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1. Rationale and design of the Kidney Precision Medicine Project

Author

de Boer, Ian H, Alpers, Charles E, Azeloglu, Evren U, Balis, Ulysses GJ, Barasch, Jonathan M, Barisoni, Laura, Blank, Kristina N, Bomback, Andrew S, Brown, Keith, Dagher, Pierre C, Dighe, Ashveena L, Eadon, Michael T, El-Achkar, Tarek M, Gaut, Joseph P, Hacohen, Nir, He, Yongqun, Hodgin, Jeffrey B, Jain, Sanjay, Kellum, John A, Kiryluk, Krzysztof, Knight, Richard, Laszik, Zoltan G, Lienczewski, Chrysta, Mariani, Laura H, McClelland, Robyn L, Menez, Steven, Moledina, Dennis G, Mooney, Sean D, O’Toole, John F, Palevsky, Paul M, Parikh, Chirag R, Poggio, Emilio D, Rosas, Sylvia E, Rosengart, Matthew R, Sarwal, Minnie M, Schaub, Jennifer A, Sedor, John R, Sharma, Kumar, Steck, Becky, Toto, Robert D, Troyanskaya, Olga G, Tuttle, Katherine R, Vazquez, Miguel A, Waikar, Sushrut S, Williams, Kayleen, Wilson, Francis Perry, Zhang, Kun, Iyengar, Ravi, Kretzler, Matthias, Himmelfarb, Jonathan, Project, Kidney Precision Medicine, Lecker, Stewart, Stillman, Isaac, Waikar, Sushrut, Mcmahon, Gearoid, Weins, Astrid, Short, Samuel, Hoover, Paul, Aulisio, Mark, Cooperman, Leslie, Herlitz, Leal, O’Toole, John, Poggio, Emilio, Sedor, John, Jolly, Stacey, Appelbaum, Paul, Balderes, Olivia, Barasch, Jonathan, Bomback, Andrew, Canetta, Pietro A, d’Agati, Vivette D, Kudose, Satoru, Mehl, Karla, Radhakrishnan, Jai, Weng, Chenhua, Alexandrov, Theodore, Ashkar, Tarek, Barwinska, Daria, Dagher, Pierre, Dunn, Kenneth, Eadon, Michael, Ferkowicz, Michael, Kelly, Katherine, Sutton, Timothy, Winfree, Seth, Parikh, Chirag, Rosenberg, Avi, Villalobos, Pam, Malik, Rubab, Fine, Derek, Atta, Mohammed, Trujillo, Jose Manuel Monroy, Slack, Alison, Rosas, Sylvia, and Williams, Mark

Subjects
Clinical Research, Transplantation, Kidney Disease, Prevention, Renal and urogenital, Good Health and Well Being, Acute Kidney Injury, Adult, Humans, Kidney, Precision Medicine, Prospective Studies, Proteomics, Renal Insufficiency, Chronic, acute kidney injury, chronic kidney disease, diabetes, hypertension, precision medicine, Kidney Precision Medicine Project, Clinical Sciences, Urology & Nephrology
Abstract

Chronic kidney disease (CKD) and acute kidney injury (AKI) are common, heterogeneous, and morbid diseases. Mechanistic characterization of CKD and AKI in patients may facilitate a precision-medicine approach to prevention, diagnosis, and treatment. The Kidney Precision Medicine Project aims to ethically and safely obtain kidney biopsies from participants with CKD or AKI, create a reference kidney atlas, and characterize disease subgroups to stratify patients based on molecular features of disease, clinical characteristics, and associated outcomes. An additional aim is to identify critical cells, pathways, and targets for novel therapies and preventive strategies. This project is a multicenter prospective cohort study of adults with CKD or AKI who undergo a protocol kidney biopsy for research purposes. This investigation focuses on kidney diseases that are most prevalent and therefore substantially burden the public health, including CKD attributed to diabetes or hypertension and AKI attributed to ischemic and toxic injuries. Reference kidney tissues (for example, living-donor kidney biopsies) will also be evaluated. Traditional and digital pathology will be combined with transcriptomic, proteomic, and metabolomic analysis of the kidney tissue as well as deep clinical phenotyping for supervised and unsupervised subgroup analysis and systems biology analysis. Participants will be followed prospectively for 10 years to ascertain clinical outcomes. Cell types, locations, and functions will be characterized in health and disease in an open, searchable, online kidney tissue atlas. All data from the Kidney Precision Medicine Project will be made readily available for broad use by scientists, clinicians, and patients.

