Clinical Characteristics and Outcomes of Non-ICU Hospitalization for COVID-19 in a Nonepicenter, Centrally Monitored Healthcare System

Abstract

BACKGROUND: The clinical characteristics and outcomes associated with non–intensive care unit (non-ICU) hospitalizations for coronavirus disease 2019 (COVID-19) outside disease epicenters remain poorly characterized. METHODS: Systematic analysis of all non-ICU patient hospitalizations for COVID-19 completing discharge between March 13 and May 1, 2020, in a large US health care system utilizing off-site central monitoring. Variables of interest were examined in relation to a composite event rate of death, ICU transfer, or increased oxygen requirement to high-flow nasal cannula, noninvasive ventilation, or mechanical ventilation. RESULTS: Among 350 patients (age, 64 ± 16 years; 55% male), most (73%) required 3 L/min or less of supplemental oxygen during admission. Telemetry was widely utilized (79%) yet arrhythmias were uncommon (14%) and were predominantly (90%) among patients with abnormal troponin levels or known cardiovascular disease. Ventricular tachycardia was rare (5%), nonsustained, and not associated with hydroxychloroquine/azithromycin treatment. Adverse events occurred in 62 patients (18%), including 22 deaths (6%), 48 ICU transfers (14%), and 49 patients with increased oxygen requirement (14%) and were independently associated with elevated C-reactive protein (odds ratio, 1.09 per 1 mg/dL; 95% CI, 1.01-1.18; P = .04) and lactate dehydrogenase (OR, 1.006 per 1U/L; 95% CI, 1.001-1.012; P = .03) in multivariable analysis. CONCLUSION: Among non–critically ill patients hospitalized within a nonepicenter health care system, overall survival was 94% with the development of more severe illness or death independently associated with higher levels of C-reactive protein and lactate dehydrogenase on admission. Clinical decompensation was largely respiratory-related, while serious cardiac arrhythmias were rare, which suggests that telemetry can be prioritized for high-risk patients.

A Study on Factors Impacting Length of Hospital Stay of COVID-19 Inpatients

“…Comparing our two associated factors, CRP and HGB, there had been reports linking CRP level to severity of COVID-19 disease, and discussion on how anemia affects the quality of life in elder COVID-19 patients. [17][18][19] Interestingly, it was pointed out by a literature analysis that hemoglobin level may decrease in severe COVID-19 patients but the causeeffect direction is unclear. [20] As for cause-specific survival analysis, we have found even more factors to be associated with the rate of mortality or rate of discharge of a COVID-19 patient.…”

Post–COVID-19 Syndrome (Long Haul Syndrome): Description of a Multidisciplinary Clinic at Mayo Clinic and Characteristics of the Initial Patient Cohort

“…1 Although efforts to vaccinate large populations globally are ongoing and the numbers of new cases have declined in some regions of the world, a wide variation in the spectrum of clinical symptoms has been documented for those infected previouslydfrom asymptomatic individuals testing positive for the virus to others with rapidly progressive symptoms requiring hospitalization and mechanical ventilation and who may later have respiratory failure and/or death. 2,3 Advanced age, ethnicity, sex, race, elevated body mass index (calculated as the weight in kilograms divided by the height in meters squared), immunosuppression, and other medical comorbidities have been described as risk factors for severe infections requiring hospitalization. 1,[4][5][6] Although considerable epidemiological data have been published for individuals who have severe symptoms requiring inpatient care, the natural history and symptom patterns for patients with COVID-19 who do not require hospitalization is just beginning to be described.…”

COVID-19 outpatients and surviving inpatients exhibit comparable blood test results that are distinct from non-surviving inpatients

“…Our results show that among patients older than certain age, non-surviving inpatients have higher neutrophil level, lower lymphocyte level (higher NLR), lower calcium level, higher CRP, sodium, WBC, and lower HGB level, than the surviving patients; whether these are inpatients or outpatients. Comparing the two associated factors, CRP and HGB, there had been reports linking CRP level to severity of COVID-19 disease, and discussion on how anemia affects the quality of life in elder COVID-19 patients (34)(35)(36). Interestingly, Lippi et al pointed out that hemoglobin level may decrease in severe COVID-19 patients but the cause-effect direction is unclear (37).…”