Anuradha Shunmugam Veluswamy

Background: Obesity has been associated with adverse COVID-19 outcomes, but nationally representative data across multiple pandemic years remain limited. We evaluated the association between obesity and in-hospital outcomes among adults hospitalized with COVID-19 infection in the United States during 2020–2022. Methods: We conducted a retrospective cohort study using the National Inpatient Sample. Adult COVID-19 hospitalizations were categorized according to obesity status. Survey-weighted multivariable regression analyses assessed associations with in-hospital mortality, respiratory support, renal complications, thromboembolic events, sepsis-related outcomes, cardiovascular complications, length of stay, hospitalization charges, and discharge disposition. Results: The study included 1,186,914 COVID-19 hospitalizations, representing 5,934,565 weighted hospitalizations of which 1,529,022 had obesity and 4,406,543 did not have obesity. Hospitalizations with obesity involved younger individuals and greater proportions of female individuals.After adjustment, obesity was associated with increased odds of mortality (adjusted odds ratio, 1.38; 95% confidence interval, 1.36–1.40; p < 0.001), mechanical ventilation, vasopressor use, sepsis, septic shock, acute respiratory distress syndrome, extracorporeal membrane oxygenation, acute pulmonary embolism, venous embolism and thrombosis, tracheostomy, acute kidney injury, and renal replacement therapy. Obesity was also associated with longer hospital stays and higher hospitalization charges. Mortality among hospitalizations with obesity peaked in 2021 and declined in 2022. Conclusions: Obesity was independently associated with adverse clinical outcomes and greater hospital resource utilization among adults hospitalized with COVID-19 infection.

Background: COVID-19 infection has been a major cause of hospitalization and mortality in the United States. Patients with liver cirrhosis may be especially vulnerable to severe outcomes of COVID-19 infection because of immune dysfunction, systemic inflammation, portal hypertension, and reduced physiological reserve. These factors can increase the risk of severe infection, multiorgan complications, and poor inpatient outcomes. Using the 2020–2022 United States National Inpatient Sample, this study evaluates the effect of cirrhosis among adults hospitalized with COVID-19. Methods: We performed a retrospective cohort study using the National Inpatient Sample (NIS) database. Adult hospitalizations with COVID-19 from 2020 to 2022 were included and stratified according to the presence or absence of cirrhosis. Using multivariable logistic regression analyses, we evaluated in-hospital mortality as the primary outcome. Secondary outcomes included the need for mechanical ventilation, septic shock, ARDS, ECMO utilization, acute kidney injury, renal replacement therapy, length of stay, and hospital charges. Results: A total of 5,934,565 hospitalized COVID-19 patients were included, of which 115,170 had concomitant cirrhosis. COVID-19 patients with cirrhosis had a higher in-hospital mortality than those without cirrhosis (16.8% vs. 11.3%; aOR 1.28; 95% CI 1.22–1.32). Patients with liver cirrhosis were also associated with higher odds of invasive mechanical ventilation, vasopressor use, and septic shock. Conclusions: Cirrhosis was independently associated with increased in-hospital mortality and complications including the need for invasive mechanical ventilation and septic shock in adults hospitalized with COVID-19. Although mortality associated with these patients has declined over time, they represent a high-risk group that requires close monitoring.