Published
2021

2. Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States

Author

Flythe, Jennifer E, Assimon, Magdalene M, Tugman, Matthew J, Chang, Emily H, Gupta, Shruti, Shah, Jatan, Sosa, Marie Anne, Renaghan, Amanda DeMauro, Melamed, Michal L, Wilson, F Perry, Neyra, Javier A, Rashidi, Arash, Boyle, Suzanne M, Anand, Shuchi, Christov, Marta, Thomas, Leslie F, Edmonston, Daniel, Leaf, David E, Walther, Carl P, Anumudu, Samaya J, Arunthamakun, Justin, Kopecky, Kathleen F, Milligan, Gregory P, McCullough, Peter A, Nguyen, Thuy-Duyen, Shaefi, Shahzad, Krajewski, Megan L, Shankar, Sidharth, Pannu, Ameeka, Valencia, Juan D, Waikar, Sushrut S, Kibbelaar, Zoe A, Athavale, Ambarish M, Hart, Peter, Upadhyay, Shristi, Vohra, Ishaan, Green, Adam, Rachoin, Jean-Sebastien, Schorr, Christa A, Shea, Lisa, Edmonston, Daniel L, Mosher, Christopher L, Shehata, Alexandre M, Cohen, Zaza, Allusson, Valerie, Bambrick-Santoyo, Gabriela, Bhatti, Noor ul aain, Mehta, Bijal, Williams, Aquino, Brenner, Samantha K, Walters, Patricia, Go, Ronaldo C, Rose, Keith M, Chan, Lili, Mathews, Kusum S, Coca, Steven G, Altman, Deena R, Saha, Aparna, Soh, Howard, Wen, Huei Hsun, Bose, Sonali, Leven, Emily A, Wang, Jing G, Mosoyan, Gohar, Nadkarni, Girish N, Pattharanitima, Pattharawin, Gallagher, Emily J, Friedman, Allon N, Guirguis, John, Kapoor, Rajat, Meshberger, Christopher, Kelly, Katherine J, Parikh, Chirag R, Garibaldi, Brian T, Corona-Villalobos, Celia P, Wen, Yumeng, Menez, Steven, Malik, Rubab F, Cervantes, Carmen Elena, Gautam, Samir C, Mallappallil, Mary C, Ouyang, Jie, John, Sabu, Yap, Ernie, Melaku, Yohannes, Mohamed, Ibrahim, Bajracharya, Siddhartha, Puri, Isha, Thaxton, Mariah, Bhattacharya, Jyotsna, Wagner, John, Boudourakis, Leon, Nguyen, H Bryant, Ahoubim, Afshin, Kashani, Kianoush, Tehranian, Shahrzad, Sirganagari, Dheeraj Reddy, Guru, Pramod K, and Zhou, Yan

Subjects
Clinical Research, Cardiovascular, Clinical Trials and Supportive Activities, Kidney Disease, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Renal and urogenital, Good Health and Well Being, Aged, COVID-19, Comorbidity, Critical Illness, Female, Hospital Mortality, Humans, Intensive Care Units, Kidney Function Tests, Male, Renal Dialysis, Renal Insufficiency, Chronic, Retrospective Studies, Risk Factors, SARS-CoV-2, Treatment Outcome, United States, STOP-COVID Investigators, COVID-19 outcome, Coronavirus disease 2019, altered mental status, chronic kidney disease, clinical course, clinical trajectory, critical illness, dialysis, end-stage kidney disease, end-stage renal disease, glomerular filtration rate, in-hospital mortality, intensive care unit, prognosis, renal function, severe COVID-19, severe acute respiratory syndrome coronavirus 2, Clinical Sciences, Public Health and Health Services, Urology & Nephrology
Abstract

