Mortality Among US Patients Hospitalized With SARS-CoV-2 Infection

Quick Takes

  • There was a significant decrease in in-hospital mortality among patients with SARS-CoV-2–positive tests from March to November 2020.
  • Of note, in-hospital mortality decreases were not associated with a shift toward a higher proportion of younger hospitalized patients with SARS-CoV-2–positive tests.
  • Reasons for decreases in mortality may potentially include increased clinical experience in caring for and ventilating patients and use of prone positioning, systemic steroids, and remdesivir.

Study Questions:

What are the trends in in-hospital mortality among patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)?

Methods:

The investigators conducted a retrospective cohort study and included patients who were hospitalized for ≥1 day at one of 209 US acute care hospitals of variable size, in urban and rural areas, between March 1 and November 21, 2020. Eligible patients had a SARS-CoV-2 polymerase chain reaction (PCR) or antigen test within 7 days of admission or during hospitalization, and a record of discharge or in-hospital death. SARS-CoV-2 infection was defined as a positive SARS-CoV-2 PCR or antigen test within 7 days before admission or during hospitalization. Mortality was extracted from electronically available data. Linear regression was used to evaluate trends for mortality over time.

Results:

Among 503,409 admitted patients, 42,604 (8.5%) had SARS-CoV-2–positive tests. Of those with SARS-CoV-2–positive tests, 21,592 (50.7%) were male patients. Hospital admissions among patients with SARS-CoV-2–positive tests were highest in the group aged ≥65 years (19,929 [46.8%]), followed by those aged 50-64 years (11,602 [27.2%]) and 18-49 years (10,619 [24.9%]). Hospital admissions among patients 18-49 years of age increased from 1,099 of 5,319 (20.7%) in April to 1,266 of 4,184 (30.3%) in June and 2,156 of 7,280 (29.6%) in July, briefly exceeding those in the group 50-64 years of age (June: 1,194 of 4,184 [28.5%]; 2,039 of 7,280 [28.0%]).

Patients with SARS-CoV-2–positive tests had higher in-hospital mortality than patients with SARS-CoV-2–negative tests (4,705 [11.0%] vs. 11,707 of 460,805 [2.5%]; p < 0.001). In-hospital mortality rates increased with increasing age for both patients with SARS-CoV-2–negative tests and SARS-CoV-2–positive tests. In patients with SARS-CoV-2–negative tests, mortality increased from 45 of 11,255 (0.4%) in those <18 years to 4,812 of 107,394 (4.5%) in those >75 years. In patients with SARS-CoV-2–positive tests, mortality increased from 1 of 454 (0.2%) of those <18 years to 2,149 of 10,287 (20.9%) in those >75 years. In-hospital mortality rates among patients with SARS-CoV-2–negative tests were similar for male and female patients (6,273 of 209,086 [3.0%] vs. 5,538 of 251,719 [2.2%]), but higher mortality was observed among male patients with SARS-CoV-2–positive tests (2,700 of 21,592 [12.5%]) compared with female patients with SARS-CoV-2–positive tests (2,016 of 21,012 [9.60%]).

Overall, in-hospital mortality increased from March to April (63 of 597 [10.6%] to 1,047 of 5,319 [19.7%]), then decreased significantly to November (499 of 5,350 [9.3%]; p = 0.04), with significant decreases in the oldest age groups (50-64 years: 197 of 1,542 [12.8%] to 73 of 1,341 [5.4%]; p = 0.02; 65-75 years: 269 of 1,182 [22.8%] to 137 of 1,332 [10.3%]; p = 0.006; >75 years: 535 of 1,479 [36.2%] to 262 of 1,505 [17.4%]; p = 0.03).

Conclusions:

The authors concluded that in-hospital mortality for SARS-CoV-2 declined across all age groups during the period evaluated.

Perspective:

This multicenter, geographically representative, retrospective cohort study found a significant decrease in in-hospital mortality among patients with SARS-CoV-2–positive tests from March to November 2020. Of note, in-hospital mortality decreases were not associated with a shift toward a higher proportion of younger hospitalized patients with SARS-CoV-2–positive tests, who tend to have lower in-hospital mortality. Reasons for decreases in mortality since the start of the pandemic may potentially include increased clinical experience in caring for and ventilating patients and use of prone positioning, systemic corticosteroids, and remdesivir.

Clinical Topics: Geriatric Cardiology, Prevention

Keywords: ACC COVID-19 Podcast, Adrenal Cortex Hormones, Coronavirus Infections, COVID-19, Geriatrics, Hospital Mortality, Patient Admission, Patient Discharge, Polymerase Chain Reaction, Primary Prevention, Prone Position, SARS-CoV-2, Steroids, Ventilators, Mechanical


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