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Characteristics and Outcomes of COVID-19 Patients Hospitalized in New York City
Quick Takes
- In this case series that included 5,700 patients hospitalized with COVID-19 in the New York City area, the most common comorbidities were hypertension, obesity, and diabetes.
- Among patients who were discharged or died (n = 2,634), 14.2% were treated in the intensive care unit, 12.2% received invasive mechanical ventilation, 3.2% were treated with kidney replacement therapy, and 21% died.
- The absence of data on patients who remained hospitalized at the final study date may have biased the findings, including the high mortality rate of patients who received mechanical ventilation >65 years of age.
Study Questions:
What are the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) hospitalized in a US health care system?
Methods:
The investigators included all sequentially hospitalized COVID-19 patients between March 1, 2020, and April 4, 2020, inclusive of these dates, and report on this case series of patients admitted to 12 hospitals in New York City, Long Island, and Westchester County, NY, within the Northwell Health system. Confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample among patients requiring admission was the inclusion criteria. Demographics, baseline comorbidities, presenting vital signs, and test results were collected. The main outcome was clinical outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death.
Results:
A total of 5,700 patients were included (median age, 63 years [interquartile range {IQR}, 52-75; range, 0-107 years]; 39.7% female). The most common comorbidities were hypertension (3,026; 56.6%), obesity (1,737; 41.7%), and diabetes (1,808; 33.8%). At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate >24 breaths/minute, and 27.8% received supplemental oxygen. The rate of respiratory virus co-infection was 2.1%. Outcomes were assessed for 2,634 patients who were discharged or had died at the study endpoint. During hospitalization, 373 patients (14.2%) (median age, 68 years [IQR, 56-78]; 33.5% female) were treated in the intensive care unit care, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died. Mortality for those requiring mechanical ventilation was 88.1%. The median post-discharge follow-up time was 4.4 days (IQR, 2.2-9.3). A total of 45 patients (2.2%) were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0-4.5) for readmitted patients. Among the 3,066 patients who remained hospitalized at the final study follow-up date (median age, 65 years [IQR, 54-75]), the median follow-up at time of censoring was 4.5 days (IQR, 2.4-8.1).
Conclusions:
The authors concluded that their study provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID-19 in the New York City area.
Perspective:
These data provide several important insights into the characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID-19 in the New York City area. Older persons, men, and those with pre-existing hypertension and/or diabetes were highly prevalent in this case series and the pattern was similar to data reported from China. However, mortality rates in this case series were significantly lower, possibly due to differences in thresholds for hospitalization. The findings of high mortality rates among ventilated patients are similar to smaller case series reports of critically ill patients in the US. Longer-term follow-up of these patients, including those who remain in the hospital, is indicated to provide a clearer picture of outcomes in these patients.
Clinical Topics: Cardiovascular Care Team, COVID-19 Hub, Prevention, Hypertension
Keywords: Coronavirus, COVID-19, Critical Illness, Diabetes Mellitus, Hypertension, Intensive Care Units, Kidney Diseases, New York City, Obesity, Patient Discharge, Patient Readmission, Obesity, Primary Prevention, Respiration, Artificial, Respiratory Rate, severe acute respiratory syndrome coronavirus 2
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