Rationale & objectiveUnderlying kidney disease is an emerging risk factor for more severe coronavirus disease 2019 (COVID-19) illness. We examined the clinical courses of critically ill COVID-19 patients with and without pre-existing chronic kidney disease (CKD) and investigated the association between the degree of underlying kidney disease and in-hospital outcomes.Study designRetrospective cohort study.Settings & participants4,264 critically ill patients with COVID-19 (143 patients with pre-existing kidney failure receiving maintenance dialysis; 521 patients with pre-existing non-dialysis-dependent CKD; and 3,600 patients without pre-existing CKD) admitted to intensive care units (ICUs) at 68 hospitals across the United States.Predictor(s)Presence (vs absence) of pre-existing kidney disease.Outcome(s)In-hospital mortality (primary); respiratory failure, shock, ventricular arrhythmia/cardiac arrest, thromboembolic events, major bleeds, and acute liver injury (secondary).Analytical approachWe used standardized differences to compare patient characteristics (values>0.10 indicate a meaningful difference between groups) and multivariable-adjusted Fine and Gray survival models to examine outcome associations.ResultsDialysis patients had a shorter time from symptom onset to ICU admission compared to other groups (median of 4 [IQR, 2-9] days for maintenance dialysis patients; 7 [IQR, 3-10] days for non-dialysis-dependent CKD patients; and 7 [IQR, 4-10] days for patients without pre-existing CKD). More dialysis patients (25%) reported altered mental status than those with non-dialysis-dependent CKD (20%; standardized difference=0.12) and those without pre-existing CKD (12%; standardized difference=0.36). Half of dialysis and non-dialysis-dependent CKD patients died within 28 days of ICU admission versus 35% of patients without pre-existing CKD. Compared to patients without pre-existing CKD, dialysis patients had higher risk for 28-day in-hospital death (adjusted HR, 1.41 [95% CI, 1.09-1.81]), while patients with non-dialysis-dependent CKD had an intermediate risk (adjusted HR, 1.25 [95% CI, 1.08-1.44]).LimitationsPotential residual confounding.ConclusionsFindings highlight the high mortality of individuals with underlying kidney disease and severe COVID-19, underscoring the importance of identifying safe and effective COVID-19 therapies in this vulnerable population.

Published
2021

3. Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

Author

Geetha, Duvuru, Kronbichler, Andreas, Rutter, Megan, Bajpai, Divya, Menez, Steven, Weissenbacher, Annemarie, Anand, Shuchi, Lin, Eugene, Carlson, Nicholas, Sozio, Stephen, Fowler, Kevin, Bignall, Ray, Ducharlet, Kathryn, Tannor, Elliot K, Wijewickrama, Eranga, Hafidz, Muhammad IA, Tesar, Vladimir, Hoover, Robert, Crews, Deidra, Varnell, Charles, Danziger-Isakov, Lara, Jha, Vivekanand, Mohan, Sumit, Parikh, Chirag, Luyckx, Valerie, Geetha, Duvuru [0000-0001-8353-5542], Kronbichler, Andreas [0000-0002-2945-2946], Menez, Steven [0000-0003-2490-025X], Jha, Vivekanand [0000-0002-8015-9470], Parikh, Chirag [0000-0001-9051-7385], and Apollo - University of Cambridge Repository

Subjects
SARS-CoV-2, Renal Dialysis, Humans, COVID-19, Acute Kidney Injury, Kidney, Pandemics
Abstract

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce.

