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There is paucity of data regarding the outcomes of hospitalized acute pulmonary embolism (PE) patients with heart failure (HF) and Coronavirus Disease 2019 (COVID-19) infection. We utilized the 2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study to investigate the outcomes of hospitalized acute PE patients with HF and COVID-19, looking at its impact on inhospital mortality, thrombolysis, and thrombectomy utilization as well as hospital length of stay (LOS). A total of 23,413 hospitalized acute PE patients with HF were identified in our study, of which 1.26% (n=295/23,413) had COVID-19 infection. Utilizing a stepwise survey multivariable logistic regression model that adjusted for confounders, COVID-19 infection among acute PE patients with HF was found to be an independent predictor of overall in-hospital mortality (adjusted odds ratio [aOR]: 2.77; 95% confidence interval [CI], 1.15-6.67; p=0.023) and thrombolysis utilization (aOR: 5.52; 95% CI, 2.57-11.84; p = 0.001) compared to those without COVID-19. However, there were comparable rates of thrombectomy utilization and LOS among acute PE patients with HF regardless of the COVID-19 infection status. On subgroup analysis, patients with HF with reduced ejection fraction was found to be associated with increased risk for in-hospital mortality (aOR: 3.89; 95% CI, 1.33-11.39; p= 0.013) and thrombectomy utilization (aOR: 4.58; 95% CI, 1.08-19.41; p =0.042), whereas both HF subtypes were associated with increased thrombolysis utilization. COVID-19 infection among acute PE patients with HF was associated with higher over-all in-hospital mortality and increased thrombolysis utilization but had comparable hospital LOS as well as thrombectomy utilization. [ABSTRACT FROM AUTHOR]

Identify factors associated with readmission after an index hospital admission for coronavirus disease 2019 (COVID‐19) infection in a single center serving an underserved and predominantly minority population. This retrospective descriptive study included 275 patients who tested COVID‐19 positive via reverse transcriptase‐polymerase chain reaction assay at our institution and who survived the index hospitalization. The main outcomes were 1‐ and 6‐month readmission rates after an index hospitalization for COVID‐19. The mortality rate among the readmitted patients was also determined. Factors independently associated with readmission were investigated using multivariable logistic regression. A final sample of 275 patients was included. The mean age was 64.69 ± 14.64 (SD), 133 (48%) were female and 194 (70%) were African American. Their chronic medical conditions included hypertension 203 (74%) and diabetes mellitus 121 (44%). After the hospitalization, 1‐month readmission rate was 7.6%, while 6‐month readmission rate was 24%. Nine percent of patients who were readmitted subsequently died. Coronary artery disease (CAD) was significantly associated with 6‐month readmission odds ratio (OR), 2.15 (95% confidence interval [CI]: 1.04–4.44; p = 0.039) after adjustment for age, gender, ethnicity, and comorbidities. Readmissions were due to cardiac, respiratory, and musculoskeletal symptoms. Hispanic ethnicity was associated with increased readmission OR, 3.16 (95% CI: 1.01–9.88; p = 0.048). No significant difference was found between inflammatory markers or clinical outcomes during the index hospitalization among patients who were readmitted compared to those who were not. A significant number of patients hospitalized for COVID‐19 may be readmitted. The presence of CAD is independently associated with high rates of 6‐month readmission. [ABSTRACT FROM AUTHOR]

Introduction: Venous thromboembolism (VTE) is reported in up to 27% of patients with COVID‐19 due to SARS‐CoV‐2 infection. Dysregulated systemic inflammation and various patient traits are presumed to underlie this anomaly. Optimal VTE prophylaxis in COVID‐19 patients has not been established due to a lack of validated models for predicting VTE in this population. Our study aims to address this deficiency by identifying demographic and clinical characteristics of COVID‐19 patients associated with increased VTE risk. Methods: This study is a retrospective analysis of all adult patients (final sample, n = 355) hospitalized with confirmed COVID‐19 at Einstein Medical Center Philadelphia between March 1 and April 24, 2020. Demographic and clinical patient data were collected and factors associated with VTE were identified and analyzed using t‐tests, multivariable logistic regression, and receiver operating characteristic (ROC) curves. Results: Thirty patients (8.5%) developed VTE. Patients with VTE had significantly higher D‐dimer levels on admission (P = 0.045) and peak D‐dimer levels (P < 0.0001), in addition to higher rates of vasopressor requirements (P = 0.038), intubation (P = 0.003), and death (P = 0.023). Age (OR 1.042), obstructive sleep apnea (OR 5.107), and need for intubation (OR 3.796) were associated with significantly increased odds of VTE. Peak D‐dimer level was a good predictor of VTE (AUC 0.806, P < 0.0001) and a D‐dimer cutoff of >6640 ng/mL had high (>70%) sensitivity and specificity for VTE. Conclusion: Peak D‐dimer level may be the most reliable clinical marker in COVID‐19 patients for predicting VTE and future prospective studies should attempt to further validate this. [ABSTRACT FROM AUTHOR]

