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Retrospective cohort study of clinical characteristics of 2199 hospitalised patients with COVID-19 in New York City

Paranjpe, Ishan; Russak, Adam J; De Freitas, Jessica K; Lala, Anuradha; Miotto, Riccardo; Vaid, Akhil; Johnson, Kipp W; Danieletto, Matteo; Golden, Eddye; Meyer, Dara; Singh, Manbir; Somani, Sulaiman; Kapoor, Arjun; O'Hagan, Ross; Manna, Sayan; Nangia, Udit; Jaladanki, Suraj K; O'Reilly, Paul; Huckins, Laura M; Glowe, Patricia; Kia, Arash; Timsina, Prem; Freeman, Robert M; Levin, Matthew A; Jhang, Jeffrey; Firpo, Adolfo; Kovatch, Patricia; Finkelstein, Joseph; Aberg, Judith A; Bagiella, Emilia; Horowitz, Carol R; Murphy, Barbara; Fayad, Zahi A; Narula, Jagat; Nestler, Eric J; Fuster, V; Cordon-Cardo, Carlos; Charney, Dennis; Reich, David L; Just, Allan; Bottinger, Erwin P; Charney, Alexander W; Glicksberg, Benjamin S; Nadkarni, Girish N
OBJECTIVE:The COVID-19 pandemic is a global public health crisis, with over 33 million cases and 999 000 deaths worldwide. Data are needed regarding the clinical course of hospitalised patients, particularly in the USA. We aimed to compare clinical characteristic of patients with COVID-19 who had in-hospital mortality with those who were discharged alive. DESIGN:Demographic, clinical and outcomes data for patients admitted to five Mount Sinai Health System hospitals with confirmed COVID-19 between 27 February and 2 April 2020 were identified through institutional electronic health records. We performed a retrospective comparative analysis of patients who had in-hospital mortality or were discharged alive. SETTING:All patients were admitted to the Mount Sinai Health System, a large quaternary care urban hospital system. PARTICIPANTS:Participants over the age of 18 years were included. PRIMARY OUTCOMES:We investigated in-hospital mortality during the study period. RESULTS:A total of 2199 patients with COVID-19 were hospitalised during the study period. As of 2 April, 1121 (51%) patients remained hospitalised, and 1078 (49%) completed their hospital course. Of the latter, the overall mortality was 29%, and 36% required intensive care. The median age was 65 years overall and 75 years in those who died. Pre-existing conditions were present in 65% of those who died and 46% of those discharged. In those who died, the admission median lymphocyte percentage was 11.7%, D-dimer was 2.4 μg/mL, C reactive protein was 162 mg/L and procalcitonin was 0.44 ng/mL. In those discharged, the admission median lymphocyte percentage was 16.6%, D-dimer was 0.93 μg/mL, C reactive protein was 79 mg/L and procalcitonin was 0.09 ng/mL. CONCLUSIONS:In our cohort of hospitalised patients, requirement of intensive care and mortality were high. Patients who died typically had more pre-existing conditions and greater perturbations in inflammatory markers as compared with those who were discharged.
PMCID:7702220
PMID: 33247020
ISSN: 2044-6055
CID: 5193972

Convalescent plasma treatment of severe COVID-19: a propensity score-matched control study

Liu, Sean T H; Lin, Hung-Mo; Baine, Ian; Wajnberg, Ania; Gumprecht, Jeffrey P; Rahman, Farah; Rodriguez, Denise; Tandon, Pranai; Bassily-Marcus, Adel; Bander, Jeffrey; Sanky, Charles; Dupper, Amy; Zheng, Allen; Nguyen, Freddy T; Amanat, Fatima; Stadlbauer, Daniel; Altman, Deena R; Chen, Benjamin K; Krammer, Florian; Mendu, Damodara Rao; Firpo-Betancourt, Adolfo; Levin, Matthew A; Bagiella, Emilia; Casadevall, Arturo; Cordon-Cardo, Carlos; Jhang, Jeffrey S; Arinsburg, Suzanne A; Reich, David L; Aberg, Judith A; Bouvier, Nicole M
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a new human disease with few effective treatments1. Convalescent plasma, donated by persons who have recovered from COVID-19, is the acellular component of blood that contains antibodies, including those that specifically recognize SARS-CoV-2. These antibodies, when transfused into patients infected with SARS-CoV-2, are thought to exert an antiviral effect, suppressing virus replication before patients have mounted their own humoral immune responses2,3. Virus-specific antibodies from recovered persons are often the first available therapy for an emerging infectious disease, a stopgap treatment while new antivirals and vaccines are being developed1,2. This retrospective, propensity score-matched case-control study assessed the effectiveness of convalescent plasma therapy in 39 patients with severe or life-threatening COVID-19 at The Mount Sinai Hospital in New York City. Oxygen requirements on day 14 after transfusion worsened in 17.9% of plasma recipients versus 28.2% of propensity score-matched controls who were hospitalized with COVID-19 (adjusted odds ratio (OR), 0.86; 95% confidence interval (CI), 0.75-0.98; chi-square test P value = 0.025). Survival also improved in plasma recipients (adjusted hazard ratio (HR), 0.34; 95% CI, 0.13-0.89; chi-square test P = 0.027). Convalescent plasma is potentially effective against COVID-19, but adequately powered, randomized controlled trials are needed.
PMID: 32934372
ISSN: 1546-170x
CID: 5193922

