Towards Precision Medicine for COVID-19 ARDS - An Analysis of the NorthCARDS (Northwell Health COVID-19 ARDS) Dataset to Identify Associations Between Patient-level Factors, Inpatient Treatment and Clinical Trajectories on Mechanical Ventilation Liberation and Survival

The investigators will leverage the NorthCARDS dataset for this analysis. This dataset includes over 1500 persons admitted to the Northwell Health System who had PCR positive COVID19 testing and were invasively mechanically ventilated for ARDS. Registry development was initiated in April 2020 and continues with prospective data collection for all mechanically ventilated COVID19 ARDS patients among the Northwell Health hospitals. Data structuring and engineering is informed by weekly multi-disciplinary review including frontline clinicians, data scientists, biostatisticians and data engineers within medical informatics. Random selection of patients for individual 'manual' chart review occurs for data assumptions and recording.

The two outcomes to be modeled using multivariable regression analyses will be:

1. Index hospital survival and
2. Time to liberation from mechanical ventilation.

Liberation from mechanical ventilation will be defined as non-palliative extubation and persistent extubation for greater than one week. Outcomes will be obtained from electronic health record queries. Patients in whom the investigators do not have outcomes data by November 30,2020 will be censored in analyses, and descriptive statistics will be summarized and presented separately.

The investigators will approach this analysis using both hypothesis-driven methods wherein known risk factors for poor outcomes will be included in the multivariable regression models (logistic regression for Model 1, and Cox Proportional Hazards for Model 2); and investigators will also perform data-driven variable selection for the models. A priori defined risk factors that will be included in the models will be: Age, Gender, BMI, functional status at baseline (nursing home versus community admission), Comorbidities (coronary artery disease, Chronic Kidney Disease, Neurologic disorders, COPD, Diabetes, Active cancer, Hypertension); Inpatient treatments (for continuous values will be (max, median, trajectory)) including PEEP levels, Driving Pressure, FiO2, hypoxemia (Pao2:Fio2), type of mechanical ventilator (portable versus not), COVID-targeted medications (e.g., azithromycin, hydroxychloroquine, corticosteroids); and end-organ damage in-hospital: liver dysfunction, Kidney dysfunction, coagulopathy, (captured via SOFA scores), cardiac dysfunction, and shock requiring vasopressor/inotrope. Calendar-time, hospital type (community versus tertiary hospital) and hospital capacity (measured as number of hospital beds filled and time from admission order in ER to being transferred to an inpatient bed) will also be included in the analyses to account for temporal and systemic influences of outcomes.