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Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

Educational Objective
To understand the characteristics and comorbidities of patients hospitalized with COVID-19 in the New York City area
1 Credit CME
Key Points

Question  What are the characteristics, clinical presentation, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in the US?

Findings  In this case series that included 5700 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 = 2634), 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.

Meaning  This study provides characteristics and early outcomes of patients hospitalized with COVID-19 in the New York City area.

Abstract

Importance  There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).

Objective  To describe the clinical characteristics and outcomes of patients with COVID-19 hospitalized in a US health care system.

Design, Setting, and Participants  Case series of patients with COVID-19 admitted to 12 hospitals in New York City, Long Island, and Westchester County, New York, within the Northwell Health system. The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates.

Exposures  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.

Main Outcomes and Measures  Clinical outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death. Demographics, baseline comorbidities, presenting vital signs, and test results were also collected.

Results  A total of 5700 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 (3026; 56.6%), obesity (1737; 41.7%), and diabetes (1808; 33.8%). At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/min, and 27.8% received supplemental oxygen. The rate of respiratory virus co-infection was 2.1%. Outcomes were assessed for 2634 patients who were discharged or had died at the study end point. 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. As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital. The median postdischarge 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 3066 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 and Relevance  This case series provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID-19 in the New York City area.

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Article Information

Corresponding Author: Karina W. Davidson, PhD, Northwell Health, 130 E 59th St, Ste 14C, New York, NY 10022 (KDavidson2@northwell.edu).

Accepted for Publication: April 16, 2020.

Published Online: April 22, 2020. doi:10.1001/jama.2020.6775

Correction: This article was corrected on April 24, 2020, to clarify the mortality rate of ventilated patients, correct the COVID-19 positive/negative test results, and correct the data for concurrent entero/rhinovirus infection in Table 2.

The Northwell COVID-19 Research Consortium Authors: Douglas P. Barnaby, MD, MSc; Lance B. Becker, MD; John D. Chelico, MD, MA; Stuart L. Cohen, MD; Jennifer Cookingham, MHA; Kevin Coppa, BS; Michael A. Diefenbach, PhD; Andrew J. Dominello, BA; Joan Duer-Hefele, RN, MA; Louise Falzon, BA, PGDipInf; Jordan Gitlin, MD; Negin Hajizadeh, MD, MPH; Tiffany G. Harvin, MBA; David A. Hirschwerk, MD; Eun Ji Kim, MD, MS, MS; Zachary M. Kozel, MD; Lyndonna M. Marrast, MD, MPH; Jazmin N. Mogavero, MA; Gabrielle A. Osorio, MPH; Michael Qiu, MD, PhD; Theodoros P. Zanos, PhD.

Affiliations of The Northwell COVID-19 Research Consortium Authors: Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York (Barnaby, Chelico, Cohen, Cookingham, Diefenbach, Dominello, Duer-Hefele, Falzon, Hajizadeh, Harvin, Kim, Marrast, Mogavero, Osorio); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York (Barnaby, Becker, Chelico, Cohen, Gitlin, Hajizadeh, Hirschwerk, Kim, Kozel, Marrast); Department of Information Services, Northwell Health, New Hyde Park, New York (Coppa, Qiu); Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York (Zanos).

Author Contributions: Drs Richardson and Davidson had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Richardson, Hirsch, Narasimhan, Crawford, McGinn, Davidson, Barnaby, Chelico, Cohen, Cookingham, Coppa, Diefenbach, Duer-Hefele, Dominello, Falzon, Gitlin, Hirschwerk, Kozel, Marrast, Mogavero.

Acquisition, analysis, or interpretation of data: Richardson, Hirsch, Narasimhan, Crawford, Davidson, Barnaby, Becker, Chelico, Cohen, Coppa, Diefenbach, Duer-Hefele, Hajizadeh, Harvin, Hirschwerk, Kim, Kozel, Marrast, Osorio, Qiu, Zanos.

Drafting of the manuscript: Richardson, McGinn, Davidson, Cookingham, Falzon, Harvin, Mogavero, Qiu.

Critical revision of the manuscript for important intellectual content: Richardson, Hirsch, Narasimhan, Crawford, McGinn, Barnaby, Becker, Chelico, Cohen, Coppa, Diefenbach, Duer-Hefele, Dominello, Gitlin, Hajizadeh, Hirschwerk, Kim, Kozel, Marrast, Osorio, Zanos.

Statistical analysis: Hirsch, Chelico, Zanos.

Obtained funding: Richardson.

Administrative, technical, or material support: Richardson, Narasimhan, Crawford, Davidson, Chelico, Cookingham, Diefenbach, Dominello, Harvin, Mogavero, Osorio, Zanos.

Supervision: Narasimhan, McGinn, Becker, Chelico, Zanos.

Conflict of Interest Disclosures: Dr Crawford reported receiving grants from Regeneron outside the submitted work. Dr Becker reported serving on the scientific advisory board for Nihon Kohden and receiving grants from the National Institutes of Health, United Therapeutics, Philips, Zoll, and Patient-Centered Outcomes Research Institute outside the submitted work. Dr Cohen reported receiving personal fees from Infervision outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by grants R24AG064191 from the National Institute on Aging of the National Institutes of Health; R01LM012836 from the National Library of Medicine of the National Institutes of Health; and K23HL145114 from the National Heart, Lung, and Blood Institute.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

The Northwell COVID-19 Research Consortium Investigators: Douglas P. Barnaby, MD, MSc, Lance B. Becker, MD, John D. Chelico, MD, MA, Stuart L. Cohen, MD, Jennifer Cookingham, MHA, Kevin Coppa, BS, Michael A. Diefenbach, PhD, Andrew J. Dominello, BA, Joan Duer-Hefele, RN, MA, Louise Falzon, BA, Jordan Gitlin, MD, Negin Hajizadeh, MD, MPH, Tiffany G. Harvin, MBA, David A. Hirschwerk, MD, Eun Ji Kim, MD, MS, MS, Zachary M. Kozel, MD, Lyndonna M. Marrast, MD, MPH, Jazmin N. Mogavero, MA, Gabrielle A. Osorio, MPH, Michael Qiu, MD, PhD, and Theodoros P. Zanos, PhD.

Disclaimer: The views expressed in this article are those of the authors and do not represent the views of the National Institutes of Health, the US Department of Health and Human Services, or any other government entity. Karina W. Davidson is a member of the US Preventive Services Task Force (USPSTF). This article does not represent the views and policies of the USPSTF.

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