{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T07:55:00Z","timestamp":1767858900641,"version":"3.49.0"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T00:00:00Z","timestamp":1625529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000104","name":"National Aeronautics and Space Administration","doi-asserted-by":"publisher","award":["80NSSC19K1079"],"award-info":[{"award-number":["80NSSC19K1079"]}],"id":[{"id":"10.13039\/100000104","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000104","name":"National Aeronautics and Space Administration","doi-asserted-by":"publisher","award":["FIP0005"],"award-info":[{"award-number":["FIP0005"]}],"id":[{"id":"10.13039\/100000104","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["HL135093"],"award-info":[{"award-number":["HL135093"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>With the continuing rise of SARS-CoV2 infection globally and the emergence of various waves in different countries, understanding characteristics of susceptibility to infection, clinical severity, and outcomes remain vital. In this retrospective study, data was extracted for 39,539 patients from the de-identified Mount Sinai Health System COVID-19 database. We assessed the risk of mortality based on the presence of comorbidities and organ-specific sequelae in 7,032 CoV2 positive (+) patients. Prevalence of cardiovascular and metabolic comorbidities was high among SARS-CoV2+ individuals. Diabetes, obesity, coronary artery disease, hypertension, atrial fibrillation, and heart failure all increased overall mortality risk, while asthma did not. Ethnicity modified the risk of mortality associated with these comorbidities. With regards to secondary complications in the setting of infection, individuals with acute kidney injury and acute myocardial injury showed an increase in mortality risk. Cerebral infarcts and acute venous thromboembolic events were not associated with increased risk of mortality. Biomarkers for cardiovascular injury, coagulation, and inflammation were compared between deceased and survived individuals. We found that cardiac and coagulation biomarkers were elevated and fell beyond normal range more often in deceased patients. Several, but not all, inflammatory markers evaluated were increased in deceased patients. In summary, we identified comorbidities and sequelae along with peripheral blood biomarkers that were associated with elevated clinical severity and poor outcomes in COVID-19 patients. Overall, these findings detail the granularity of previously reported factors which may impact susceptibility, clinical severity, and mortality during the course of COVID-19 disease.<\/jats:p>","DOI":"10.1371\/journal.pone.0253660","type":"journal-article","created":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T17:29:50Z","timestamp":1625592590000},"page":"e0253660","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":21,"title":["Comorbidities, sequelae, blood biomarkers and their associated clinical outcomes in the Mount Sinai Health System COVID-19 patients"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7319-9685","authenticated-orcid":true,"given":"Agnieszka","family":"Brojakowska","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abrisham","family":"Eskandari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8826-4649","authenticated-orcid":true,"given":"Malik","family":"Bisserier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Bander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venkata Naga Srikanth","family":"Garikipati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lahouaria","family":"Hadri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Goukassian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7781-0314","authenticated-orcid":true,"given":"Kenneth M.","family":"Fish","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,7,6]]},"reference":[{"issue":"10223","key":"pone.0253660.ref001","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study","volume":"395","author":"N Chen","year":"2020","journal-title":"Lancet"},{"issue":"10229","key":"pone.0253660.ref002","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study","volume":"395","author":"F Zhou","year":"2020","journal-title":"Lancet"},{"issue":"4","key":"pone.0253660.ref003","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/S2213-2600(20)30076-X","article-title":"Pathological findings of COVID-19 associated with acute respiratory distress syndrome","volume":"8","author":"Z Xu","year":"2020","journal-title":"Lancet Respir Med"},{"key":"pone.0253660.ref004","article-title":"Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)","author":"T Guo","year":"2020","journal-title":"JAMA Cardiol"},{"key":"pone.0253660.ref005","article-title":"Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China","author":"S Shi","year":"2020","journal-title":"JAMA Cardiol"},{"key":"pone.0253660.ref006","article-title":"Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China","author":"D Wang","year":"2020","journal-title":"JAMA"},{"issue":"5","key":"pone.0253660.ref007","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study","volume":"8","author":"X Yang","year":"2020","journal-title":"Lancet Respir Med"},{"issue":"18","key":"pone.0253660.ref008","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"WJ Guan","year":"2020","journal-title":"N Engl J Med"},{"issue":"10223","key":"pone.0253660.ref009","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"C Huang","year":"2020","journal-title":"Lancet"},{"issue":"3","key":"pone.0253660.ref010","doi-asserted-by":"crossref","first-page":"668","DOI":"10.14336\/AD.2020.0502","article-title":"Comorbid Chronic Diseases are Strongly Correlated with Disease Severity among COVID-19 Patients: A Systematic Review and