Characteristics and Outcomes of US Patients Hospitalized With COVID-19

Author:

Peltan Ithan D.1,Caldwell Ellen2,Admon Andrew J.3,Attia Engi F.4,Gundel Stephanie J.5,Mathews Kusum S.6,Nagrebetsky Alexander7,Sahetya Sarina K.8,Ulysse Christine9,Brown Samuel M.10,Chang Steven Y.11,Goodwin Andrew J.12,Hope Aluko A.13,Iwashyna Theodore J.14,Johnson Nicholas J.15,Lanspa Michael J.16,Richardson Lynne D.17,Vranas Kelly C.18,Angus Derek C.19,Baron Rebecca M.20,Haaland Benjamin A.21,Hayden Douglas L.22,Thompson B. Taylor23,Rice Todd W.24,Hough Catherine L.25

Affiliation:

1. Ithan D. Peltan is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, Utah, and an adjunct assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.

2. Ellen Caldwell is a data analyst/biostatistician, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle.

3. Andrew J. Admon is a clinical instructor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan School of Medicine, Ann Arbor.

4. Engi F. Attia is an assistant professor, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington.

5. Stephanie J. Gundel is a research coordinator, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington.

6. Kusum S. Mathews is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.

7. Alexander Nagrebetsky is an assistant professor, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

8. Sarina K. Sahetya is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

9. Christine Ulysse is a statistician, Division of Biostatistics, Department of Medicine, Massachusetts General Hospital.

10. Samuel M. Brown is a professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah School of Medicine.

11. Steven Y. Chang is a professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at University of California, Los Angeles (UCLA).

12. Andrew J. Goodwin is a professor, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston.

13. Aluko A. Hope is an associate professor, Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center and Albert Einstein School of Medicine, Bronx, New York.

14. Theodore J. Iwashyna is a professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan School of Medicine, and Veterans Affairs (VA) Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.

15. Nicholas J. Johnson is an associate professor, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, and Department of Emergency Medicine, University of Washington.

16. Michael J. Lanspa is an associate professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah School of Medicine.

17. Lynne D. Richardson is a professor, Departments of Emergency Medicine and Population Health Sciences, and codirector, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai.

18. Kelly C. Vranas is an assistant professor, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland.

19. Derek C. Angus is a professor and chair, Department of Critical Care Medicine, University of Pittsburgh Medical Center and University of Pittsburgh Schools of the Health Sciences, Pittsburgh, Pennsylvania.

20. Rebecca M. Baron is an associate professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston.

21. Benjamin A. Haaland is an associate professor, Department of Population Health Sciences, University of Utah School of Medicine.

22. Douglas L. Hayden is an assistant professor, Division of Biostatistics, Department of Medicine, Massachusetts General Hospital.

23. B. Taylor Thompson is a professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School.

24. Todd W. Rice is an associate professor, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.

25. Catherine L. Hough is a professor and chief, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Oregon Health and Science University.

Abstract

Background Understanding COVID-19 epidemiology is crucial to clinical care and to clinical trial design and interpretation. Objective To describe characteristics, treatment, and outcomes among patients hospitalized with COVID-19 early in the pandemic. Methods A retrospective cohort study of consecutive adult patients with laboratory-confirmed, symptomatic SARS-CoV-2 infection admitted to 57 US hospitals from March 1 to April 1, 2020. Results Of 1480 inpatients with COVID-19, median (IQR) age was 62.0 (49.4-72.9) years, 649 (43.9%) were female, and 822 of 1338 (61.4%) were non-White or Hispanic/Latino. Intensive care unit admission occurred in 575 patients (38.9%), mostly within 4 days of hospital presentation. Respiratory failure affected 583 patients (39.4%), including 284 (19.2%) within 24 hours of hospital presentation and 413 (27.9%) who received invasive mechanical ventilation. Median (IQR) hospital stay was 8 (5-15) days overall and 15 (9-24) days among intensive care unit patients. Hospital mortality was 17.7% (n=262). Risk factors for hospital death identified by penalized multivariable regression included older age; male sex; comorbidity burden; symptoms-to-admission interval; hypotension; hypoxemia; and higher white blood cell count, creatinine level, respiratory rate, and heart rate. Of 1218 survivors, 221 (18.1%) required new respiratory support at discharge and 259 of 1153 (22.5%) admitted from home required new health care services. Conclusions In a geographically diverse early-pandemic COVID-19 cohort with complete hospital folllow-up, hospital mortality was associated with older age, comorbidity burden, and male sex. Intensive care unit admissions occurred early and were associated with protracted hospital stays. Survivors often required new health care services or respiratory support at discharge.

Publisher

AACN Publishing

Subject

Critical Care,General Medicine

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