COVID-19 disease in New York City pediatric hematology and oncology patients.
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ABSTRACT:
SUBMITTER: Gampel B
PROVIDER: S-EPMC7361160 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposePediatric oncology patients undergoing active chemotherapy are suspected to be at a high risk for severe disease secondary to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection; however, data to support this are lacking. We aim to describe the characteristics of coronavirus disease 2019 (COVID-19) in this population and also its impact on pediatric cancer care in the New York region during the peak of the pandemic.Patients and methodsThis multicenter, retrospective study included 13 institutions. Clinical and laboratory information on 98 patients ≤21 years of age receiving active anticancer therapy, who tested positive for SARS-CoV-2 by nasopharyngeal swab polymerase chain reaction (PCR), was collected.ResultsOf the 578 pediatric oncology patients tested for COVID-19, 98 were positive, of whom 73 were symptomatic. Most experienced mild disease, 28 required inpatient management, 25 needed oxygen support, and seven required mechanical ventilation. There is a slightly higher risk of severe disease in males and obese patients, though not statistically significant. Persistent lymphopenia was noted in severe cases. Delays in cancer therapy occurred in 67% of SARS-CoV-2-positive patients. Of four deaths, none were solely attributable to COVID-19. The impact of the pandemic on pediatric oncology care was significant, with 54% of institutions reporting delays in chemotherapy, 46% delays in surgery, and 30% delays in transplant.ConclusionIn this large multi-institutional cohort, we observed that mortality and morbidity from COVID-19 amongst pediatric oncology patients were low overall, but higher than reported in general pediatrics. Certain subgroups might be at higher risk of severe disease. Delays in cancer care due to SARS-CoV-2 remain a concern.
| S-EPMC7883045 | biostudies-literature
Project description:BackgroundCOVID-19 has affected millions of people, and several chronic medical conditions appear to increase the risk of severe COVID-19. However, our understanding of COVID-19 outcomes in patients with CKD remains limited.MethodsThis was a retrospective cohort study of patients with and without CKD consecutively admitted with COVID-19 to three affiliated hospitals in New York City. Pre-COVID-19 CKD diagnoses were identified by billing codes and verified by manual chart review. In-hospital mortality was compared between patients with and without underlying CKD. Logistic regression was used to adjust this analysis for confounders and to identify patient characteristics associated with mortality.ResultsWe identified 280 patients with CKD, and 4098 patients without CKD hospitalized with COVID-19. The median age of the CKD group was 75 (65-84) years, and age of the non-CKD group 62 (48-75) years. Baseline (pre-COVID-19) serum creatinine in patients with CKD was 1.5 (1.2-2.2) mg/dl. In-hospital mortality was 30% in patients with CKD versus 20% in patients without CKD (P<0.001). The risk of in-hospital death in patients with CKD remained higher than in patients without CKD after adjustment for comorbidities (hypertension, diabetes mellitus, asthma, and chronic obstructive pulmonary disease), adjusted OR 1.4 (95% CI,1.1 to 1.9), P=0.01. When stratified by age, elderly patients with CKD (age >70 years) had higher mortality than their age-matched control patients without CKD. In patients with CKD, factors associated with in-hospital mortality were age (adjusted OR, 1.09 [95% CI, 1.06 to 1.12]), P<0.001, baseline and admission serum phosphorus (adjusted OR, 1.5 [95% CI, 1.03 to 2.1], P=0.03 and 1.4 [95% CI, 1.1 to 1.7], P=0.001), serum creatinine on admission >0.3 mg/dl above the baseline (adjusted OR 2.6 [95% CI, 1.2 to 5.4]P=0.01), and diagnosis of acute on chronic kidney injury during hospitalization (adjusted OR 4.6 [95% CI, 2.3 to 8.9], P<0.001).ConclusionsCKD is an independent risk factor for COVID-19-associated in-hospital mortality in elderly patients. Acute-on-chronic kidney injury increases the odds of in-hospital mortality in patients with CKD hospitalized with COVID-19.
