Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.
Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.
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DOI：
10.1001/jama.2020.6775
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发表时间：
2020-01-01
期刊：
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作者：
Richardson, Safiya;Hirsch, Jamie S.;,
重要性：描述因2019冠状病毒病（COVID-19）需要住院治疗的美国患者的特征和结局的信息有限。目的：描述在美国医疗保健系统住院的COVID-19患者的临床特征和结局。设计、设置和参与者：在Northwell卫生系统内，在纽约市、长岛和纽约韦斯特切斯特县的12家医院住院的COVID-19患者的病例系列。该研究纳入了2020年3月1日至2020年4月4日期间（包括这些日期）的所有连续住院患者。暴露：一名需要入院的病人的鼻咽样本经聚合酶链反应测试呈阳性，证实感染严重急性呼吸系统综合征冠状病毒2型。主要结局和指标：住院期间的临床结局，如有创机械通气、肾脏替代治疗和死亡。还收集了人口统计学、基线合并症、生命体征和检查结果。结果：共纳入5700例患者（中位年龄63岁[四分位距{IQR}，52-75岁;范围，0-107岁]; 39.7%为女性）。最常见的合并症为高血压（3026; 56.6%）、肥胖（1737; 41.7%）和糖尿病（1808; 33.8%）。在分诊时，30.7%的患者发热，17.3%的患者呼吸频率大于24次/min，27.8%的患者接受了辅助供氧。呼吸道病毒合并感染率为2.1%。对2634例在研究终点时出院或死亡的患者的结局进行了评估。住院期间，373例患者（14.2%）（中位年龄68岁[IQR，56-78]; 33.5%为女性）在重症监护室接受治疗，320例（12.2%）接受有创机械通气，81例（3.2%）接受肾脏替代治疗，553例（21%）死亡。截至2020年4月4日，对于需要机械通气的患者（n = 1151，20.2%），38例（3.3%）存活出院，282例（24.5%）死亡，831例（72.2%）仍在住院。中位出院后随访时间为4.4天（IQR，2.2-9.3）。研究期间共有45例患者（2.2%）再次入院。对于再入院患者，中位再入院时间为3天（IQR，1.0-4.5）。在最终研究随访日期仍住院的3066例患者中（中位年龄，65岁[IQR，54-75]），删失时的中位随访时间为4.5天（IQR，2.4-8.1）。结论和相关性：该病例系列提供了纽约市地区确诊COVID-19的连续住院患者的特征和早期结局。
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.