Meta-Analysis","volume":"11","author":"H Liu","year":"2020","journal-title":"Aging Dis"},{"key":"pone.0253660.ref011","doi-asserted-by":"crossref","first-page":"e43","DOI":"10.1590\/s1678-9946202062043","article-title":"Prevalence of comorbidities in patients and mortality cases affected by SARS-CoV2: a systematic review and meta-analysis","volume":"62","author":"OA Espinosa","year":"2020","journal-title":"Rev Inst Med Trop Sao Paulo"},{"issue":"10228","key":"pone.0253660.ref012","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.1016\/S0140-6736(20)30558-4","article-title":"Comorbidities and multi-organ injuries in the treatment of COVID-19","volume":"395","author":"T Wang","year":"2020","journal-title":"Lancet"},{"issue":"7","key":"pone.0253660.ref013","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1038\/s41591-020-0968-3","article-title":"Extrapulmonary manifestations of COVID-19","volume":"26","author":"A Gupta","year":"2020","journal-title":"Nat Med"},{"key":"pone.0253660.ref014","doi-asserted-by":"crossref","first-page":"117788","DOI":"10.1016\/j.lfs.2020.117788","article-title":"The role of biomarkers in diagnosis of COVID-19\u2014A systematic review","volume":"254","author":"M Kermali","year":"2020","journal-title":"Life Sci"},{"issue":"7","key":"pone.0253660.ref015","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1515\/cclm-2020-0369","article-title":"Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis","volume":"58","author":"BM Henry","year":"2020","journal-title":"Clin Chem Lab Med"},{"issue":"6","key":"pone.0253660.ref016","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1080\/10408363.2020.1770685","article-title":"Biomarkers associated with COVID-19 disease progression","volume":"57","author":"G Ponti","year":"2020","journal-title":"Crit Rev Clin Lab Sci"},{"issue":"4","key":"pone.0253660.ref017","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1161\/CIRCRESAHA.120.317447","article-title":"The Emerging Threat of (Micro)Thrombosis in COVID-19 and Its Therapeutic Implications","volume":"127","author":"JD McFadyen","year":"2020","journal-title":"Circ Res"},{"key":"pone.0253660.ref018","article-title":"COVID-19 and its implications for thrombosis and anticoagulation","author":"JM Connors","year":"2020","journal-title":"Blood"},{"issue":"11","key":"pone.0253660.ref019","doi-asserted-by":"crossref","first-page":"2467","DOI":"10.1016\/j.mayocp.2020.08.030","article-title":"Anticoagulation in COVID-19: A Systematic Review, Meta-analysis, and Rapid Guidance From Mayo Clinic","volume":"95","author":"RD McBane","year":"2020","journal-title":"Mayo Clin Proc"},{"issue":"17","key":"pone.0253660.ref020","first-page":"9161","article-title":"Imbalance between procoagulant factors and natural coagulation inhibitors contributes to hypercoagulability in the critically ill COVID-19 patient: clinical implications","volume":"24","author":"S Voicu","year":"2020","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"1","key":"pone.0253660.ref021","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1177\/1074248420958973","article-title":"COVID-19 Infection: Viral Macro- and Micro-Vascular Coagulopathy and Thromboembolism\/Prophylactic and Therapeutic Management","volume":"26","author":"AS Manolis","year":"2021","journal-title":"J Cardiovasc Pharmacol Ther"},{"key":"pone.0253660.ref022","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.thromres.2020.04.024","article-title":"Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy","volume":"191","author":"C Lodigiani","year":"2020","journal-title":"Thromb Res"},{"key":"pone.0253660.ref023","article-title":"Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19","author":"I Paranjpe","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"pone.0253660.ref024","article-title":"Clinical Characteristics of Hospitalized Covid-19 Patients in New York City","author":"I Paranjpe","year":"2020","journal-title":"medRxiv: the preprint server for health sciences"},{"issue":"6","key":"pone.0253660.ref025","article-title":"Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes","volume":"31","author":"L Zhu","year":"2020","journal-title":"Cell metabolism"},{"key":"pone.0253660.ref026","article-title":"The impact of COPD and smoking history on the severity of COVID-19: A systemic review and meta-analysis","author":"Q Zhao","year":"2020","journal-title":"Journal of medical virology"},{"key":"pone.0253660.ref027","first-page":"1","article-title":"Comorbidity and its Impact on Patients with COVID-19","author":"A Sanyaolu","year":"2020","journal-title":"SN Compr Clin Med"},{"issue":"6","key":"pone.0253660.ref028","article-title":"Cardiovascular comorbidity and its impact on patients with COVID-19","volume":"55","author":"WJ Guan","year":"2020","journal-title":"The European respiratory journal"},{"issue":"4","key":"pone.0253660.ref029","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.dsx.2020.04.004","article-title":"Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations","volume":"14","author":"AK Singh","year":"2020","journal-title":"Diabetes Metab Syndr"},{"issue":"5","key":"pone.0253660.ref030","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s00038-020-01390-7","article-title":"Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis","volume":"65","author":"V Jain","year":"2020","journal-title":"Int J Public Health"},{"issue":"3","key":"pone.0253660.ref031","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.dsx.2020.03.013","article-title":"Cardiovascular disease and COVID-19","volume":"14","author":"M Bansal","year":"2020","journal-title":"Diabetes Metab Syndr"},{"key":"pone.0253660.ref032","article-title":"Effect of Repetitive Acute Hypoxic Preconditioning on Airway Reactivity During House Dust Mite\u2014Induced Allergic Inflammation","author":"C