Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit
Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit
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DOI：
10.1001/jamanetworkopen.2020.12270
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发表时间：
2020-06-16
影响因子：
13.8
通讯作者：
Brar, Indira
中科院分区：
文献类型：
--
作者：
Suleyman, Geehan;Fadel, Raef A.;Brar, Indira
问题在疫情爆发的早期阶段，在密歇根州东南部的亨利福特卫生系统评估的2019年冠状病毒病患者的临床特征和结局是什么？在这个病例系列中，涉及463名连续确诊的2019年冠状病毒病患者，在底特律大都市的5家医院系统中进行了评估，72.1%的患者是非洲裔美国人，94.0%的患者至少有1种合并症。在355例住院患者中，39.7%需要入住重症监护室，其中80.8%接受有创机械通气，40.4%在30天内死亡。在底特律大都市2019年的一系列冠状病毒病患者中，高比例的患者入院并需要入住重症监护室和有创机械通气，重症监护室患者的死亡率为40.4%。本病例系列描述了冠状病毒病患者的临床特征和结局2019重要性2019年12月下旬，中国武汉爆发新型严重急性呼吸系统综合征冠状病毒2型疫情，疫情持续时间为2019年12月31日至2019年12月31日。关于美国城市社区感染患者的临床特征和结局的数据有限。目的描述2019冠状病毒病（COVID-19）患者的临床特征和结局，并对住院和门诊患者人群进行比较分析。设计、设置和参与者本研究是一项病例系列研究，包括2020年3月9日至3月27日在密歇根州底特律市的亨利福特卫生系统评估的463名连续COVID-19患者。数据分析于二零二零年三月至四月进行。经检验证实感染严重急性呼吸系统综合症冠状病毒2。主要结果和测量收集了人口统计学数据、潜在的合并症、临床表现、并发症、治疗和结果。结果在463例COVID-19患者（平均[SD]年龄，57.5 [16.8]岁）中，259例（55.9%）为女性，334例（72.1%）为非洲裔美国人。大多数患者（435例[94.0%]）至少有1种合并症，包括高血压（295例患者[63.7%]）、慢性肾脏疾病（182例患者[39.3%]）和糖尿病（178例患者[38.4%]）。常见症状为咳嗽（347例患者[74.9%]）、发热（315例患者[68.0%]）和呼吸困难（282例患者[60.9%]）。355例患者（76.7%）住院; 141例（39.7%）需要重症监护室管理，其中114例（80.8%）需要有创机械通气。男性（比值比[OR]，2.0; 95%CI，1.3-3.2; P = 0.001）、重度肥胖（OR，2.0; 95%CI，1.4-3.6; P = 0.02）和慢性肾脏疾病（OR，2.0; 95%CI，1.3-3.3; P = 0.006）与入住重症监护室独立相关。与全科病房的患者相比，入住重症监护病房的患者住院时间更长，呼吸衰竭和需要有创机械通气的急性呼吸窘迫综合征、需要透析的急性肾损伤、休克和死亡率更高（57例患者[40.4%] vs 15例患者[7.0%]）。29例（11.2%）出院患者再次入院，总体而言，20.0%在30天内死亡。男性（OR，1.8; 95% CI，1.1-3.1; P = .03）和年龄大于60岁（OR，5.3; 95% CI，2.9-9.7; P < .001）与死亡率显著相关，而非裔美国人则与死亡率无关（OR，0.98; 95% CI，0.54-1.8; P = .86）。结论和相关性在这次对城市大都市COVID-19患者的回顾中，大多数是非洲裔美国人，共病患病率高，住院率、重症监护室入院率、并发症率和COVID-19导致的死亡率都很高。
Question What are the clinical characteristics and outcomes of patients with coronavirus disease 2019 evaluated at Henry Ford Health System in Southeast Michigan during the early phase of the outbreak? Findings In this case series involving 463 consecutive patients with confirmed coronavirus disease 2019 evaluated at a 5-hospital system serving metropolitan Detroit, 72.1% of patients were African American and 94.0% had at least 1 comorbidity. Among the 355 patients who were hospitalized, 39.7% required intensive care unit admission, of whom 80.8% underwent invasive mechanical ventilation and 40.4% died within 30 days. Meaning In this series of patients with coronavirus disease 2019 in metropolitan Detroit, a high proportion were admitted and required intensive care unit admission and invasive mechanical ventilation with a mortality rate of 40.4% among patients in the intensive care unit.This case series describes the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) at a health system in metropolitan Detroit, Michigan, and provides a comparative analysis of hospitalized and ambulatory patient populations.Importance In late December 2019, an outbreak caused by a novel severe acute respiratory syndrome coronavirus 2 emerged in Wuhan, China. Data on the clinical characteristics and outcomes of infected patients in urban communities in the US are limited. Objectives To describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and to perform a comparative analysis of hospitalized and ambulatory patient populations. Design, Setting, and Participants This study is a case series of 463 consecutive patients with COVID-19 evaluated at Henry Ford Health System in metropolitan Detroit, Michigan, from March 9 to March 27, 2020. Data analysis was performed from March to April 2020. Exposure Laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. Main Outcomes and Measures Demographic data, underlying comorbidities, clinical presentation, complications, treatment, and outcomes were collected. Results Of 463 patients with COVID-19 (mean [SD] age, 57.5 [16.8] years), 259 (55.9%) were female, and 334 (72.1%) were African American. Most patients (435 [94.0%]) had at least 1 comorbidity, including hypertension (295 patients [63.7%]), chronic kidney disease (182 patients [39.3%]), and diabetes (178 patients [38.4%]). Common symptoms at presentation were cough (347 patients [74.9%]), fever (315 patients [68.0%]), and dyspnea (282 patients [60.9%]). Three hundred fifty-five patients (76.7%) were hospitalized; 141 (39.7%) required intensive care unit management and 114 (80.8%) of those patients required invasive mechanical ventilation. Male sex (odds ratio [OR], 2.0; 95% CI, 1.3-3.2; P = .001), severe obesity (OR, 2.0; 95% CI, 1.4-3.6; P = .02), and chronic kidney disease (OR, 2.0; 95% CI, 1.3-3.3; P = .006) were independently associated with intensive care unit admission. Patients admitted to the intensive care unit had longer length of stay and higher incidence of respiratory failure and acute respiratory distress syndrome requiring invasive mechanical ventilation, acute kidney injury requiring dialysis, shock, and mortality (57 patients [40.4%] vs 15 patients [7.0%]) compared with patients in the general practice unit. Twenty-nine (11.2%) of those discharged from the hospital were readmitted and, overall, 20.0% died within 30 days. Male sex (OR, 1.8; 95% CI, 1.1-3.1; P = .03) and age older than 60 years (OR, 5.3; 95% CI, 2.9-9.7; P < .001) were significantly associated with mortality, whereas African American race was not (OR, 0.98; 95% CI, 0.54-1.8; P = .86). Conclusions and Relevance In this review of urban metropolitan patients with COVID-19, most were African American with a high prevalence of comorbid conditions and high rates of hospitalization, intensive care unit admission, complications, and mortality due to COVID-19.