Background/Objectives: Clinical studies have shown that patients who had sepsis with COVID-19 infection had worse clinical outcomes; however, there is a paucity of data on the association between concurrent COVID-19 infection and outcomes among patients with sepsis. Hence, we conducted a retrospective cohort study using the National Inpatient Sample (NIS) database from 2020 through 2022 to evaluate the association between concurrent COVID-19 infection and outcomes among patients with sepsis. Methods: Adult hospitalizations with sepsis were identified using ICD-10-CM codes; hospitalizations with septic shock were excluded, and the remaining cohort was stratified by concurrent COVID-19 infection status. Survey-weighted multivariate regression analysis was performed. Results: Patients with sepsis with concurrent COVID-19 infection had worse outcomes with higher mortality rate (15.6% vs. 5.4%; aOR 3.70; 95% CI 3.62–3.79), higher need for invasive ventilation (13.1% vs. 6.5%) and NIV (non-invasive ventilation) (10.2% vs. 4.9%), higher incidence of acute kidney injury (37.6% vs. 36.7%), acute respiratory failure (57.5% vs. 20.3%), disseminated intravascular coagulation (DIC) (0.4% vs. 0.3%), cardiac arrest (3.1% vs. 1.5%), acute respiratory distress syndrome (ARDS) (7.9% vs. 0.4%), higher need for renal replacement therapy (4.9% vs. 4.5%), tracheostomy (1.6% vs. 0.6%), extracorporeal membrane oxygenation (ECMO) (0.2% vs. 0.04%), longer length of hospital stay (10.3 days vs. 7.6 days), and higher total charges ($127,632 vs. $93,735, respectively). Conclusions: The results demonstrate that COVID-19 infection was independently associated with worse clinical outcomes among those hospitalized with sepsis. These results underscore the need for early recognition, aggressive treatment, and targeted therapy in this high-risk clinical group.

Asthma exacerbation, frequently triggered by viral infections, is a leading cause of hospitalization, respiratory failure, and death. COVID-19 and asthma share a bidirectional relationship, with each potentially worsening the other. We compared outcomes in hospitalized asthma exacerbation patients with and without COVID-19 using the National Inpatient Sample (2020–2022), adjusting for confounders via multivariable logistic regression. Among 603,219 hospitalizations for asthma exacerbation, 69,600 (11.5%) had concomitant COVID-19. The COVID-19 group had significantly higher in-hospital mortality (6.7% vs. 1.4%; aOR 6.09; 95% CI 5.54-6.69) and greater need for invasive mechanical ventilation (10.1% vs. 4.9%; aOR 2.30; 95% CI 2.15-2.45), despite lower non-invasive ventilation use. Mean length of stay (7.7 vs. 4.6 days) and total hospital charges ($97,133 vs. $58,547) were also higher. These patients were more critically ill, with higher rates of respiratory failure, ARDS, acute kidney injury, and pulmonary embolism, and greater use of ECMO, renal replacement therapy, tracheostomy, and vasopressors. COVID-19 was independently associated with worse clinical outcomes among hospitalized asthma exacerbation patients. Early recognition of COVID-19 in asthma exacerbation is warranted to guide risk stratification and timely management.

COVID-19 has resulted in more than 100 million reported infections in the United States. Hypertension is a highly prevalent comorbidity among adults hospitalized with COVID-19 and is commonly associated with cardiovascular disease, chronic kidney disease, endothelial dysfunction, and systemic inflammation. Our study aimed to evaluate the impact of hypertension on outcomes among COVID-19 hospitalizations. We conducted a retrospective study using the National Inpatient Sample. We included 5.9 million adult hospitalizations with confirmed COVID-19 between 2020 and 2022, of which 3.7 million had concomitant HTN and 2.2 million did not. After multivariable adjustment, HTN was associated with higher odds of noninvasive ventilation (aOR 1.40, 95% CI 1.37–1.43), acute kidney injury (aOR 1.64, 95% CI 1.62–1.67), renal replacement therapy (aOR 4.17, 95% CI 4.02–4.34), atrial fibrillation (aOR 1.76, 95% CI 1.74–1.79), acute myocardial infarction (aOR 1.52, 95% CI 1.48–1.56), ischemic stroke (aOR 1.50, 95% CI 1.44–1.57), cardiac arrest (aOR 1.21, 95% CI 1.17–1.25), severe COVID-19 (aOR 1.78, 95% CI 1.75–1.80), and critical COVID-19 (aOR 1.65, 95% CI 1.63–1.67). HTN was also associated with a slightly longer adjusted length of stay and higher adjusted total charges. The hypertension group had higher crude in-hospital mortality (12.6% vs. 9.3%); however, after multivariable adjustment, hypertension was associated with lower odds of in-hospital mortality (aOR 0.92, 95% CI 0.90–0.93; p < 0.001). Overall, hypertension was associated with increased inpatient morbidity and a complicated hospital course among hospitalizations with COVID-19, despite lower adjusted odds of in-hospital mortality.

