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Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study.
BMJ. 2020 May 22; 369:m1966.BMJ

Abstract

OBJECTIVE

To 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.

DESIGN

Prospective cohort study.

SETTING

Single academic medical center in New York City and Long Island.

PARTICIPANTS

5279 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 MEASURES

Outcomes 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.

RESULTS

Of 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.

CONCLUSIONS

Age 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.

Authors+Show Affiliations

Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA. NYU Langone Health, New York, NY, USA.Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street #633, New York, NY 10016, USA. Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA.Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA.NYU Langone Health, New York, NY, USA.Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.NYU Langone Health, New York, NY, USA.NYU Langone Health, New York, NY, USA.NYU Langone Health, New York, NY, USA. Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY, USA.NYU Langone Health, New York, NY, USA. Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA leora.horwitz@nyulangone.org. Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street #633, New York, NY 10016, USA. Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32444366

Citation

Petrilli, Christopher M., et al. "Factors Associated With Hospital Admission and Critical Illness Among 5279 People With Coronavirus Disease 2019 in New York City: Prospective Cohort Study." BMJ (Clinical Research Ed.), vol. 369, 2020, pp. m1966.
Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966.
Petrilli, C. M., Jones, S. A., Yang, J., Rajagopalan, H., O'Donnell, L., Chernyak, Y., Tobin, K. A., Cerfolio, R. J., Francois, F., & Horwitz, L. I. (2020). Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ (Clinical Research Ed.), 369, m1966. https://doi.org/10.1136/bmj.m1966
Petrilli CM, et al. Factors Associated With Hospital Admission and Critical Illness Among 5279 People With Coronavirus Disease 2019 in New York City: Prospective Cohort Study. BMJ. 2020 May 22;369:m1966. PubMed PMID: 32444366.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. AU - Petrilli,Christopher M, AU - Jones,Simon A, AU - Yang,Jie, AU - Rajagopalan,Harish, AU - O'Donnell,Luke, AU - Chernyak,Yelena, AU - Tobin,Katie A, AU - Cerfolio,Robert J, AU - Francois,Fritz, AU - Horwitz,Leora I, Y1 - 2020/05/22/ PY - 2020/5/24/entrez PY - 2020/5/24/pubmed PY - 2020/5/29/medline SP - m1966 EP - m1966 JF - BMJ (Clinical research ed.) JO - BMJ VL - 369 N2 - OBJECTIVE: To 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. DESIGN: Prospective cohort study. SETTING: Single academic medical center in New York City and Long Island. PARTICIPANTS: 5279 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 MEASURES: Outcomes 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. RESULTS: Of 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. CONCLUSIONS: Age 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. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/32444366/Factors_associated_with_hospital_admission_and_critical_illness_among_5279_people_with_coronavirus_disease_2019_in_New_York_City:_prospective_cohort_study_ L2 - https://www.bmj.com/lookup/pmidlookup?view=long&amp;pmid=32444366 DB - PRIME DP - Unbound Medicine ER -