| S-EPMC7901833 | biostudies-literature
Project description:BackgroundNew York City (NYC) is the epicenter of severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) in the United States. Clinical characteristics and outcomes of vulnerable populations, such as those with gynecologic cancer who develop COVID-19 infections, is limited.MethodsPatients from 6 NYC-area hospital systems with known gynecologic cancer and a COVID-19 diagnosis were identified. Demographic and clinical outcome data were abstracted through a review of electronic medical records.ResultsRecords for 121 patients with gynecologic cancer and COVID-19 were abstracted; the median age at the COVID-19 diagnosis was 64.0 years (interquartile range, 51.0-73.0 years). Sixty-six of the 121 patients (54.5%) required hospitalization; among the hospitalized patients, 45 (68.2%) required respiratory intervention, 20 (30.3%) were admitted to the intensive care unit, and 9 (13.6%) underwent invasive mechanical ventilation. Seventeen patients (14.0%) died of COVID-19 complications. No patient requiring mechanical ventilation survived. On multivariable analysis, hospitalization was associated with an age ≥64 years (risk ratio [RR], 1.73; 95% confidence interval [CI], 1.18-2.51), African American race (RR, 1.56; 95% CI, 1.13-2.15), and 3 or more comorbidities (RR, 1.43; 95% CI, 1.03-1.98). Only recent immunotherapy use (RR, 3.49; 95% CI, 1.08-11.27) was associated with death due to COVID-19 on multivariable analysis; chemotherapy treatment and recent major surgery were not predictive of COVID-19 severity or mortality.ConclusionsThe case fatality rate among gynecologic oncology patients with a COVID-19 infection is 14.0%. Recent immunotherapy use is associated with an increased risk of mortality related to COVID-19 infection.Lay summaryThe case fatality rate among gynecologic oncology patients with a coronavirus disease 2019 (COVID-19) infection is 14.0%; there is no association between cytotoxic chemotherapy and cancer-directed surgery and COVID-19 severity or death. As such, patients can be counseled regarding the safety of continued anticancer treatments during the pandemic. This is important because the ability to continue cancer therapies for cancer control and cure is critical.
| S-EPMC8654115 | biostudies-literature
Project description: Not available
| S-EPMC7350987 | biostudies-literature
Project description:BackgroundNew York City emerged as an epicenter of the coronavirus disease 2019 (COVID-19) pandemic.ObjectiveTo describe the clinical characteristics and risk factors associated with mortality in a large patient population in the USA.DesignRetrospective cohort study.Participants6493 patients who had laboratory-confirmed COVID-19 with clinical outcomes between March 13 and April 17, 2020, who were seen in one of the 8 hospitals and/or over 400 ambulatory practices in the New York City metropolitan area MAIN MEASURES: Clinical characteristics and risk factors associated with in-hospital mortality.Key resultsA total of 858 of 6493 (13.2%) patients in our total cohort died: 52/2785 (1.9%) ambulatory patients and 806/3708 (21.7%) hospitalized patients. Cox proportional hazard regression modeling showed an increased risk of in-hospital mortality associated with age older than 50 years (hazard ratio [HR] 2.34, CI 1.47-3.71), systolic blood pressure less than 90 mmHg (HR 1.38, CI 1.06-1.80), a respiratory rate greater than 24 per min (HR 1.43, CI 1.13-1.83), peripheral oxygen saturation less than 92% (HR 2.12, CI 1.56-2.88), estimated glomerular filtration rate less than 60 mL/min/1.73m2 (HR 1.80, CI 1.60-2.02), IL-6 greater than 100 pg/mL (HR 1.50, CI 1.12-2.03), D-dimer greater than 2 mcg/mL (HR 1.19, CI 1.02-1.39), and troponin greater than 0.03 ng/mL (HR 1.40, CI 1.23-1.62). Decreased risk of in-hospital mortality was associated with female sex (HR 0.84, CI 0.77-0.90), African American race (HR 0.78 CI 0.65-0.95), and hydroxychloroquine use (HR 0.53, CI 0.41-0.67).ConclusionsAmong patients with COVID-19, older age, male sex, hypotension, tachypnea, hypoxia, impaired renal function, elevated D-dimer, and elevated troponin were associated with increased in-hospital mortality and hydroxychloroquine use was associated with decreased in-hospital mortality.