Published
2022

4. Outcomes of critically ill solid organ transplant patients with COVID-19 in the United States

Author

Molnar, Miklos Z., Bhalla, Anshul, Azhar, Ambreen, Tsujita, Makoto, Talwar, Manish, Balaraman, Vasanthi, Sodhi, Amik, Kadaria, Dipen, Eason, James D., Hayek, Salim S., Coca, Steven G., Shaefi, Shahzad, Neyra, Javier A., Gupta, Shruti, Leaf, David E., Kovesdy, Csaba P., Walther, Carl P., Anumudu, Samaya J., Arunthamakun, Justin, Kopecky, Kathleen F., Milligan, Gregory P., McCullough, Peter A., Nguyen, Thuy‐Duyen, Krajewski, Megan L., Shankar, Sidharth, Pannu, Ameeka, Valencia, Juan D., Waikar, Sushrut S., Kibbelaar, Zoe A., Athavale, Ambarish M., Hart, Peter, Upadhyay, Shristi, Vohra, Ishaan, Oyintayo, Ajiboye, Green, Adam, Rachoin, Jean‐Sebastien, Schorr, Christa A., Shea, Lisa, Edmonston, Daniel L., Mosher, Christopher L., Shehata, Alexandre M, Cohen, Zaza, Allusson, Valerie, Bambrick‐Santoyo, Gabriela, Bhatti, Noor ul aain, Mehta, Bijal, Williams, Aquino, Brenner, Samantha K., Walters, Patricia, Go, Ronaldo C., Rose, Keith M., Hernán, Miguel A., Lisk, Rebecca, Zhou, Amy M., Kim, Ethan C., Chan, Lili, Mathews, Kusum S., Altman, Deena R., Saha, Aparna, Soh, Howard, Wen, Huei Hsun, Bose, Sonali, Leven, Emily A., Wang, Jing G., Mosoyan, Gohar, Nadkarni, Girish N., Pattharanitima, Pattharawin, Gallagher, Emily J., Friedman, Allon N., Guirguis, John, Kapoor, Rajat, Meshberger, Christopher, Kelly, Katherine J., Parikh, Chirag R., Garibaldi, Brian T., Corona‐Villalobos, Celia P., Wen, Yumeng, Menez, Steven, Malik, Rubab F., Cervantes, Carmen Elena, Gautam, Samir C., Mallappallil, Mary C., Ouyang, Jie, John, Sabu, Yap, Ernie, Melaku, Yohannes, Mohamed, Ibrahim, Bajracharya, Siddhartha, Puri, Isha, Thaxton, Mariah, Bhattacharya, Jyotsna, Wagner, John, Boudourakis, Leon, Nguyen, H. Bryant, Ahoubim, Afshin, Kashani, Kianoush, Tehranian, Shahrzad, Thomas, Leslie F., Sirganagari, Dheeraj Reddy, Guru, Pramod K., Zhou, Yan, Bergl, Paul A., Rodriguez, Jesus, Shah, Jatan A., Gupta, Mrigank S., Kumar, Princy N., Lazarous, Deepa G., Kassaye, Seble G., Melamed, Michal L., Johns, Tanya S., Mocerino, Ryan, Prudhvi, Kalyan, Zhu, Denzel, Levy, Rebecca V., Azzi, Yorg, Fisher, Molly, Yunes, Milagros, Sedaliu, Kaltrina, Golestaneh, Ladan, Brogan, Maureen, Kumar, Neelja, Chang, Michael, Thakkar, Jyotsana, Raichoudhury, Ritesh, Athreya, Akshay, Farag, Mohamed, Schenck, Edward J., Cho, Soo Jung, Plataki, Maria, Alvarez‐Mulett, Sergio L., Gomez‐Escobar, Luis G., Pan, Di, Lee, Stefi, Krishnan, Jamuna, Whalen, William, Charytan, David, Macina, Ashley, Chaudhry, Sobaata, Wu, Benjamin, Modersitzki, Frank, Srivastava, Anand, Leidner, Alexander, Martinez, Carlos, Kruser, Jacqueline M., Wunderink, Richard G., Hodakowski, Alexander J., Velez, Juan Carlos Q., Price‐Haywood, Eboni G., Matute‐Trochez, Luis A., Hasty, Anna E., Mohamed, Muner MB, Avasare, Rupali S., Zonies, David, Leaf, David E, Sise, Meghan E., Newman, Erik T., Omar, Samah Abu, Pokharel, Kapil K., Sharma, Shreyak, Singh, Harkarandeep, Correa, Simon, Shaukat, Tanveer, Kamal, Omer, Wang, Wei, Yang, Heather, Boateng, Jeffery O., Lee, Meghan, Strohbehn, Ian A., Li, Jiahua, Mueller, Ariel L., Redfern, Roberta E., Cairl, Nicholas S., Naimy, Gabriel, Abu‐Saif, Abeer, Hall, Danyell, Bickley, Laura, Rowan, Chris, Madhani‐Lovely, Farah, Peev, Vasil, Reiser, Jochen, Byun, John J., Vissing, Andrew, Kapania, Esha M., Post, Zoe, Patel, Nilam P., Hermes, Joy‐Marie, Sutherland, Anne K., Patrawalla, Amee, Finkel, Diana G., Danek, Barbara A., Arikapudi, Sowminya, Paer, Jeffrey M., Cangialosi, Peter, Liotta, Mark, Radbel, Jared, Puri, Sonika, Sunderram, Jag, Scharf, Matthew T., Ahmed, Ayesha, Berim, Ilya, Vatson, Jayanth S., Anand, Shuchi, Levitt, Joseph E., Garcia, Pablo, Boyle, Suzanne M., Song, Rui, Arif, Ali, Zhang, Jingjing, Woo, Sang Hoon, Deng, Xiaoying, Katz‐Greenberg, Goni, Senter, Katharine, Sharshir, Moh’d A., Rusnak, Vadym V, Ali, Muhammad Imran, Peters, Terri, Hughes, Kathy, Bansal, Anip, Podoll, Amber S., Chonchol, Michel, Sharma, Sunita, Burnham, Ellen L., Douin, David J., Rashidi, Arash, Hejal, Rana, Judd, Eric, Latta, Laura, Tolwani, Ashita, Albertson, Timothy E., Adams, Jason Y., Chang, Steven Y., Beutler, Rebecca M., Schulze, Carl E., Macedo, Etienne, Rhee, Harin, Liu, Kathleen D., Jotwani, Vasantha K., Koyner, Jay L., Shah, Chintan V., Jaikaransingh, Vishal, Toth‐Manikowski, Stephanie M., Joo, Min J., Lash, James P., Chaaban, Nourhan, Elias, Madona, Ahmad, Yahya, Iardino, Alfredo, Au, Elizabeth H., Sharma, Jill H., Sosa, Marie Anne, Taldone, Sabrina, Contreras, Gabriel, Zerda, David De La, Fornoni, Alessia, Gershengorn, Hayley B., Blakely, Pennelope, Berlin, Hanna, Azam, Tariq U., Shadid, Husam, Pan, Michael, Hayer, Patrick O’, Meloche, Chelsea, Feroze, Rafey, Kishan J. Padalia, Bitar, Abbas, Leya, Jeff, Donnelly, John P., Admon, Andrew J., Flythe, Jennifer E., Tugman, Matthew J., Chang, Emily H., Brown, Brent R., Leonberg‐Yoo, Amanda K., Spiardi, Ryan C., Miano, Todd A., Roche, Meaghan S., Vasquez, Charles R., Bansal, Amar D., Ernecoff, Natalie C., Kapoor, Sanjana, Verma, Siddharth, Chen, Huiwen, Hedayati, S. Susan, Nadamuni, Mridula V., Shastri, Shani, Willett, Duwayne L., Short, Samuel A.P., Renaghan, Amanda D., Enfield, Kyle B., Bhatraju, Pavan K., Malik, A. Bilal, Semler, Matthew W., Vijayan, Anitha, Joy, Christina Mariyam, Li, Tingting, Goldberg, Seth, Kao, Patricia F., Schumaker, Greg L., Goyal, Nitender, Faugno, Anthony J., Hsu, Caroline M., Tariq, Asma, Meyer, Leah, Kshirsagar, Ravi K., Jose, Aju, Weiner, Daniel E., Christov, Marta, Griffiths, Jennifer, Gupta, Sanjeev, Kapoor, Aromma, Wilson, Perry, Arora, Tanima, and Ugwuowo, Ugochukwu