Humoral response and PCR positivity in patients with COVID-19 in the New York City region, USA: an observational study

Wajnberg, Ania; Mansour, Mayce; Leven, Emily; Bouvier, Nicole M; Patel, Gopi; Firpo-Betancourt, Adolfo; Mendu, Rao; Jhang, Jeffrey; Arinsburg, Suzanne; Gitman, Melissa; Houldsworth, Jane; Sordillo, Emilia; Paniz-Mondolfi, Alberto; Baine, Ian; Simon, Viviana; Aberg, Judith; Krammer, Florian; Reich, David; Cordon-Cardo, Carlos
BACKGROUND:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. The proportion of infected individuals who seroconvert is still an open question. In addition, it has been shown in some individuals that viral genome can be detected up to 3 months after symptom resolution. We investigated both seroconversion and PCR positivity in a large cohort of convalescent serum donors in the New York City (NY, USA) region. METHODS:In this observational study, we ran an outreach programme in the New York City area. We recruited participants via the REDCap (Vanderbilt University, Nashville, TN, USA) online survey response. Individuals with confirmed or suspected SARS-CoV-2 infection were screened via PCR for presence of viral genome and via ELISA for presence of anti-SARS-CoV-2 spike antibodies. One-way ANOVA and Fisher's exact test were used to measure the association of age, gender, symptom duration, and days from symptom onset and resolution with positive antibody results. FINDINGS/RESULTS:Between March 26 and April 10, 2020, we measured SARS-CoV-2 antibody titres in 1343 people. Of the 624 participants with confirmed SARS-CoV-2 infection who had serologies done after 4 weeks, all but three seroconverted to the SARS-CoV-2 spike protein, whereas 269 (37%) of 719 participants with suspected SARS-CoV-2 infection seroconverted. PCR positivity was detected up to 28 days from symptom resolution. INTERPRETATION/CONCLUSIONS:Most patients with confirmed COVID-19 seroconvert, potentially providing immunity to reinfection. We also report that in a large proportion of individuals, viral genome can be detected via PCR in the upper respiratory tract for weeks after symptom resolution, but it is unclear whether this signal represents infectious virus. Analysis of our large cohort suggests that most patients with mild COVID-19 seroconvert 4 weeks after illness, and raises questions about the use of PCR to clear positive individuals. FUNDING/BACKGROUND:None.
PMCID:7518831
PMID: 33015652
ISSN: 2666-5247
CID: 5193932

Anti-SARS-CoV-2 spike antibodies are stable in convalescent plasma when stored at 4° Celsius for at least 6 weeks [Letter]

Stadlbauer, Daniel; Baine, Ian; Amanat, Fatima; Jiang, Kaijun; Lally, Kimberly; Krammer, Florian; Jhang, Jeffrey S; Arinsburg, Suzanne A
PMCID:7461441
PMID: 32798271
ISSN: 1537-2995
CID: 5193902

