Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic

Roth, Gregory A.; Emmons-Bell, Sophia; Alger, Heather M.; Bradley, Steven M; Das, Sandeep R; Lemos, James A. de; Gakidou, Emmanuela; Elkind, Mitchell S.V.; Hay, Simon I.; Hall, Jennifer L.; Johnson, Catherine O.; Morrow, David A.; Rodríguez, Fátima; Rutan, Christine; Shakil, Saate; Sorensen, Reed J D; Stevens, Laura; Wang, Tracy Y.; Walchok, Jason; Williams, Joseph; Murray, Christopher J L

doi:10.1001/jamanetworkopen.2021.8828

Cited by 124 publications

(124 citation statements)

References 19 publications

(23 reference statements)

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“…Discharge status improved from April to December 2020 with an increase of home discharge by 20%, whereas discharge due to death fell by 14%. A recent report also showed that in-hospital mortality, LOS, and use of mechanical ventilation in patients with COVID-19 decreased from March/April to September/November 2020 (mortality fell from 19 to 11%, LOS fell from 10.7 to 7.5 days, and use of mechanical ventilation fell from 23.3 to 13.9% of patients) [ 22 ]. The trend of decrease in mortality and cost from our analyses may be associated with improved understanding of the pathophysiology of COVID-19 with time and the associated availability and implementation of newer treatment protocols, including increased use of medications such as glucocorticoids and remdesivir [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Inpatient Hospital Costs for COVID-19 Patients in the United States

et al. 2021

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Introduction Reliable cost and resource use data for COVID-19 hospitalizations are crucial to better inform local healthcare resource decisions; however, available data are limited and vary significantly. Methods COVID-19 hospital admissions data from the Premier Healthcare Database were evaluated to estimate hospital costs, length of stay (LOS), and discharge status. Adult COVID-19 patients (ICD-10-CM: U07.1) hospitalized in the US from April 1 to December 31, 2020, were identified. Analyses were stratified by patient and hospital characteristics, levels of care during hospitalization, and discharge status. Factors associated with changes in costs, LOS, and discharge status were estimated using regression analyses. Monthly trends in costs, LOS, and discharge status were examined. Results Of the 247,590 hospitalized COVID-19 patients, 49% were women, 76% were aged ≥ 50, and 36% were admitted to intensive care units (ICU). Overall median hospital LOS, cost, and cost/day were 6 days, US$11,267, and $1772, respectively; overall median ICU LOS, cost, and cost/day were 5 days, $13,443, and $2902, respectively. Patients requiring mechanical ventilation had the highest hospital and ICU median costs ($47,454 and $41,510) and LOS (16 and 11 days), respectively. Overall, 14% of patients died in hospital and 52% were discharged home. Older age, Black and Caucasian race, hypertension and obesity, treatment with extracorporeal membrane oxygenation, and discharge to long-term care facilities were major drivers of costs, LOS, and risk of death. Admissions in December had significantly lower median hospital and ICU costs and LOS compared to April. Conclusion The burden from COVID-19 in terms of hospital and ICU costs and LOS has been substantial, though significant decreases in cost and LOS and increases in the share of hospital discharges to home were observed from April to December 2020. These estimates will be useful for inputs to economic models, disease burden forecasts, and local healthcare resource planning. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01887-4.

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Section: Discussionmentioning

confidence: 99%

Inpatient Hospital Costs for COVID-19 Patients in the United States

et al. 2021

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“…Ticinesi et al reported that while COVID-19 patients treated with COVID-19 at an Italian hospital hub during the first weeks of the pandemic were younger and had fewer comorbidities than those admitted between late March and early June 2020, mortality decreased from 27% to 22% [ 42 ]. Likewise, a large retrospective study analyzing the hospital course of 20,736 COVID-19 patients in the US recently demonstrated that in-hospital mortality rates decreased from 19% in March and April 2020 to 11% in September through November 2020 and that this difference persisted after accounting for age, sex, and comorbidities [ 43 ]. Of note, our hospital was never overwhelmed and there were sufficient resources for treating every patient with all therapeutic options of modern intensive care medicine at any time of the pandemic without the need for triage.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Clinical Course of COVID-19 Patients Treated at a German Tertiary Center during the First and Second Waves in the Year 2020

