Comparing body mass index and obesity-related comorbidities as predictors in hospitalized COVID-19 patients.

The association between body mass index (BMI) and poor COVID-19 outcomes in patients has been demonstrated across numerous studies. However, obesity-related comorbidities have also been shown to be associated with poor outcomes. The purpose of this study was to determine whether BMI or obesity-associated comorbidities contribute to elevated COVID-19 severity in non-elderly, hospitalized patients with elevated BMI (≥25 kg/m2 ). This was a single-center, retrospective cohort study of 526 hospitalized, non-elderly adult (aged 18-64) COVID-19 patients with BMI ≥25 kg/m2 in suburban New York from March 6 to May 11, 2020. The Edmonton Obesity Staging System (EOSS) was used to quantify the severity of obesity-related comorbidities. EOSS was compared with BMI in multivariable regression analyses to predict COVID-19 outcomes. We found that higher EOSS scores were associated with poor outcomes after demographic adjustment, unlike BMI. Specifically, patients with increased EOSS scores had increased odds of acute kidney injury (adjusted odds ratio [aOR] = 6.40; 95% CI 3.71-11.05), intensive care unit admission (aOR = 10.71; 95% CI 3.23-35.51), mechanical ventilation (aOR = 3.10; 95% CI 2.01-4.78) and mortality (aOR = 5.05; 95% CI 1.83-13.90). Obesity-related comorbidity burden as determined by EOSS was a better predictor of poor COVID-19 outcomes relative to BMI, suggesting that comorbidity burden may be driving risk in those hospitalized with elevated BMI.

A reference guide to rapidly implementing an institutional dashboard for resource allocation and oversight during COVID-19 pandemic surge.

OBJECTIVES: We develop a dashboard that leverages electronic health record (EHR) data to monitor intensive care unit patient status and ventilator utilization in the setting of the COVID-19 pandemic. MATERIALS AND METHODS: Data visualization software is used to display information from critical care data mart that extracts information from the EHR. A multidisciplinary collaborative led the development. RESULTS: The dashboard displays institution-level ventilator utilization details, as well as patient-level details such as ventilator settings, organ-system specific parameters, laboratory values, and infusions. DISCUSSION: Components of the dashboard were selected to facilitate the determination of resources and simultaneous assessment of multiple patients. Abnormal values are color coded. An overall illness assessment score is tracked daily to capture illness severity over time. CONCLUSION: This reference guide shares the architecture and sample reusable code to implement a robust, flexible, and scalable dashboard for monitoring ventilator utilization and illness severity in intensive care unit ventilated patients.

Effect of injection technique on temporal parametric imaging derived from digital subtraction angiography in patient specific phantoms.

Parametric imaging maps (PIM's) derived from digital subtraction angiography (DSA) for the cerebral arterial flow assessment in clinical settings have been proposed, but experiments have yet to determine the reliability of such studies. For this study, we have observed the effects of different injection techniques on PIM's. A flow circuit set to physiologic conditions was created using an internal carotid artery phantom. PIM's were derived for two catheter positions, two different contrast bolus injection volumes (5ml and 10 ml), and four injection rates (5, 10, 15 and 20 ml/s). Using a gamma variate fitting approach, we derived PIM's for mean-transit-time (MTT), time-to-peak (TTP) and bolus-arrivaltime (BAT). For the same injection rates, a larger bolus resulted in an increased MTT and TTP, while a faster injection rate resulted in a shorter MTT, TTP, and BAT. In addition, the position of the catheter tip within the vasculature directly affected the PIM. The experiment showed that the PIM is strongly correlated with the injection conditions, and, therefore, they have to be interpreted with caution. PIM images must be taken from the same patient to be able to be meaningfully compared. These comparisons can include pre- and post-treatment images taken immediately before and after an interventional procedure or simultaneous arterial flow comparisons through the left and right cerebral hemispheres. Due to the strong correlation between PIM and injection conditions, this study indicates that this assessment method should be used only to compare flow changes before and after treatment within the same patient using the same injection conditions.