An inflammatory cytokine signature predicts COVID-19 severity and survival

Del Valle, Diane Marie; Kim-Schulze, Seunghee; Huang, Hsin-Hui; Beckmann, Noam D; Nirenberg, Sharon; Wang, Bo; Lavin, Yonit; Swartz, Talia H; Madduri, Deepu; Stock, Aryeh; Marron, Thomas U; Xie, Hui; Patel, Manishkumar; Tuballes, Kevin; Van Oekelen, Oliver; Rahman, Adeeb; Kovatch, Patricia; Aberg, Judith A; Schadt, Eric; Jagannath, Sundar; Mazumdar, Madhu; Charney, Alexander W; Firpo-Betancourt, Adolfo; Mendu, Damodara Rao; Jhang, Jeffrey; Reich, David; Sigel, Keith; Cordon-Cardo, Carlos; Feldmann, Marc; Parekh, Samir; Merad, Miriam; Gnjatic, Sacha
Several studies have revealed that the hyper-inflammatory response induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major cause of disease severity and death. However, predictive biomarkers of pathogenic inflammation to help guide targetable immune pathways are critically lacking. We implemented a rapid multiplex cytokine assay to measure serum interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α and IL-1β in hospitalized patients with coronavirus disease 2019 (COVID-19) upon admission to the Mount Sinai Health System in New York. Patients (n = 1,484) were followed up to 41 d after admission (median, 8 d), and clinical information, laboratory test results and patient outcomes were collected. We found that high serum IL-6, IL-8 and TNF-α levels at the time of hospitalization were strong and independent predictors of patient survival (P < 0.0001, P = 0.0205 and P = 0.0140, respectively). Notably, when adjusting for disease severity, common laboratory inflammation markers, hypoxia and other vitals, demographics, and a range of comorbidities, IL-6 and TNF-α serum levels remained independent and significant predictors of disease severity and death. These findings were validated in a second cohort of patients (n = 231). We propose that serum IL-6 and TNF-α levels should be considered in the management and treatment of patients with COVID-19 to stratify prospective clinical trials, guide resource allocation and inform therapeutic options.
PMID: 32839624
ISSN: 1546-170x
CID: 5193912

An inflammatory cytokine signature helps predict COVID-19 severity and death

Del Valle, Diane Marie; Kim-Schulze, Seunghee; Hsin-Hui, Huang; Beckmann, Noam D; Nirenberg, Sharon; Wang, Bo; Lavin, Yonit; Swartz, Talia; Madduri, Deepu; Stock, Aryeh; Marron, Thomas; Xie, Hui; Patel, Manish Kumar; van Oekelen, Oliver; Rahman, Adeeb; Kovatch, Patricia; Aberg, Judith; Schadt, Eric; Jagannath, Sundar; Mazumdar, Madhu; Charney, Alexander; Firpo-Betancourt, Adolfo; Mendu, Damodara Rao; Jhang, Jeffrey; Reich, David; Sigel, Keith; Cordon-Cardo, Carlos; Feldmann, Marc; Parekh, Samir; Merad, Miriam; Gnjatic, Sacha
The COVID-19 pandemic caused by infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to more than 100,000 deaths in the United States. Several studies have revealed that the hyper-inflammatory response induced by SARS-CoV-2 is a major cause of disease severity and death in infected patients. However, predictive biomarkers of pathogenic inflammation to help guide targetable immune pathways are critically lacking. We implemented a rapid multiplex cytokine assay to measure serum IL-6, IL-8, TNF-α, and IL-1β in hospitalized COVID-19 patients upon admission to the Mount Sinai Health System in New York. Patients (n=1484) were followed up to 41 days (median 8 days) and clinical information, laboratory test results and patient outcomes were collected. In 244 patients, cytokine measurements were repeated over time, and effect of drugs could be assessed. Kaplan-Meier methods were used to compare survival by cytokine strata, followed by Cox regression models to evaluate the independent predictive value of baseline cytokines. We found that high serum IL-6, IL-8, and TNF-α levels at the time of hospitalization were strong and independent predictors of patient survival. Importantly, when adjusting for disease severity score, common laboratory inflammation markers, hypoxia and other vitals, demographics, and a range of comorbidities, IL-6 and TNF-α serum levels remained independent and significant predictors of disease severity and death. We propose that serum IL-6 and TNF-α levels should be considered in the management and treatment of COVID-19 patients to stratify prospective clinical trials, guide resource allocation and inform therapeutic options. We also propose that patients with high IL-6 and TNF-α levels should be assessed for combinatorial blockade of pathogenic inflammation in this disease.
PMID: 32511562
ISSN: n/a
CID: 5193882