Obesity has been associated with worse outcomes in patients with COVID-19 infection, but nationally representative data across multiple pandemic years remain limited. We conducted a retrospective cohort study using the National Inpatient Sample database from 2020 to 2022 to evaluate the association between obesity and in-hospital outcomes among adults hospitalized with COVID-19 in the United States. Adult hospitalizations with COVID-19 infection were identified and stratified according to the presence or absence of obesity. Multivariable regression analyses were performed to assess the association of obesity with in-hospital mortality, respiratory support, renal complications, thromboembolic events, sepsis-related outcomes, cardiovascular complications, hospital length of stay, total hospitalization charges, and discharge disposition. A total of 5,934,565 adult COVID-19 hospitalizations were included, of which 1,450,164 patients had obesity, and 4,484,401 did not. Patients with obesity were younger, more likely to be female, and more commonly African American or Hispanic. After multivariable adjustment, obesity was associated with increased odds of mortality (aOR, 1.27; 95% CI, 1.25–1.29; p < 0.001), respiratory support, vasopressor use, sepsis, septic shock, acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO), acute pulmonary embolism, acute deep venous thrombosis, tracheostomy, acute kidney injury, and renal replacement therapy, along with longer hospital stays and higher total hospitalization charges. Mortality among patients with obesity peaked in 2021 and declined in 2022. Obesity appears to be an independent predictor of adverse in-hospital outcomes in adults hospitalized with COVID-19.

Clinical studies have shown that patients who had sepsis with COVID-19 infection had worse clinical outcomes, however, there is a paucity of data on the nationwide impact of COVID-19 infection in patients with sepsis. Hence, we conducted a retrospective cohort study using the National Inpatient Sample (NIS) database from 2020 through 2022 to determine the impact of COVID-19 infection on the outcomes of patients with sepsis. Adult sepsis hospitalizations were identified using ICD-10-CM codes and stratified by concurrent COVID-19 infection status. Survey weighted multivariate regression analysis was performed. Patients with sepsis with concurrent COVID-19 infection had worse outcomes with higher mortality rate (15.6% vs 5.4%; aOR 3.71; 95% CI 3.62-3.80), higher need for invasive ventilation (13.1% vs 6.5%) and NIV (non-invasive ventilation) (10.2% vs 4.9%), higher incidence of acute kidney injury (37.6% vs 36.7%), acute respiratory failure (57.5% vs 20.3%), acute liver failure (1.0% vs 1.2%), disseminated intravascular coagulation (DIC) (0.4% vs 0.3%), cardiac arrest (3.1% vs 1.5%), acute respiratory distress syndrome (ARDS) (7.9% vs 0.4%), higher need for renal replacement therapy (4.9% vs 4.5%), tracheostomy (1.6% vs 0.6%), extra corporeal membrane oxygenation (ECMO) (0.2% vs 0.04%), longer length of hospital stay (10.3 days vs 7.6 days), higher total charges ($127,632 vs $93,735 respectively). The results demonstrate that the COVID-19 infection was independently associated with worse clinical outcomes among hospitalized with sepsis. These results underscore the need for early recognition, aggressive treatment, and targeted therapy in this high-risk clinical group.

Background: COVID-19 infection has been a major cause of hospitalization and mortality in the United States. Patients with liver cirrhosis may be especially vulnerable to severe outcomes of COVID-19 infection because of immune dysfunction, systemic inflammation, portal hypertension, and reduced physiologic reserve. These factors can increase the risk of severe infection, multiorgan complications, and poor inpatient outcomes. Using the 2020-2022 United States National Inpatient Sample, this study evaluates the effect of cirrhosis among adults hospitalized with COVID-19. Methods: We performed a retrospective cohort study using the National Inpatient Sample (NIS) database. Adult hospitalizations with COVID-19 from 2020 to 2022 were included and stratified according to the presence or absence of cirrhosis. Using multivariable logistic regression analyses, we evaluated in-hospital mortality as the primary outcome. Secondary outcomes included need for mechanical ventilation, septic shock, ARDS, ECMO utilization, acute kidney injury, renal replacement therapy, length of stay, and hospital charges. Results: A total of 5,934,565 hospitalized COVID-19 patients were included, of which 115,170 had concomitant cirrhosis. COVID-19 patients with cirrhosis had a higher in-hospital mortality than those without cirrhosis (16.8% vs. 11.3%; aOR 1.28; 95% CI 1.22-1.32). Patients with liver cirrhosis were also associated with higher odds of invasive mechanical ventilation, vasopressor use and septic shock. Conclusions: Cirrhosis was independently associated with increased in-hospital mortality and complications including need for invasive mechanical ventilation and septic shock in adults hospitalized with COVID-19. Although mortality associated with these patients have declined over time, they represent a high risk group that requires close monitoring.

