Trends in COVID-19 patient characteristics in a large electronic health record database in the United States: A cohort study

Abstract

Background Electronic health record (EHR) databases provide an opportunity to facilitate characterization and trends in patients with COVID-19. Methods Patients with COVID-19 were identified based on an ICD-10 diagnosis code for COVID-19 (U07.1) and/or a positive SARS-CoV-2 viral lab result from January 2020 to November 2020. Patients were characterized in terms of demographics, healthcare utilization, clinical comorbidities, therapies, laboratory results, and procedures/care received, including critical care, intubation/ventilation, and occurrence of death were described, overall and by month. Results There were 393,773 patients with COVID-19 and 56,996 with a COVID-19 associated hospitalization. A greater percentage of patients hospitalized with COVID-19 relative to all COVID-19 cases were older, male, African American, and lived in the Northeast and South. The most common comorbidities before admission/infection date were hypertension (40.8%), diabetes (29.5%), and obesity (23.8%), and the most common diagnoses during hospitalization were pneumonia (59.6%), acute respiratory failure (44.8%), and dyspnea (28.0%). A total of 85.7% of patients hospitalized with COVID-19 had CRP values > 10 mg/L, 75.5% had fibrinogen values > 400 mg/dL, and 76.8% had D-dimer values > 250 ng/mL. Median values for platelets, CRP, lactate dehydrogenase, D-dimer, and fibrinogen tended to decrease from January-March to November. The use of chloroquine/hydroxychloroquine during hospitalization peaked by March (71.2%) and was used rarely by May (5.1%) and less than 1% afterwards, while the use of remdesivir had increased by May (10.0%) followed by dexamethasone by June (27.7%). All-cause mortality was 3.2% overall and 15.0% among those hospitalized; 21.0% received critical care and 16.0% received intubation/ventilation/ECMO. Conclusions This study characterizes US patients with COVID-19 and their management during hospitalization over the first eleven months of this disease pandemic.

Characteristics and Outcomes of Cryptococcosis among Patients with and without COVID-19

“…Additionally, most patients in our study identified as White, regardless of HIV status. Though the differences in age and ethnicity were significant between groups in our study, the findings are most likely due to the distribution of COVID-19 in the U.S., particularly during the early stages of the pandemic [17].…”

Trends in management and outcomes of COVID patients admitted to a Swiss tertiary care hospital

“…The reported mortality in our cohort was lower than reported in other European countries, for example France (first wave 16.2%, second wave 17.7%) or Germany (first wave 19.1%, second wave 19.8%) which may results from difference in populations admitted to the hospital and systems of care 29 , 30 . Interestingly, no mortality reduction was observed across the two waves in these latter countries, whereas a large North American database reported an important reduction of critical care admission (30.9% to 13.3%) among hospitalized patients from spring to November 2020, but did not adjust for demographic variables, comorbidities or markers of disease severity 31 . Another cohort including 51 510 COVID patients reported a mortality reduction over time for patients with a positive rtPCR testing, but not in the group of clinically diagnosed COVID-19 infections 32 .…”

“…. Interestingly, no mortality reduction was observed across the two waves in these latter countries, whereas a large North American database reported an important reduction of critical care admission (30.9% to 13.3%) among hospitalized patients from spring to November 2020, but did not adjust for demographic variables, comorbidities or markers of disease severity31 . Another cohort including 51 510 COVID patients reported a mortality reduction over time for patients with a positive rtPCR testing, but not in the group of clinically diagnosed COVID-19 infections32 .…”

Leveraging informative missing data to learn about acute respiratory distress syndrome and mortality in long-term hospitalized COVID-19 patients throughout the years of the pandemic

“…Over the course of the pandemic, physicians learned how to better manage the disease, thus changes in trends from 2020 to 2021 might indicate emerging subphenotypes or better laboratory monitoring practices [21][22][23] . Information about comorbidities and best practices for monitoring patients is valuable for saving lives and reducing burden on the healthcare system.…”