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Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit.
JAMA Netw Open. 2020 06 01; 3(6):e2012270.JN

Abstract

Importance

In late December 2019, an outbreak caused by a novel severe acute respiratory syndrome coronavirus 2 emerged in Wuhan, China. Data on the clinical characteristics and outcomes of infected patients in urban communities in the US are limited.

Objectives

To describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and to perform a comparative analysis of hospitalized and ambulatory patient populations.

Design, Setting, and Participants

This study is a case series of 463 consecutive patients with COVID-19 evaluated at Henry Ford Health System in metropolitan Detroit, Michigan, from March 9 to March 27, 2020. Data analysis was performed from March to April 2020.

Exposure

Laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection.

Main Outcomes and Measures

Demographic data, underlying comorbidities, clinical presentation, complications, treatment, and outcomes were collected.

Results

Of 463 patients with COVID-19 (mean [SD] age, 57.5 [16.8] years), 259 (55.9%) were female, and 334 (72.1%) were African American. Most patients (435 [94.0%]) had at least 1 comorbidity, including hypertension (295 patients [63.7%]), chronic kidney disease (182 patients [39.3%]), and diabetes (178 patients [38.4%]). Common symptoms at presentation were cough (347 patients [74.9%]), fever (315 patients [68.0%]), and dyspnea (282 patients [60.9%]). Three hundred fifty-five patients (76.7%) were hospitalized; 141 (39.7%) required intensive care unit management and 114 (80.8%) of those patients required invasive mechanical ventilation. Male sex (odds ratio [OR], 2.0; 95% CI, 1.3-3.2; P = .001), severe obesity (OR, 2.0; 95% CI, 1.4-3.6; P = .02), and chronic kidney disease (OR, 2.0; 95% CI, 1.3-3.3; P = .006) were independently associated with intensive care unit admission. Patients admitted to the intensive care unit had longer length of stay and higher incidence of respiratory failure and acute respiratory distress syndrome requiring invasive mechanical ventilation, acute kidney injury requiring dialysis, shock, and mortality (57 patients [40.4%] vs 15 patients [7.0%]) compared with patients in the general practice unit. Twenty-nine (11.2%) of those discharged from the hospital were readmitted and, overall, 20.0% died within 30 days. Male sex (OR, 1.8; 95% CI, 1.1-3.1; P = .03) and age older than 60 years (OR, 5.3; 95% CI, 2.9-9.7; P < .001) were significantly associated with mortality, whereas African American race was not (OR, 0.98; 95% CI, 0.54-1.8; P = .86).

Conclusions and Relevance

In this review of urban metropolitan patients with COVID-19, most were African American with a high prevalence of comorbid conditions and high rates of hospitalization, intensive care unit admission, complications, and mortality due to COVID-19.

Authors+Show Affiliations

Department of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan.Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.Department of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan.Department of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan.Department of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan.Department of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan.Department of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan. School of Medicine, Wayne State University, Detroit, Michigan.Department of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan. School of Medicine, Wayne State University, Detroit, Michigan.Department of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan. School of Medicine, Wayne State University, Detroit, Michigan. Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan.Department of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan. School of Medicine, Wayne State University, Detroit, Michigan.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32543702

