis Power simulations determined that at least 1,300 patients were required to achieve multivariable-adjusted power estimates (α=0.05, power=0.80); a priori projections completed in April indicated May 15th as study closing date. Sex as a biological variable Patients who died prior to admission ranged in age from 46-101 years, none were depressed, six were female, and had on average 1.75 comorbidities including COPD and atrial fibrillation but not depression or chronic heart failure. Table 2: Resources
Software and Algorithms Sentences Resources All analyses were completed using Stata 15.1/SE [StataCorp]. StataCorpsuggested: (Stata, RRID:SCR_012763)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations: Though being among the earliest studies to identify pre-existing conditions that increase risk of mortality in COVID+ patients, this study is also limited in focusing on patients admitted to a single hospital on Long Island, NY. Information about race/ethnicity and socioeconomic status were not recorded. A number of studies have noted neuropsychiatric changes among COVID+ patients (12). NY. The current study did not seek to determine indicators of cardiovascular, pulmonary, or cerebrovascular indicators of COVID-19 severity but instead sought to identify patients for whom exposure to SARS-CoV-2 may be more deadly. Analyses did not identify dementia as a risk factor for mortality despite the fact that Alzheimer’s disease, a main cause of dementia, is a neuroinflammatory condition that causes elevated levels of c-reactive protein and cytokines commonly related to COVID-19. However, since individuals with Alzheimer’s disease and vascular dementia are most commonly cared for in nursing homes, where a large number of outpatient deaths are known to have occurred, this effect may be underestimated in studies such as this one that rely on inpatient samples. In the case that encephalopathy is present, but may not always become severe, future research is warranted to examine the potential for a lasting post-COVID encephalopathy among survivors. Major depression is a heterogeneous condition with a range of potential etiologies; we were unable here to examine whether subsynd...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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