Subjects
Male, medicine.medical_specialty, Critical Illness, medicine.medical_treatment, Comorbidity, 030230 surgery, Organ transplantation, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Intensive care, medicine, Humans, Immunology and Allergy, Pharmacology (medical), Hospital Mortality, Renal replacement therapy, Pandemics, Survival rate, Aged, Transplantation, SARS-CoV-2, business.industry, Acute kidney injury, COVID-19, Original Articles, Organ Transplantation, Middle Aged, medicine.disease, United States, Hospitalization, Survival Rate, Intensive Care Units, Relative risk, Propensity score matching, Original Article, Female, business, Follow-Up Studies, Cohort study
Abstract

National data on patient characteristics, treatment, and outcomes of critically ill coronavirus disease 2019 (COVID-19) solid organ transplant (SOT) patients are limited. We analyzed data from a multicenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units (ICUs) at 68 hospitals across the United States from March 4 to May 8, 2020. From 4153 patients, we created a propensity score matched cohort of 386 patients, including 98 SOT patients and 288 non-SOT patients. We used a binomial generalized linear model (log-binomial model) to examine the association of SOT status with death and other clinical outcomes. Among the 386 patients, the median age was 60 years, 72% were male, and 41% were black. Death within 28 days of ICU admission was similar in SOT and non-SOT patients (40% and 43%, respectively; relative risk [RR] 0.92; 95% confidence interval [CI]: 0.70-1.22). Other outcomes and requirement for organ support including receipt of mechanical ventilation, development of acute respiratory distress syndrome, and receipt of vasopressors were also similar between groups. There was a trend toward higher risk of acute kidney injury requiring renal replacement therapy in SOT vs. non-SOT patients (37% vs. 27%; RR [95% CI]: 1.34 [0.97-1.85]). Death and organ support requirement were similar between SOT and non-SOT critically ill patients with COVID-19.

