Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study

AbstractObjectiveTo describe outcomes of people admitted to hospital with coronavirus disease 2019 (covid-19) in the United States, and the clinical and laboratory characteristics associated with severity of illness.DesignProspective cohort study.SettingSingle academic medical center in New York Cit...

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Vydáno v:BMJ (Online) Ročník 369; s. m1966
Hlavní autoři: Petrilli, Christopher M, Jones, Simon A, Yang, Jie, Rajagopalan, Harish, O’Donnell, Luke, Chernyak, Yelena, Tobin, Katie A, Cerfolio, Robert J, Francois, Fritz, Horwitz, Leora I
Médium: Journal Article
Jazyk:angličtina
Vydáno: England British Medical Journal Publishing Group 22.05.2020
BMJ Publishing Group LTD
BMJ Publishing Group Ltd
Témata:
Adult
Age Factors
Aged
Betacoronavirus
Body mass index
C-reactive protein
Calcium-binding protein
Cardiovascular disease
Cohort analysis
Comorbidity
Confidence intervals
Congestive heart failure
Coronaviridae
Coronavirus Infections - epidemiology
Coronavirus Infections - mortality
Coronaviruses
COVID-19
Critical Care
Critical Illness - epidemiology
Epidemics
Female
Hispanic people
Hospitalization
Hospitalization - statistics & numerical data
Hospitals
Humans
Illnesses
Intensive care
Kidney diseases
Laboratories
Libraries
Male
Mechanical ventilation
Middle Aged
Mortality
New York City - epidemiology
Oxygen
Pandemics
Patients
Pneumonia, Viral - epidemiology
Pneumonia, Viral - mortality
Prospective Studies
Respiration, Artificial
Risk Factors
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Signs
Skin cancer
Troponin
Ventilators
Vital signs
Young Adult
New York City
Long Island New York
United States > US
China
New York City New York
ISSN:1756-1833, 0959-8138, 1756-1833
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Shrnutí:AbstractObjectiveTo describe outcomes of people admitted to hospital with coronavirus disease 2019 (covid-19) in the United States, and the clinical and laboratory characteristics associated with severity of illness.DesignProspective cohort study.SettingSingle academic medical center in New York City and Long Island.Participants5279 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection between 1 March 2020 and 8 April 2020. The final date of follow up was 5 May 2020.Main outcome measuresOutcomes were admission to hospital, critical illness (intensive care, mechanical ventilation, discharge to hospice care, or death), and discharge to hospice care or death. Predictors included patient characteristics, medical history, vital signs, and laboratory results. Multivariable logistic regression was conducted to identify risk factors for adverse outcomes, and competing risk survival analysis for mortality.ResultsOf 11 544 people tested for SARS-Cov-2, 5566 (48.2%) were positive. After exclusions, 5279 were included. 2741 of these 5279 (51.9%) were admitted to hospital, of whom 1904 (69.5%) were discharged alive without hospice care and 665 (24.3%) were discharged to hospice care or died. Of 647 (23.6%) patients requiring mechanical ventilation, 391 (60.4%) died and 170 (26.2%) were extubated or discharged. The strongest risk for hospital admission was associated with age, with an odds ratio of >2 for all age groups older than 44 years and 37.9 (95% confidence interval 26.1 to 56.0) for ages 75 years and older. Other risks were heart failure (4.4, 2.6 to 8.0), male sex (2.8, 2.4 to 3.2), chronic kidney disease (2.6, 1.9 to 3.6), and any increase in body mass index (BMI) (eg, for BMI >40: 2.5, 1.8 to 3.4). The strongest risks for critical illness besides age were associated with heart failure (1.9, 1.4 to 2.5), BMI >40 (1.5, 1.0 to 2.2), and male sex (1.5, 1.3 to 1.8). Admission oxygen saturation of <88% (3.7, 2.8 to 4.8), troponin level >1 (4.8, 2.1 to 10.9), C reactive protein level >200 (5.1, 2.8 to 9.2), and D-dimer level >2500 (3.9, 2.6 to 6.0) were, however, more strongly associated with critical illness than age or comorbidities. Risk of critical illness decreased significantly over the study period. Similar associations were found for mortality alone.ConclusionsAge and comorbidities were found to be strong predictors of hospital admission and to a lesser extent of critical illness and mortality in people with covid-19; however, impairment of oxygen on admission and markers of inflammation were most strongly associated with critical illness and mortality. Outcomes seem to be improving over time, potentially suggesting improvements in care.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:1756-1833
0959-8138
1756-1833
DOI:10.1136/bmj.m1966