Brehm

Heyer

Roedl

et al. 2021

JCM

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In this study, we directly compared coronavirus disease 2019 (COVID-19) patients hospitalized during the first (27 February–28 July 2020) and second (29 July–31 December 2020) wave of the pandemic at a large tertiary center in northern Germany. Patients who presented during the first (n = 174) and second (n = 331) wave did not differ in age (median [IQR], 59 years [46, 71] vs. 58 years [42, 73]; p = 0.82) or age-adjusted Charlson Comorbidity Index (median [IQR], 2 [1, 4] vs. 2 [0, 4]; p = 0.50). During the second wave, a higher proportion of patients were treated as outpatients (11% [n = 20] vs. 20% [n = 67]), fewer patients were admitted to the intensive care unit (43% [n = 75] vs. 29% [n = 96]), and duration of hospitalization was significantly shorter (median days [IQR], 14 [8, 34] vs. 11 [5, 19]; p < 0.001). However, in-hospital mortality was high throughout the pandemic and did not differ between the two periods (16% [n = 27] vs. 16% [n = 54]; p = 0.89). While novel treatment strategies and increased knowledge about the clinical management of COVID-19 may have resulted in a less severe disease course in some patients, in-hospital mortality remained unaltered at a high level. These findings highlight the unabated need for efforts to hamper severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) transmission, to increase vaccination coverage, and to develop novel treatment strategies to prevent mortality and decrease morbidity.

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“…The present work aims to describe high resolution SpO2 signal characteristics and potential usage along the treatment course for non-critical, critical with or without oxygen support and critical mechanically ventilated patients. The specific objectives of this work are: (1) Determining global SpO2 signal characteristics correlated with disease severity and/or the level of respiratory support; (2) Investigating the optimal definition of a relative or absolute threshold for defining clinically relevant desaturations; (3) Defining characteristics of the SpO2 signal including desaturation parameters and oximetry derived digital biomarkers (OBMs) allowing for the differentiation between critical and non-critical groups or those affected by the level of support; (4) highlighting the potential of OBMs extracted from high resolution SpO2 signal for the detection of early signs of deterioration leading to the indication of mechanical ventilation and for tracking patient's response to medical treatment.…”

Section: Methodsmentioning

confidence: 99%

“…The ongoing coronavirus disease 2019 (COVID-19) pandemic has spread all over the world and caused, as of early August 2021, over 4•3 million deaths. Approximately 15-20% of confirmed cases develop severe disease, while the fatality rate is 2-5% [1][2][3] depending on the country and the monitored period.…”

Section: Introductionmentioning

confidence: 99%

Descriptive characteristics of continuous oximetry measurement in moderate to severe COVID-19 patients

Sobel

Levy

Almog

et al. 2021

Preprint

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Background: Non-invasive oxygen saturation (SpO2) measurement is a central vital sign that supports the management of COVID-19 patients. However, reports on SpO2 characteristics (patterns and dynamics) are scarce and none, to our knowledge, has analysed high resolution continuous SpO2 in COVID-19. Methods: SpO2 signal sampled at 1Hz and clinical data were collected from COVID-19 departments at the Rambam Health Care Campus (Haifa, Israel) between May 1st, 2020 and February 1st, 2021. Data from a total of 367 COVID-19 patients, totalling 27K hours of continuous SpO2 recording, could be retrieved, including 205 non-critical and 162 critical cases. Desaturations based on different SpO2 threshold definitions and oximetry derived digital biomarkers (OBMs) were extracted and compared across severity and support levels. Findings: An absolute SpO2 threshold at 93% was the most efficient in discriminating between critical and non-critical patients without support or under oxygen support. Under no support, the non-critical group depicted a fold change (FC) of 1,8 times more frequent desaturations compared to the critical group. However, the hypoxic burden was 1,6 times more important in critical versus non-critical patients. Other OBMs depicted significant differences, notably the percentage of time below 93% SpO2 (CT93) was the most discriminating OBM. Mechanical ventilation depicted a strong effect on SpO2 by significantly reducing the frequency (1,85 FC) and depth (1,21 FC) of desaturations. OBMs related to periodicity and hypoxic burden were markedly affected up to several hours before the initiation of the mechanical ventilation. Interpretation: This is the first report investigating continuous SpO2 measurements in hospitalized patients affected with COVID-19. SpO2 characteristics differ between critical and non-critical patients and are impacted by the level of support. OBMs from high resolution SpO2 signal may enable to anticipate clinically relevant events, monitoring of treatment response and may be indicative of future deterioration.

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Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic

Cited by 124 publications

References 19 publications

Inpatient Hospital Costs for COVID-19 Patients in the United States

Inpatient Hospital Costs for COVID-19 Patients in the United States

Patient Characteristics and Clinical Course of COVID-19 Patients Treated at a German Tertiary Center during the First and Second Waves in the Year 2020

Descriptive characteristics of continuous oximetry measurement in moderate to severe COVID-19 patients

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