Published
2020

5. Post-Operative Biomarkers and Risk of Chronic Kidney Disease After Cardiac Surgery: the TRIBE-AKI Study

Author

Menez, Steven, Moledina, Dennis G., Garg, Amit X., Thiessen-Philbrook, Heather, McArthur, Eric, Jia, Yaqi, Liu, Caroline, Obeid, Wassim, Mansour, Sherry G., Koyner, Jay L., Shlipak, Michael G., Wilson, Francis P., Coca, Steven G., and Parikh, Chirag R.

Subjects
Adult, Canada, Risk Factors, Disease Progression, Humans, Prospective Studies, Acute Kidney Injury, Cardiac Surgical Procedures, Renal Insufficiency, Chronic, Article, Biomarkers, United States, Glomerular Filtration Rate
Abstract

Patients undergoing cardiac surgery are placed under intense physiologic stress. Blood and urine biomarkers measured peri-operatively may help identify patients at higher risk for adverse long-term kidney outcomes. We sought to determine the independent associations of various biomarkers with development or progression of CKD following cardiac surgery. In this sub-study of the prospective cohort TRIBE AKI Study, we evaluated 613 adult patients undergoing cardiac surgery from 2007–2010 in Canada in our primary analysis. We tested the association of 40 blood and urinary biomarkers with the primary composite outcome of CKD incidence or progression. In those with baseline eGFR>60 mL/min/1.73m(2), we defined CKD incidence as a 25% reduction and eGFR

