Comparative Analysis of Clinical Outcomes for COVID-19 and Influenza among Cardiac Transplant Recipients in the United States
Abstract
:1. Introduction
2. Materials and Methods
2.1. Covariates
- Patient: age, race, sex, comorbidities, insurance status, mean income in patient’s zip code, and disposition.
- Hospital: location, teaching status, bed size, and region.
- Illness severity: length of stay, mortality, hospitalization cost, Elixhauser comorbidity score.
- In-hospital complications: as below.
2.2. Study Outcomes
2.3. Statistical Methods
3. Results
3.1. Demographics and Baseline Comorbidities
3.2. In-Hospital Mortality
3.3. In-Hospital Complications
3.4. In-Hospital Quality Measures and Disposition
4. Discussion
5. Future Implications
6. Limitations
7. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Heart Transplant Patients with COVID-19 | Heart Transplant Patients with Influenza | p-Value |
---|---|---|---|
n = 2460 | n = 1155 (47.0%) | n = 1305 (53.0%) | |
Sex (Female) | 24.2% | 23.4% | 0.828 |
Mean age years (SD) | 0.249 | ||
Male | 61.3 (14.2) | 59.8 (14.8) | |
Female | 57.4 (14.4) | 54.9 (15.5) | |
Age Groups | 0.150 | ||
≥18–29 | 3.9% | 7.3% | |
30–49 | 17.3% | 15.3% | |
50–69 | 48.5% | 54.0% | |
≥70 | 30.3% | 23.4% | |
Race | 0.282 | ||
Caucasians | 49.3% | 55.1% | |
African American | 31.7% | 25.6% | |
Hispanics | 15.9% | 13.0% | |
Asian or Pacific Islander | 0.9% | 3.2% | |
Native American | 0.4% | 1.2% | |
Others | 1.8% | 2.0% | |
Median Household Income | 0.075 | ||
0–25th percentile | 27.1% | 29.3% | |
26–50th percentile | 30.1% | 21.1% | |
51–75th percentile | 26.2% | 26.2% | |
≥76th percentile | 16.6% | 23.4% | |
Insurance Status | 0.521 | ||
Medicare | 65.3% | 63.0% | |
Medicaid | 9.8% | 7.0% | |
Private | 24.0% | 28.8% | |
Self-pay | 0.9% | 1.2% | |
Hospital Division | 0.753 | ||
New England | 2.6% | 5.8% | |
Middle Atlantic | 19.1% | 13.8% | |
East North Central | 14.7% | 17.6% | |
West North Central | 9.1% | 7.7% | |
South Atlantic | 16.5% | 20.3% | |
East South Central | 6.9% | 6.5% | |
West South Central | 15.6% | 12.6% | |
Mountain | 6.1% | 5.4% | |
Pacific | 9.5% | 10.3% | |
Hospital Bedsize | 0.960 | ||
Small | 9.1% | 8.4% | |
Medium | 17.3% | 18.0% | |
Large | 73.6% | 73.6% | |
Hosptal Teaching Status | 0.030 | ||
Rural | 5.6% | 2.3% | |
Urban non-teaching | 4.3% | 8.8% | |
Urban teaching | 90.0% | 88.9% | |
Comorbidities Mean Elixhauser Score (SD) | 4.8 (1.9) | 4.2 (1.9) | |
Pulmonary Circulation Disorder | 5.6% | 6.1% | 0.816 |
Peripheral Vascular Disorder | 13.4% | 14.6% | 0.714 |
Hypertension | 64.5% | 60.5% | 0.360 |
Chronic Pulmonary Disease | 16.9% | 23.0% | 0.094 |
Diabetes | 53.7% | 54.0% | 0.930 |
Hypothyroidism | 18.2% | 16.1% | 0.533 |
Liver Disease | 6.5% | 4.2% | 0.262 |
Lymphoma | 0.9% | 1.5% | 0.502 |
Metastatic Cancer | 1.3% | 0.4% | 0.295 |
Solid Tumor without Metastasis | 3.5% | 1.5% | 0.185 |
Rheumatoid Arthritis | 3.0% | 0.4% | 0.020 |
Coagulopathy | 18.6% | 11.9% | 0.038 |
Obesity | 22.5% | 11.9% | 0.001 |
Weight Loss | 10.0% | 8.1% | 0.465 |
Alcohol Abuse | 2.2% | 0.4% | 0.077 |
Drug Abuse | 1.7% | 1.5% | 0.862 |
Depression | 14.7% | 17.6% | 0.408 |
Chronic Kidney Disease | 39.8% | 26.8% | 0.003 |