Citation

Suleyman, Geehan, et al. "Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit." JAMA Network Open, vol. 3, no. 6, 2020, pp. e2012270.
Suleyman G, Fadel RA, Malette KM, et al. Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit. JAMA Netw Open. 2020;3(6):e2012270.
Suleyman, G., Fadel, R. A., Malette, K. M., Hammond, C., Abdulla, H., Entz, A., Demertzis, Z., Hanna, Z., Failla, A., Dagher, C., Chaudhry, Z., Vahia, A., Abreu Lanfranco, O., Ramesh, M., Zervos, M. J., Alangaden, G., Miller, J., & Brar, I. (2020). Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit. JAMA Network Open, 3(6), e2012270. https://doi.org/10.1001/jamanetworkopen.2020.12270
Suleyman G, et al. Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit. JAMA Netw Open. 2020 06 1;3(6):e2012270. PubMed PMID: 32543702.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit. AU - Suleyman,Geehan, AU - Fadel,Raef A, AU - Malette,Kelly M, AU - Hammond,Charles, AU - Abdulla,Hafsa, AU - Entz,Abigail, AU - Demertzis,Zachary, AU - Hanna,Zachary, AU - Failla,Andrew, AU - Dagher,Carina, AU - Chaudhry,Zohra, AU - Vahia,Amit, AU - Abreu Lanfranco,Odaliz, AU - Ramesh,Mayur, AU - Zervos,Marcus J, AU - Alangaden,George, AU - Miller,Joseph, AU - Brar,Indira, Y1 - 2020/06/01/ PY - 2020/6/17/entrez PY - 2020/6/17/pubmed PY - 2020/6/25/medline SP - e2012270 EP - e2012270 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 6 N2 - Importance: In late December 2019, an outbreak caused by a novel severe acute respiratory syndrome coronavirus 2 emerged in Wuhan, China. Data on the clinical characteristics and outcomes of infected patients in urban communities in the US are limited. Objectives: To describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and to perform a comparative analysis of hospitalized and ambulatory patient populations. Design, Setting, and Participants: This study is a case series of 463 consecutive patients with COVID-19 evaluated at Henry Ford Health System in metropolitan Detroit, Michigan, from March 9 to March 27, 2020. Data analysis was performed from March to April 2020. Exposure: Laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. Main Outcomes and Measures: Demographic data, underlying comorbidities, clinical presentation, complications, treatment, and outcomes were collected. Results: Of 463 patients with COVID-19 (mean [SD] age, 57.5 [16.8] years), 259 (55.9%) were female, and 334 (72.1%) were African American. Most patients (435 [94.0%]) had at least 1 comorbidity, including hypertension (295 patients [63.7%]), chronic kidney disease (182 patients [39.3%]), and diabetes (178 patients [38.4%]). Common symptoms at presentation were cough (347 patients [74.9%]), fever (315 patients [68.0%]), and dyspnea (282 patients [60.9%]). Three hundred fifty-five patients (76.7%) were hospitalized; 141 (39.7%) required intensive care unit management and 114 (80.8%) of those patients required invasive mechanical ventilation. Male sex (odds ratio [OR], 2.0; 95% CI, 1.3-3.2; P = .001), severe obesity (OR, 2.0; 95% CI, 1.4-3.6; P = .02), and chronic kidney disease (OR, 2.0; 95% CI, 1.3-3.3; P = .006) were independently associated with intensive care unit admission. Patients admitted to the intensive care unit had longer length of stay and higher incidence of respiratory failure and acute respiratory distress syndrome requiring invasive mechanical ventilation, acute kidney injury requiring dialysis, shock, and mortality (57 patients [40.4%] vs 15 patients [7.0%]) compared with patients in the general practice unit. Twenty-nine (11.2%) of those discharged from the hospital were readmitted and, overall, 20.0% died within 30 days. Male sex (OR, 1.8; 95% CI, 1.1-3.1; P = .03) and age older than 60 years (OR, 5.3; 95% CI, 2.9-9.7; P < .001) were significantly associated with mortality, whereas African American race was not (OR, 0.98; 95% CI, 0.54-1.8; P = .86). Conclusions and Relevance: In this review of urban metropolitan patients with COVID-19, most were African American with a high prevalence of comorbid conditions and high rates of hospitalization, intensive care unit admission, complications, and mortality due to COVID-19. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/32543702/Clinical_Characteristics_and_Morbidity_Associated_With_Coronavirus_Disease_2019_in_a_Series_of_Patients_in_Metropolitan_Detroit_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.12270 DB - PRIME DP - Unbound Medicine ER -