Asthma exacerbation, frequently triggered by viral infections, is a leading cause of hospitalization, respiratory failure, and death. COVID-19 and asthma share a bidirectional relationship, with each potentially worsening the other. We compared outcomes in hospitalized asthma exacerbation patients with and without COVID-19 using the National Inpatient Sample (2020–2022), adjusting for confounders via multivariable logistic regression. Among 603,219 hospitalizations for asthma exacerbation, 69,600 (11.5%) had concomitant COVID-19. The COVID-19 group had significantly higher in-hospital mortality (6.7% vs. 1.4%; aOR 6.16; 95% CI 5.61-6.76) and greater need for invasive mechanical ventilation (10.1% vs. 4.9%; aOR 2.30; 95% CI 2.15-2.45), despite lower non-invasive ventilation use. Mean length of stay (7.7 vs. 4.6 days) and total hospital charges ($97,133 vs. $58,547) were also higher. These patients were more critically ill, with higher rates of respiratory failure, ARDS, acute kidney injury, and pulmonary embolism, and greater use of ECMO, renal replacement therapy, tracheostomy, and vasopressors. COVID-19 was independently associated with worse clinical outcomes among hospitalized asthma exacerbation patients. Early recognition of COVID-19 in asthma exacerbation is warranted to guide risk stratification and timely management.

Introduction: COVID-19, in addition to its direct detrimental respiratory infection, is associated with multiple systemic complications involving different organs, including the liver. COVID-19 has been associated with liver injury through multiple mechanisms, including direct viral effects on liver cells, immune-mediated injury, cytokine-driven inflammation, ischemic hepatitis, microvascular thrombosis, and sepsis-related multiorgan dysfunction. Acute liver failure (ALF) is the acute form of liver damage, which has a high mortality, and recovery is dependent on various factors. We studied the effect of COVID-19 on clinical outcomes such as mortality, length of stay, and need for non-invasive and invasive ventilation in patients with acute liver failure. Methods: We performed a retrospective cohort analysis using the Nationwide Inpatient Sample (NIS) database from 2020 to 2022. Adult patients admitted to the hospital with acute liver failure were divided into 2 groups based on their COVID-19 infection status. We analyzed differences in mortality, length of stay, need for non-invasive and invasive ventilation, acute kidney injury, need for renal replacement therapy, and total charges to evaluate the effects on outcomes, and the results were then adjusted for demographic and hospital factors. Results: Of 633,155 patients with acute liver failure, 66,785 had concurrent COVID-19 infection, while 566,370 did not. Patients with concurrent COVID-19 infection had significantly higher in-hospital mortality (63.9% vs. 36.0%) and greater utilization of noninvasive ventilation (14.9% vs. 6.4%), invasive mechanical ventilation (68.9% vs. 41.7%), higher incidence of acute kidney injury (81.4% vs. 70.3%) and higher need for renal replacement therapy (26.8% vs. 16.9%). They also experienced longer hospital stays (17.1 vs. 10.7 days) and higher total charges ($345,072 vs. $221,268). The findings were statistically significant after adjusting for demographics and clinical factors. Conclusions: Patients hospitalized with acute liver failure and concurrent COVID-19 infection experienced worse clinical outcomes, including higher in-hospital mortality, greater need for ventilatory support and renal replacement therapy, and higher hospital resource utilization. Notably, COVID-19 was independently associated with worse outcomes even among patients with fewer baseline comorbidities. These findings underscore the importance of early recognition of COVID-19 in patients presenting with acute liver failure, as well as prompt, multidisciplinary management to optimize clinical outcomes.