Published
2020

6. In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study

Author

Hayek, Salim S, Brenner, Samantha K, Azam, Tariq U, Shadid, Husam R, Anderson, Elizabeth, Berlin, Hanna, Pan, Michael, Meloche, Chelsea, Feroz, Rafey, O’Hayer, Patrick, Kaakati, Rayan, Bitar, Abbas, Padalia, Kishan, Perry, Daniel, Blakely, Pennelope, Gupta, Shruti, Shaefi, Shahzad, Srivastava, Anand, Charytan, David M, Bansal, Anip, Mallappallil, Mary, Melamed, Michal L, Shehata, Alexandre M, Sunderram, Jag, Mathews, Kusum S, Sutherland, Anne K, Nallamothu, Brahmajee K, Leaf, David E, Malik, A Bilal, Abu-Saif, Abeer, Green, Adam, Ahoubim, Afshin, Oyintayo, Ajiboye, Jose, Aju, Athreya, Akshay, Jacobs, Alanna L, Fornoni, Alessia, Hodakowski, Alexander J, Leidner, Alexander S, Iardino, Alfredo, Friedman, Allon N, Renaghan, Amanda D, Leonberg-Yoo, Amanda K, Bansal, Amar D, Athavale, Ambarish M, Podoll, Amber S, Azhar, Ambreen, Patrawalla, Amee, Pannu, Ameeka, Zhou, Amy M, Admon, Andrew J, Vissing, Andrew, Vijayan, Anitha, Hasty, Anna E, Faugno, Anthony J, Saha, Aparna, Williams, Aquino, Rashidi, Arash, Mueller, Ariel L, Kapoor, Aromma, Tolwani, Ashita, Macina, Ashley, Tariq, Asma, Ahmed, Ayesha, Danek, Barbara A, Wu, Benjamin, Shukla, Bhavarth, Mehta, Bijal, Brown, Brent R, Garibaldi, Brian T, Schulze, Carl E, Walther, Carl P, Martinez, Carlos, Hsu, Caroline M, Corona-Villalobos, Celia P, Vasquez, Charles R, Shah, Chintan V, Parikh, Chirag R, Rowan, Chris, Schorr, Christa A, Joy, Christina Mariyam, Mosher, Christopher L, Meshberger, Christopher, Kovesdy, Csaba P, Weiner, Daniel E, Edmonston, Daniel L, Perry, Danny, Hall, Danyell, Charytan, David, De La Zerda, David, Zonies, David, Altman, Deena R, Lazarous, Deepa G, Zhu, Denzel, Sirganagari, Dheeraj Reddy, Pan, Di, Finkel, Diana G, Willett, Duwayne L, Price-Haywood, Eboni G, Schenck, Edward J, Cervantes, Carmen Elena, Au, Elizabeth H, Burnham, Ellen L, Leven, Emily A, Chang, Emily H, Gallagher, Emily J, Judd, Eric, Newman, Erik T, Yap, Ernie, Kapania, Esha M, Kim, Ethan C, Macedo, Etienne, Madhani-Lovely, Farah, Modersitzki, Frank, Contreras, Gabriel, Naimy, Gabriel, Bambrick-Santoyo, Gabriela, Nadkarni, Girish N, Mosoyan, Gohar, Katz-Greenberg, Goni, Schumaker, Greg L, Milligan, Gregory P, Nguyen, H Bryant, Rhee, Harin, Singh, Harkarandeep, Gershengorn, Hayley B, Yang, Heather, Soh, Howard, Wen, Huei Hsun, Chen, Huiwen, Shadid, Husam, Strohbehn, Ian A, Mohamed, Ibrahim, Berim, Ilya, Puri, Isha, Vohra, Ishaan, Kruser, Jacqueline M, Lash, James P, Krishnan, Jamuna, Radbel, Jared, Adams, Jason Y, Shah, Jatan A, Neyra, Javier A, Koyner, Jay L, Vatson, Jayanth S, Rachoin, Jean-Sebastien, Boateng, Jeffery O, Paer, Jeffrey M, Flythe, Jennifer E, Griffiths, Jennifer, Rodriguez, Jesus, Li, Jiahua, Ouyang, Jie, Sharma, Jill H, Wang, Jing G, Zhang, Jingjing, Reiser, Jochen, Guirguis, John, Byun, John J, Donnelly, John P, Wagner, John, Levitt, Joseph E, Hermes, Joy-Marie, Velez, Juan Carlos Q, Valencia, Juan D, Arunthamakun, Justin, Thakkar, Jyotsana, Bhattacharya, Jyotsna, Sedaliu, Kaltrina, Prudhvi, Kalyan, Pokharel, Kapil K, Senter, Katharine, Kelly, Katherine J, Liu, Kathleen D, Kopecky, Kathleen F, Rose, Keith M, Kashani, Kianoush, Padalia, Kishan J, Hess, Kristen M, Enfield, Kyle B, Golestaneh, Ladan, Bickley, Laura, Latta, Laura, Meyer, Leah, Boudourakis, Leon, Thomas, Leslie F, Chan, Lili, Shea, Lisa, Matute-Trochez, Luis A, Gomez-Escobar, Luis G, Elias, Madona, Plataki, Maria, Thaxton, Mariah, Sosa, Marie Anne, Liotta, Mark, Christov, Marta, Mallappallil, Mary C, Tugman, Matthew J, Scharf, Matthew T, Semler, Matthew W, Brogan, Maureen, Roche, Meaghan S, Krajewski, Megan L, Sise, Meghan E, Lee, Meghan, Chang, Michael, Chonchol, Michel, Hernán, Miguel A, Molnar, Miklos Z, Yunes, Milagros, Joo, Min J, Sharshir, Moh’d A, Farag, Mohamed, Fisher, Molly, Nadamuni, Mridula V, Gupta, Mrigank S, Ali, Muhammad Imran, Mohamed, Muner MB, Ernecoff, Natalie C, Kumar, Neelja, Cairl, Nicholas S, Patel, Nilam P, Goyal, Nitender, ul aain Bhatti, Noor, Chaaban, Nourhan, Kamal, Omer, Garcia, Pablo, Kao, Patricia F, Walters, Patricia, O’ Hayer, Patrick, Pattharanitima, Pattharawin, Bergl, Paul A, Bhatraju, Pavan K, Wilson, Perry, McCullough, Peter A, Cangialosi, Peter, Hart, Peter, Guru, Pramod K, Kumar, Princy N, Feroze, Rafey, Kapoor, Rajat, Hejal, Rana, Kshirsagar, Ravi K, Lisk, Rebecca, Beutler, Rebecca M, Levy, Rebecca V, Wunderink, Richard G, Raichoudhury, Ritesh, Redfern, Roberta E, Go, Ronaldo C, Malik, Rubab F, Song, Rui, Avasare, Rupali S, Mocerino, Ryan, Spiardi, Ryan C, Hedayati, S Susan, Taldone, Sabrina, John, Sabu, Abu Omar, Samah, Anumudu, Samaya J, Gautam, Samir C, Short, Samuel AP, Woo, Sang Hoon, Kapoor, Sanjana, Gupta, Sanjeev, Kassaye, Seble G, Alvarez-Mulett, Sergio L, Goldberg, Seth, Tehranian, Shahrzad, Shastri, Shani, Sharma, Shreyak, Upadhyay, Shristi, Anand, Shuchi, Bajracharya, Siddhartha, Verma, Siddharth, Shankar, Sidharth, Correa, Simon, Chaudhry, Sobaata, Bose, Sonali, Puri, Sonika, Cho, Soo Jung, Arikapudi, Sowminya, Lee, Stefi, Toth-Manikowski, Stephanie M, Coca, Steven G, Menez, Steven, Chang, Steven Y, Sharma, Sunita, Waikar, Sushrut S, Boyle, Suzanne M, Arora, Tanima, Ferreira, Tanira, Shaukat, Tanveer, Johns, Tanya S, Nguyen, Thuy-Duyen, Albertson, Timothy E, Li, Tingting, Miano, Todd A, Ugwuowo, Ugochukwu, Rusnak, Vadym V, Allusson, Valerie, Jotwani, Vasantha K, Peev, Vasil, Jaikaransingh, Vishal, Cruz, Vivian S, Wang, Wei, Whalen, William, Deng, Xiaoying, Ahmad, Yahya, Zhou, Yan, Melaku, Yohannes, Azzi, Yorg, Wen, Yumeng, Cohen, Zaza, Kibbelaar, Zoe A, and Post, Zoe