Variable | Heart Transplant Patients with COVID-19 | Heart Transplant Patients with Influenza | p-Value |
---|---|---|---|
In-hospital mortality (n = 120) | 9.5% | 0.8% | |
Adjusted odds ratio 1 51.6 (4.3–615.9) | 0.002 | ||
Mechanical ventilation | 13.9% | 5.4% | |
Adjusted odds ratio 1 4.0 (1.2–13.1) | 0.021 | ||
Acute kidney injury on hemodialysis | 6.9% | 1.9% | |
Adjusted odds ratio 1 3.7 (0.7–21.3) | 0.137 | ||
Acute heart failure | 3.5% | 4.6% | |
Adjusted odds ratio 1 0.2 (0.1–0.9) | 0.031 | ||
Pulmonary embolism | 1.3% | 0.4% | |
Adjusted odds ratio 2 1.5 (0.0–72.6) | 0.829 | ||
Cerebrovascular accident | 1.3% | 0.8% | |
Adjusted odds ratio 1 1.1 (0.2–6.9) | 0.948 | ||
Atrial arrhythmia | 15.6% | 10.7% | |
Adjusted odds ratio 1 1.3 (0.5–3.4) | 0.576 | ||
Ventricular arrhythmias | 1.7% | 1.5% | |
Adjusted odds ratio 1 31.3 (1.6–608.5) | 0.023 | ||
Conduction abnormalities | 10.0% | 6.9% | |
Adjusted odds ratio 1 1.9 (0.7–5.1) | 0.231 | ||
Sudden cardiac arrest | 0.4% | 0.8% | |
Adjusted odds ratio 2 1.4 (0.1–24.1) | 0.809 | ||
Cardiogenic shock | 1.3% | 0.8% | |
Adjusted odds ratio 2 0.1 (0.0–4.4) | 0.201 | ||
Heart transplant rejection | 1.3% | 0.4% | |
Adjusted odds ratio 3 7.2 (0.9–57.1) | 0.062 | ||
Myocardities | 0.43% | 0.38 | |
Adjusted odds ratio 3 0.83 (0.07–10.1) | 0.08 | ||
Mean total hospitalization charge (USD) | 138,967 | 52,803 | |
84,623 higher | 0.001 | ||
Mean length of stay (days) | 9.4 | 5.9 | |
0.6 days lower | 0.877 | ||
Disposition | 0.036 | ||
Home/Routine | 67.2% | 78.8% | |
SNF 4/LTAC 5/Nursing home | 14.1% | 9.6% | |
Home health | 18.8% | 11.2% | |
AMA 6 | - | 0.4% |
aOR | 95% CI (LL-UL) | p-Value | |
---|---|---|---|
White female | 0.9 | 0.1-5.2 | 0.870 |
Black male | 1.3 | 0.4-3.9 | 0.630 |
Black female | 1.2 | 0.2-8.0 | 0.810 |
Hispanic male | 0.8 | 0.1-6.3 | 0.860 |
Hispanic female | 1.0 | 0.2-6.6 | 0.980 |
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Chavarin, D.J.; Bobba, A.; Davis, M.G.; Roth, M.A.; Kasdorf, M.; Nasrullah, A.; Chourasia, P.; Gangu, K.; Avula, S.R.; Sheikh, A.B. Comparative Analysis of Clinical Outcomes for COVID-19 and Influenza among Cardiac Transplant Recipients in the United States. Viruses 2023, 15, 1700. https://doi.org/10.3390/v15081700
Chavarin DJ, Bobba A, Davis MG, Roth MA, Kasdorf M, Nasrullah A, Chourasia P, Gangu K, Avula SR, Sheikh AB. Comparative Analysis of Clinical Outcomes for COVID-19 and Influenza among Cardiac Transplant Recipients in the United States. Viruses. 2023; 15(8):1700. https://doi.org/10.3390/v15081700
Chicago/Turabian StyleChavarin, Daniel J., Aniesh Bobba, Monique G. Davis, Margaret A. Roth, Michelle Kasdorf, Adeel Nasrullah, Prabal Chourasia, Karthik Gangu, Sindhu Reddy Avula, and Abu Baker Sheikh. 2023. "Comparative Analysis of Clinical Outcomes for COVID-19 and Influenza among Cardiac Transplant Recipients in the United States" Viruses 15, no. 8: 1700. https://doi.org/10.3390/v15081700
APA StyleChavarin, D. J., Bobba, A., Davis, M. G., Roth, M. A., Kasdorf, M., Nasrullah, A., Chourasia, P., Gangu, K., Avula, S. R., & Sheikh, A. B. (2023). Comparative Analysis of Clinical Outcomes for COVID-19 and Influenza among Cardiac Transplant Recipients in the United States. Viruses, 15(8), 1700. https://doi.org/10.3390/v15081700