RetroSearch Browse

Home - News ( United States | United Kingdom | Italy | Germany ) - Football scores

Showing content from https://pubmed.ncbi.nlm.nih.gov/32444366/ below:

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

Affiliations

¹ Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
² NYU Langone Health, New York, NY, USA.
³ Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street #633, New York, NY 10016, USA.
⁴ Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA.
⁵ Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY, USA.
⁶ Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
⁷ Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA leora.horwitz@nyulangone.org.

PMID: 32444366
PMCID: PMC7243801
DOI: 10.1136/bmj.m1966

Item in Clipboard

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

Christopher M Petrilli et al. BMJ. 2020.

Affiliations

¹ Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
² NYU Langone Health, New York, NY, USA.
³ Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street #633, New York, NY 10016, USA.
⁴ Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA.
⁵ Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY, USA.
⁶ Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
⁷ Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA leora.horwitz@nyulangone.org.

PMID: 32444366
PMCID: PMC7243801
DOI: 10.1136/bmj.m1966

Item in Clipboard

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.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the Kenneth C Griffin Charitable Fund for submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures
Fig 1

Flow diagram of included participants.…

Fig 1

Flow diagram of included participants. Covid-19=coronavirus disease 2019

Fig 1

Flow diagram of included participants. Covid-19=coronavirus disease 2019

Fig 2

Cumulative incidence function for discharge…

Fig 2

Cumulative incidence function for discharge alive or death, by age group. Shading represents…

Fig 2

Cumulative incidence function for discharge alive or death, by age group. Shading represents 95% confidence intervals

Fig 3

Cumulative incidence function for discharge…

Fig 3

Cumulative incidence function for discharge alive or death, by heart failure, cancer, diabetes,…

Fig 3

Cumulative incidence function for discharge alive or death, by heart failure, cancer, diabetes, and sex. Shading represents 95% confidence intervals

Fig 4

Cumulative incidence function for discharge…

Fig 4

Cumulative incidence function for discharge alive or death, by admission oxygenation and D-dimer…

Fig 4

Cumulative incidence function for discharge alive or death, by admission oxygenation and D-dimer levels. Shading represents 95% confidence intervals

Fig 5

Cumulative incidence function for discharge…

Fig 5

Cumulative incidence function for discharge alive or death, by C reactive protein and…

Fig 5

Cumulative incidence function for discharge alive or death, by C reactive protein and lymphocyte count. Shading represents 95% confidence intervals

Comment in

Hospitalizations for Chronic Disease and Acute Conditions in the Time of COVID-19.
Blecker S, Jones SA, Petrilli CM, Admon AJ, Weerahandi H, Francois F, Horwitz LI. Blecker S, et al. JAMA Intern Med. 2021 Feb 1;181(2):269-271. doi: 10.1001/jamainternmed.2020.3978. JAMA Intern Med. 2021. PMID: 33104158 Free PMC article.
Prior bariatric surgery in COVID-19-positive patients may be protective.
Jenkins M, Maranga G, Wood GC, Petrilli CM, Fielding G, Ren-Fielding C. Jenkins M, et al. Surg Obes Relat Dis. 2021 Nov;17(11):1840-1845. doi: 10.1016/j.soard.2021.07.024. Epub 2021 Aug 8. Surg Obes Relat Dis. 2021. PMID: 34642102 Free PMC article.