Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series

Abstract

Objective To characterize patients with coronavirus disease 2019 (covid-19) in a large New York City medical center and describe their clinical course across the emergency department, hospital wards, and intensive care units. Design Retrospective manual medical record review. Setting NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City. Participants The first 1000 consecutive patients with a positive result on the reverse transcriptase polymerase chain reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to the emergency department or were admitted to hospital between 1 March and 5 April 2020. Patient data were manually abstracted from electronic medical records. Main outcome measures Characterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition. Results Of the first 1000 patients, 150 presented to the emergency department, 614 were admitted to hospital (not intensive care units), and 236 were admitted or transferred to intensive care units. The most common presenting symptoms were cough (732/1000), fever (728/1000), and dyspnea (631/1000). Patients in hospital, particularly those treated in intensive care units, often had baseline comorbidities including hypertension, diabetes, and obesity. Patients admitted to intensive care units were older, predominantly male (158/236, 66.9%), and had long lengths of stay (median 23 days, interquartile range 12-32 days); 78.0% (184/236) developed acute kidney injury and 35.2% (83/236) needed dialysis. Only 4.4% (6/136) of patients who required mechanical ventilation were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at three to four days, and at nine days. As of 30 April, 90 patients remained in hospital and 211 had died in hospital. Conclusions Patients admitted to hospital with covid-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

“…When a mean value of a continuous outcome was missing, methods by Wan [7] were utilized to impute the needed value for the meta-analysis. Since some studies [8,9,[10][11][12][13][14][15][16][17][18][19][20][21][22][23] included patients still hospitalized at endpoint (n=4,697, 37.8%), we considered two mortality scenarios methodologically: (1) best case scenario by pooling patients with known outcome and (2) worst case scenario by pooling those still hospitalized with non-survivors.…”

“…Of these, 6,875 patients were on IMV. Nine studies were from the USA [8][9][10][11]17,18,23,25,26], 13 from China [12,14,16,[20][21][22][27][28][29][30][31][32][33], two from the UK [24,32], and one each from Italy [15], Spain [13], France [19], and Mexico [35]. (Table 1) Fifteen studies were good and 13 were fair as assessed by the NIH tool.…”

“…Follow-up duration was insu cient or unreported in seven [8,10,12,14,26,29,35] among which three had fair assessments. Of note, 14 studies [8,9,[12][13][14][15][17][18][19]21,22,24,25,34] had over 20% of patients with unknown outcome at endpoint of which 8 had fair assessment. Figure 3).…”

“…ARDS is another signi cantly associated complication (pOR 6.52, 95% CI 2.66 to 16.01) we found. Problematically, ARDS itself is a heterogeneous syndrome, with the six studies[8,9,22,[31][32][33] we analyzed variously applying the Berlin criteria[59], WHO guidance[60], or no criteria at all for its diagnosis. Then there is a notion that COVID-19 ARDS may be a separate entity and that current criteria are inadequate in guiding treatment[61].…”

Epidemiologic, Clinical, and Laboratory Findings of the COVID-19 in the current pandemic: Systematic Review and Meta-analysis

“…Based on a worldwide data, the elderly (aged over 60) were at a high risk of developing into death [5,6,9,56]. The mortality in ICU was extremely higher than Non-ICU patients, varied from 26% to 78% [58][59][60][61].…”