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Leveraging the community of practice recently established through the U S National Institute of Environmental Health Sciences (NIEHS) Disaster Research Response (DR2) working group, we used a modified Delphi method to identify and prioritize environmental health sciences Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and associated Coronavirus Disease 2019 (COVID-19) research questions Twenty-six individuals with broad expertise across a variety of environmental health sciences subdisciplines were selected to participate among 45 self-nominees In Round 1, panelists submitted research questions and brief justifications In Round 2, panelists rated the priority of each question on a nine-point Likert scale Responses were trichotomized into priority categories (low priority;medium priority;and high priority) A research question was determined to meet consensus if at least 69 2% of panelists rated it within the same priority category Research needs that did not meet consensus in round 2 were redistributed for re-rating Fourteen questions met consensus as high priority in round 2, and an additional 14 questions met consensus as high priority in round 3 We discuss the impact and limitations of using this approach to identify and prioritize research questions in the context of a disaster response BACKGROUND: Patients with cardiovascular comorbidities are at high risk of poor outcome from COVID-19 However, how the burden (number) of vascular risk factors influences the risk of severe COVID-19 disease remains unresolved Our aim was to investigate the association of severe COVID-19 illness with vascular risk factor burden METHODS: We included 164 (61 8 ± 13 6 years) patients with COVID-19 in this retrospective study We compared the difference in clinical characteristics, laboratory findings and chest computed tomography (CT) findings between patients with severe and non-severe COVID-19 illness We evaluated the association between the number of vascular risk factors and the development of severe COVID-19 disease, using a Cox regression model RESULTS: Sixteen (9 8%) patients had no vascular risk factors;38 (23 2%) had 1;58 (35 4%) had 2;34 (20 7%) had 3;and 18 (10 9%) had ≥4 risk factors Twenty-nine patients (17 7%) experienced severe COVID-19 disease with a median (14 [7-27] days) duration between onset to developing severe COVID-19 disease, an event rate of 4 47 per 1000-patient days (95%CI 3 10-6 43) Kaplan-Meier curves showed a gradual increase in the risk of severe COVID-19 illness (log-rank P < 0 001) stratified by the number of vascular risk factors After adjustment for age, sex, and comorbidities as potential confounders, vascular risk factor burden remained associated with an increasing risk of severe COVID-19 illness CONCLUSIONS: Patients with increasing vascular risk factor burden have an increasing risk of severe COVID-19 disease, and this population might benefit from specific COVID-19 prevention (e g , self-isolation) and early hospital treatment measures
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