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Pneumonia, Viral, 030204 cardiovascular system & hematology, law.invention, Cohort Studies, Betacoronavirus, 03 medical and health sciences, 0302 clinical medicine, law, Intensive care, Humans, Medicine, Hospital Mortality, Cardiopulmonary resuscitation, Asystole, Pandemics, Aged, Aged, 80 and over, SARS-CoV-2, business.industry, Research, Incidence (epidemiology), COVID-19, 030208 emergency & critical care medicine, General Medicine, Middle Aged, medicine.disease, Intensive care unit, United States, Heart Arrest, Intensive Care Units, Pneumonia, Pulseless electrical activity, Emergency medicine, Female, Coronavirus Infections, business, Cohort study
Abstract

Objectives To estimate the incidence, risk factors, and outcomes associated with in-hospital cardiac arrest and cardiopulmonary resuscitation in critically ill adults with coronavirus disease 2019 (covid-19). Design Multicenter cohort study. Setting Intensive care units at 68 geographically diverse hospitals across the United States. Participants Critically ill adults (age ≥18 years) with laboratory confirmed covid-19. Main outcome measures In-hospital cardiac arrest within 14 days of admission to an intensive care unit and in-hospital mortality. Results Among 5019 critically ill patients with covid-19, 14.0% (701/5019) had in-hospital cardiac arrest, 57.1% (400/701) of whom received cardiopulmonary resuscitation. Patients who had in-hospital cardiac arrest were older (mean age 63 (standard deviation 14) v 60 (15) years), had more comorbidities, and were more likely to be admitted to a hospital with a smaller number of intensive care unit beds compared with those who did not have in-hospital cardiac arrest. Patients who received cardiopulmonary resuscitation were younger than those who did not (mean age 61 (standard deviation 14) v 67 (14) years). The most common rhythms at the time of cardiopulmonary resuscitation were pulseless electrical activity (49.8%, 199/400) and asystole (23.8%, 95/400). 48 of the 400 patients (12.0%) who received cardiopulmonary resuscitation survived to hospital discharge, and only 7.0% (28/400) survived to hospital discharge with normal or mildly impaired neurological status. Survival to hospital discharge differed by age, with 21.2% (11/52) of patients younger than 45 years surviving compared with 2.9% (1/34) of those aged 80 or older. Conclusions Cardiac arrest is common in critically ill patients with covid-19 and is associated with poor survival, particularly among older patients.

Published
2020

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