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Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study.
medRxiv. 2020 Apr 20M

Abstract

BACKGROUND

Nearly 30,000 patients with coronavirus disease-2019 (COVID-19) have been hospitalized in New York City as of April 14th, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed.

METHODS

We prospectively collected clinical, biomarker, and treatment data on critically ill adults with laboratory-confirmed-COVID-19 admitted to two hospitals in northern Manhattan between March 2nd and April 1st, 2020. The primary outcome was in-hospital mortality. Secondary outcomes included frequency and duration of invasive mechanical ventilation, frequency of vasopressor use and renal-replacement-therapy, and time to clinical deterioration following hospital admission. The relationship between clinical risk factors, biomarkers, and in-hospital mortality was modeled using Cox-proportional-hazards regression. Each patient had at least 14 days of observation.

RESULTS

Of 1,150 adults hospitalized with COVID-19 during the study period, 257 (22%) were critically ill. The median age was 62 years (interquartile range [IQR] 51-72); 170 (66%) were male. Two-hundred twelve (82%) had at least one chronic illness, the most common of which were hypertension (63%; 162/257) and diabetes mellitus (36%; 92/257). One-hundred-thirty-eight patients (54%) were obese, and 13 (5%) were healthcare workers. As of April 14th, 2020, in-hospital mortality was 33% (86/257); 47% (122/257) of patients remained hospitalized. Two-hundred-one (79%) patients received invasive mechanical ventilation (median 13 days [IQR 9-17]), and 54% (138/257) and 29% (75/257) required vasopressors and renal-replacement-therapy, respectively. The median time to clinical deterioration following hospital admission was 3 days (IQR 1-6). Older age, hypertension, chronic lung disease, and higher concentrations of interleukin-6 and d-dimer at admission were independently associated with in-hospital mortality.

CONCLUSIONS

Critical illness among patients hospitalized with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extra-pulmonary organ dysfunction, and substantial in-hospital mortality.

Authors

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Pub Type(s)

Preprint

Language

eng

PubMed ID

32511638

Citation

Cummings, Matthew J., et al. "Epidemiology, Clinical Course, and Outcomes of Critically Ill Adults With COVID-19 in New York City: a Prospective Cohort Study." MedRxiv : the Preprint Server for Health Sciences, 2020.
Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. medRxiv. 2020.
Cummings, M. J., Baldwin, M. R., Abrams, D., Jacobson, S. D., Meyer, B. J., Balough, E. M., Aaron, J. G., Claassen, J., Rabbani, L. E., Hastie, J., Hochman, B. R., Salazar-Schicchi, J., Yip, N. H., Brodie, D., & O'Donnell, M. R. (2020). Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. MedRxiv : the Preprint Server for Health Sciences. https://doi.org/10.1101/2020.04.15.20067157
Cummings MJ, et al. Epidemiology, Clinical Course, and Outcomes of Critically Ill Adults With COVID-19 in New York City: a Prospective Cohort Study. medRxiv. 2020 Apr 20; PubMed PMID: 32511638.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. AU - Cummings,Matthew J, AU - Baldwin,Matthew R, AU - Abrams,Darryl, AU - Jacobson,Samuel D, AU - Meyer,Benjamin J, AU - Balough,Elizabeth M, AU - Aaron,Justin G, AU - Claassen,Jan, AU - Rabbani,LeRoy E, AU - Hastie,Jonathan, AU - Hochman,Beth R, AU - Salazar-Schicchi,John, AU - Yip,Natalie H, AU - Brodie,Daniel, AU - O'Donnell,Max R, Y1 - 2020/04/20/ PY - 2020/6/9/entrez PY - 2020/6/9/pubmed PY - 2020/6/9/medline JF - medRxiv : the preprint server for health sciences JO - medRxiv N2 - BACKGROUND: Nearly 30,000 patients with coronavirus disease-2019 (COVID-19) have been hospitalized in New York City as of April 14th, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed. METHODS: We prospectively collected clinical, biomarker, and treatment data on critically ill adults with laboratory-confirmed-COVID-19 admitted to two hospitals in northern Manhattan between March 2nd and April 1st, 2020. The primary outcome was in-hospital mortality. Secondary outcomes included frequency and duration of invasive mechanical ventilation, frequency of vasopressor use and renal-replacement-therapy, and time to clinical deterioration following hospital admission. The relationship between clinical risk factors, biomarkers, and in-hospital mortality was modeled using Cox-proportional-hazards regression. Each patient had at least 14 days of observation. RESULTS: Of 1,150 adults hospitalized with COVID-19 during the study period, 257 (22%) were critically ill. The median age was 62 years (interquartile range [IQR] 51-72); 170 (66%) were male. Two-hundred twelve (82%) had at least one chronic illness, the most common of which were hypertension (63%; 162/257) and diabetes mellitus (36%; 92/257). One-hundred-thirty-eight patients (54%) were obese, and 13 (5%) were healthcare workers. As of April 14th, 2020, in-hospital mortality was 33% (86/257); 47% (122/257) of patients remained hospitalized. Two-hundred-one (79%) patients received invasive mechanical ventilation (median 13 days [IQR 9-17]), and 54% (138/257) and 29% (75/257) required vasopressors and renal-replacement-therapy, respectively. The median time to clinical deterioration following hospital admission was 3 days (IQR 1-6). Older age, hypertension, chronic lung disease, and higher concentrations of interleukin-6 and d-dimer at admission were independently associated with in-hospital mortality. CONCLUSIONS: Critical illness among patients hospitalized with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extra-pulmonary organ dysfunction, and substantial in-hospital mortality. UR - https://www.unboundmedicine.com/medline/citation/32511638/Epidemiology_clinical_course_and_outcomes_of_critically_ill_adults_with_COVID_19_in_New_York_City:_a_prospective_cohort_study_ L2 - https://doi.org/10.1101/2020.04.15.20067157 DB - PRIME DP - Unbound Medicine ER -
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