Clinical Characteristics of Hospitalized Covid-19 Patients in New York City

Paranjpe, Ishan; Russak, Adam J; De Freitas, Jessica K; Lala, Anuradha; Miotto, Riccardo; Vaid, Akhil; Johnson, Kipp W; Danieletto, Matteo; Golden, Eddye; Meyer, Dara; Singh, Manbir; Somani, Sulaiman; Manna, Sayan; Nangia, Udit; Kapoor, Arjun; O'Hagan, Ross; O'Reilly, Paul F; Huckins, Laura M; Glowe, Patricia; Kia, Arash; Timsina, Prem; Freeman, Robert M; Levin, Matthew A; Jhang, Jeffrey; Firpo, Adolfo; Kovatch, Patricia; Finkelstein, Joseph; Aberg, Judith A; Bagiella, Emilia; Horowitz, Carol R; Murphy, Barbara; Fayad, Zahi A; Narula, Jagat; Nestler, Eric J; Fuster, Valentin; Cordon-Cardo, Carlos; Charney, Dennis S; Reich, David L; Just, Allan C; Bottinger, Erwin P; Charney, Alexander W; Glicksberg, Benjamin S; Nadkarni, Girish N
Background/UNASSIGNED:The coronavirus 2019 (Covid-19) pandemic is a global public health crisis, with over 1.6 million cases and 95,000 deaths worldwide. Data are needed regarding the clinical course of hospitalized patients, particularly in the United States. Methods/UNASSIGNED:Demographic, clinical, and outcomes data for patients admitted to five Mount Sinai Health System hospitals with confirmed Covid-19 between February 27 and April 2, 2020 were identified through institutional electronic health records. We conducted a descriptive study of patients who had in-hospital mortality or were discharged alive. Results/UNASSIGNED:, 1,121 (51%) patients remained hospitalized, and 1,078 (49%) completed their hospital course. Of the latter, the overall mortality was 29%, and 36% required intensive care. The median age was 65 years overall and 75 years in those who died. Pre-existing conditions were present in 65% of those who died and 46% of those discharged. In those who died, the admission median lymphocyte percentage was 11.7%, D-dimer was 2.4 ug/ml, C-reactive protein was 162 mg/L, and procalcitonin was 0.44 ng/mL. In those discharged, the admission median lymphocyte percentage was 16.6%, D-dimer was 0.93 ug/ml, C-reactive protein was 79 mg/L, and procalcitonin was 0.09 ng/mL. Conclusions/UNASSIGNED:This is the largest and most diverse case series of hospitalized patients with Covid-19 in the United States to date. Requirement of intensive care and mortality were high. Patients who died typically had pre-existing conditions and severe perturbations in inflammatory markers.
PMCID:7277011
PMID: 32511655
ISSN: n/a
CID: 5193892

AN ANALYSIS OF THE UTILITY OF FFP ADMINISTRATION IN CIRRHOTIC PATIENTS UNDERGOING INVASIVE PROCEDURES [Meeting Abstract]

Diaz, Kelly E.; Tremblay, Douglas; Ozturk, Begum; Arinsburg, Suzanne; Jhang, Jeffrey; Schiano, Thomas
ISI:000540349504421
ISSN: 0016-5085
CID: 5194062

Clinical Outcomes in Patients Undergoing Non-cardiac Surgery Within 1 Year of Pci [Meeting Abstract]

Cao, Davide; Levin, Matthew A.; Sartori, Samantha; Roumeliotis, Anastasios; Chandiramani, Rishi; Nicolas, Johny; Waseem, Zaha; Bedekar, Rashi; Claessen, Bimmer E.; Goel, Ridhima; Chiarito, Mauro; Lupo, Bonnie; Jhang, Jeffrey; Dangas, George; Baber, Usman; Bhatt, Deepak L.; Sharma, Samin K.; Kini, Annapoorna; Mehran, Roxana
ISI:000607190403229
ISSN: 0009-7322
CID: 5194092

Validation of a Trypsin-Based Method to Resolve the Interference of Daratumumab [Meeting Abstract]

Ibeh, Nnaemeka; Rudon, Louella; Lomas-Francis, Christine; Jhang, Jeffrey; Galdon, Patricia; Westhoff, Connie M.; Velliquette, Randall W.; Arinsburg, Suzanne A.
ISI:000502826600318
ISSN: 0041-1132
CID: 5194052