During the current COVID pandemic, there is growing interest to identify subsets of the population that may be at a higher than average risk of infection. One such group includes people living with HIV. [ABSTRACT FROM AUTHOR]

Bacterial coinfection is associated with poor outcomes in patients with viral pneumonia, but data on its role in the mortality of patients with coronavirus disease 2019 (COVID‐19) is limited. This is a single‐center retrospective analysis of 242 patients with confirmed COVID‐19 admitted to both intensive care and non‐intensive care settings. Bacterial coinfection was determined by the presence of characteristic clinical features and positive culture results. Multivariable logistic regression was used to analyze the association of concomitant bacterial infection with inpatient death after adjusting for demographic factors and comorbidities. Antibiotic use pattern was also determined. Bacterial coinfection was detected in 46 (19%) patients. Genitourinary source was the most frequent, representing 57% of all coinfections. The overall mortality rate was 21%. Concomitant bacterial infections were independently associated with increased inpatient mortality (OR, 5.838; 95% CI, 2.647‐12.876). Patients with bacterial coinfection were relatively older (71.35 ± 11.20 vs 64.78 ± 15.23; P =.006). A total of 67% of patients received antibiotic therapy, yet 72% did not have an obvious source of bacterial infection. There was a significantly higher rate of inpatient mortality in patients who received antibiotics compared to those who did not (30% vs 5%; P <.0001). Bacterial coinfection in COVID‐19 is associated with increased mortality. Highlights: Concomitant bacterial infections were independently associated with increased inpatient mortality.Patients placed on antibiotics had poorer outcomes and higher inflammatory markers.The presence of coinfection may not be causative of worse clinical outcomes but rather signify clinical deterioration. [ABSTRACT FROM AUTHOR]

There is limited information describing the characteristics and clinical outcomes of patients infected with coronavirus disease 2019 (COVID‐19) especially those in underserved urban area with minority population in the United States. This is a retrospective single‐center study for patients who were admitted with COVID‐19 infection. Data collection was from 1 March through 24 April 2020. Demographic, clinical, laboratory, and treatment data were presented using descriptive statistics and frequencies. The χ2 test and multivariate logistic regression were used to determine association of risk factors and clinical outcomes. A total of 242 inpatients were included with a mean age of 66 ± 14.75 (±standard deviation). A total of 50% were female and 70% were African American. Comorbidities included hypertension (74%), diabetes mellitus (49%), and 19% had either COPD or asthma. Older age was associated with higher risk of inpatient death odds ratio (OR): 1.056 (95% confidence interval [CI]: 1.023‐1.090; P =.001). Inpatient mortality occurred in 70% who needed mechanical ventilation (OR: 29.51; 95% CI: 13.28‐65.60; P <.0001), 58% who required continuous renal replacement therapy/hemodialysis (CRRT/HD) (OR: 6.63; 95% CI: 2.74‐16.05; P <.0001), and 69% who needed vasopressors (OR: 30.64; 95% CI: 13.56‐69.20; P <.0001). Amongst biomarkers of disease severity, only baseline CRP levels (145 ± 116 mg/L) were associated with mortality OR: 1.008 (95% CI: 1.003‐1.012; P =.002). Majority of hospitalized patients had hypertension and diabetes. Older age was an independent risk factor for inpatient mortality. Requirement of mechanical ventilation, vasopressor use, and CRRT/HD was associated significantly with inpatient mortality. Higher baseline CRP was significantly associated with inpatient death. Highlights: Majority of patients in inner city are African American and Hispanic who have higher prevalence of hypertension and diabetes.Sex, BMI, race, and underlying co‐morbidities are not associated with worse outcomes as survivors and non‐survivors have similar baseline characteristics and our population are relatively sicker compared to previous studies.Older age was an independent risk factor for inpatient mortality. [ABSTRACT FROM AUTHOR]

Background: A lot remains unknown about the features and laboratory findings that may predict worse outcomes in patients with coronavirus disease 2019 (COVID‐19). The aim of this study was to evaluate the difference in complete blood count parameters and differential counts in patients hospitalized with COVID‐19 who survived compared to those who died. Design: We performed a single‐center retrospective study including 242 patients with confirmed COVID‐19. We described the characteristics of the complete blood count parameters in these patients. Mann‐Whitney U test was used to compare hematologic parameters of patients who died and those who survived; multivariate logistic regression was used to look for associations with mortality. Results: Patients with COVID‐19 who died had significantly lower median absolute monocyte count (AMC) (0.4 vs 0.5, P =.039) and median platelet count (169 vs 213, P =.009) compared to those who survived. Patients who died had a significantly higher neutrophil‐to‐lymphocyte ratio (6.4 vs 4.5, P =.001). The NLR was positively associated with death (OR = 1.038; 95% CI, 1.003‐1.074, P =.031), while AMC was inversely associated with death (OR = 0.200; 95% CI, 0.052‐0.761, P =.018). Conclusion: Among patients with COVID‐19, a lower AMC and higher NLR are associated with higher mortality. [ABSTRACT FROM AUTHOR]