Setzke","journal-title":"A63 PATHOPHYSIOLOGY OF ASTHMA IN CELLS, TISSUES, AND ANIMAL MODELS"},{"key":"pone.0253660.ref033","article-title":"Dexamethasone in Hospitalized Patients with Covid-19\u2014Preliminary Report","author":"RC Group","year":"2020","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0253660.ref034","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/CCM.0b013e31819292ea","article-title":"Racial and ethnic disparities in mortality from acute lung injury","volume":"37","author":"SE Erickson","year":"2009","journal-title":"Critical care medicine"},{"issue":"8","key":"pone.0253660.ref035","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1097\/00003246-200208000-00001","article-title":"Race and gender differences in acute respiratory distress syndrome deaths in the United States: an analysis of multiple-cause mortality data (1979\u20131996)","volume":"30","author":"M Moss","year":"2002","journal-title":"Critical care medicine"},{"key":"pone.0253660.ref036","first-page":"2020","author":"Z Wang","year":"2020","journal-title":"Analysis of hospitalized COVID-19 patients in the Mount Sinai Health System using electronic medical records (EMR) reveals important prognostic factors for improved clinical outcomes"},{"issue":"6","key":"pone.0253660.ref037","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1164\/rccm.202005-1583OC","article-title":"Characterization of the Inflammatory Response to Severe COVID-19 Illness","volume":"202","author":"OJ McElvaney","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0253660.ref038","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.3389\/fphar.2018.01157","article-title":"Anakinra Therapy for Non-cancer Inflammatory Diseases","volume":"9","author":"G Cavalli","year":"2018","journal-title":"Front Pharmacol"},{"issue":"5","key":"pone.0253660.ref039","first-page":"94","article-title":"Differential diagnosis of acute fatty liver and viral hepatitis in pregnancy","author":"AG Rakhmanova","year":"1988","journal-title":"Sov Med"},{"issue":"10","key":"pone.0253660.ref040","doi-asserted-by":"crossref","first-page":"e594","DOI":"10.1016\/S2665-9913(20)30275-7","article-title":"COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study","volume":"2","author":"JJ Manson","year":"2020","journal-title":"Lancet Rheumatol"},{"issue":"23","key":"pone.0253660.ref041","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1182\/blood.2020006000","article-title":"COVID-19 and its implications for thrombosis and anticoagulation","volume":"135","author":"JM Connors","year":"2020","journal-title":"Blood"},{"issue":"5","key":"pone.0253660.ref042","first-page":"523","article-title":"DIC: an update on diagnosis and treatment","volume":"58","author":"H Wada","year":"2017","journal-title":"Rinsho Ketsueki"},{"issue":"10","key":"pone.0253660.ref043","doi-asserted-by":"crossref","first-page":"2539","DOI":"10.1161\/ATVBAHA.120.314872","article-title":"Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19","volume":"40","author":"JS Berger","year":"2020","journal-title":"Arterioscler Thromb Vasc Biol"},{"issue":"9","key":"pone.0253660.ref044","doi-asserted-by":"crossref","first-page":"299","DOI":"10.12691\/ajmcr-8-9-11","article-title":"A Systematic Review of COVID-19 and Myocarditis","volume":"8","author":"PT Kariyanna","year":"2020","journal-title":"Am J Med Case Rep"},{"key":"pone.0253660.ref045","first-page":"1","article-title":"Takotsubo Syndrome in Patients with COVID-19: a Systematic Review of Published Cases","author":"S Singh","year":"2020","journal-title":"SN Compr Clin Med"},{"issue":"16","key":"pone.0253660.ref046","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1001\/jama.2020.4326","article-title":"Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State","volume":"323","author":"M Arentz","year":"2020","journal-title":"JAMA"},{"issue":"21","key":"pone.0253660.ref047","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1056\/NEJMc2010459","article-title":"Acute Cor Pulmonale in Critically Ill Patients with Covid-19","volume":"382","author":"C Creel-Bulos","year":"2020","journal-title":"N Engl J Med"},{"issue":"5","key":"pone.0253660.ref048","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.jacc.2020.06.007","article-title":"Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection","volume":"76","author":"A Lala","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"pone.0253660.ref049","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s40560-020-00466-z","article-title":"D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study","volume":"8","author":"Y Yao","year":"2020","journal-title":"J Intensive Care"},{"key":"pone.0253660.ref050","article-title":"Cardiac Troponin Testing in Patients with COVID-19: A Strategy for Testing and Reporting Results","author":"PA Kavsak","year":"2020","journal-title":"Clin Chem"},{"key":"pone.0253660.ref051","unstructured":"Andrew Abboud JLJ. Heart Failure Biomarkers in COVID-19. American College of Cardiology."},{"issue":"6","key":"pone.0253660.ref052","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1056\/NEJMp2015897","article-title":"False Negative Tests for SARS-CoV-2 Infection\u2014Challenges and Implications","volume":"383","author":"S Woloshin","year":"2020","journal-title":"N Engl J Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253660","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T17:30:36Z","timestamp":1625592636000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253660"}},"subtitle":[],"editor":[{"given":"Chiara","family":"Lazzeri","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,7,6]]},"references-count":52,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,6]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0253660","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,6]]}}}