| S-EPMC7325642 | biostudies-literature
Project description:This paper proposes an ensemble predictor for the weekly increase in the number of confirmed COVID-19 cases in the city of New York at zip code level. Within a Bayesian model averaging framework, the baseline is a Poisson regression for count data. The set of covariates includes autoregressive terms, spatial effects, and demographic and socioeconomic variables. Our results for the second wave of the coronavirus pandemic show that these regressors are more significant to predict the number of new confirmed cases as the pandemic unfolds. Both pointwise and interval forecasts exhibit strong predictive ability in-sample and out-of-sample.
| S-EPMC8242800 | biostudies-literature
Project description:INTRODUCTION:Existing socioeconomic and racial disparities in healthcare access in New York City have likely impacted the public health response to COVID-19. An ecological study was performed to determine the spatial distribution of COVID-19 testing by ZIP code Tabulation Area and investigate if testing was associated with race or SES. METHODS:Data were obtained from the New York City coronavirus data repository and 2018 American Community Survey 5-year estimates. A combined index of SES was created using principal component analysis and incorporated household income, gross rent, poverty, education, working class status, unemployment, and occupants per room. Multivariable Poisson regressions were performed to predict the number of total tests and the ratio of positive tests to total tests performed, using the SES index, racial composition, and Hispanic composition as predictors. RESULTS:The number of total tests significantly increased with the increasing proportion of white residents (?=0.004, SE=0.001, p=0.0032) but not with increasing Hispanic composition or SES index score. The ratio of positive tests to total tests significantly decreased with the increasing proportion of white residents in the ZIP code Tabulation Area (?= -0.003, SE=0.000 6, p<0.001) and with increasing SES index score (?= -0.001 6, SE=0.0007, p=0.0159). CONCLUSIONS:In New York City, COVID-19 testing has not been proportional to need; existing socioeconomic and racial disparities in healthcare access have likely impacted public health response. There is urgent need for widespread testing and public health outreach for the most vulnerable communities in New York City.
| S-EPMC7316038 | biostudies-literature
Project description: Not available
| S-EPMC8025442 | biostudies-literature
Project description:A surveillance system that uses census tract resolution and the SaTScan prospective space-time scan statistic detected clusters of increasing severe acute respiratory syndrome coronavirus 2 test percent positivity in New York City, NY, USA. Clusters included one in which patients attended the same social gathering and another that led to targeted testing and outreach.
| S-EPMC8084513 | biostudies-literature
Project description:PurposeNew York City (NYC) was the global epicenter of the COVID-19 pandemic in spring 2020. A "shelter in place" mandate was issued in March 2020. The effect on vulnerable populations of adolescent and young adult females has not been well documented.MethodsWe administered a monthly online survey between May and November 2020 to adolescent and young adult females participating in a longitudinal study at Mount Sinai Adolescent Health Center. Surveys asked about death of loved ones, financial impacts, social interactions, exposure to dangerous situations, and mental health impacts. Differences in responses by age, race/ethnicity, and living situation were assessed, and compared to data obtained on the same cohort prior to the pandemic.ResultsFour hundred seventeen females aged 15-28 years completed at least one survey, 94% of whom were youth of color. A third of responders (33%) had lost relatives or other people they were close to (loved ones). Most (68%) reported one or more financial losses, and 21% reported food insecurity, with those not living with parents or a guardian experiencing significantly higher rates. One in 10 reported experiencing sexual abuse or interpersonal partner violence during the "shelter in place" period. Over a third (37%) reported symptoms of clinical depression, which represented a significant increase compared to before the pandemic (p = .01). The negative financial impacts and higher proportion of patients with depressive symptomatology remained elevated for adolescents without support at home.ConclusionsThe COVID-19 pandemic had unprecedented negative short-term financial and psychosocial health impacts on inner-city female youth with potential long-term negative impacts.
| S-EPMC8547169 | biostudies-literature