Clinical characteristics and outcomes of hospitalized COVID-19 patients in a MERS-CoV referral hospital during the peak of the pandemic
Mazin Barry, Nouf Althabit, Layan Akkielah, Abdulellah Almohaya, Muath Alotaibi, Sara Alhasani, Abdulwahab Aldrees, Abdulaziz Alrajhi, Ali Alhiji, Fahad Almajid, Aynaa Alsharidi, Fatimah S Al-Shahrani, Naif H Alotaibi, Abdulkarim Alhetheel
International Journal of Infectious Diseases, doi:10.1016/j.ijid.2021.03.058
To describe the clinical characteristics and outcomes of hospitalized coronavirus disease 2019 patients in a middle east respiratory syndrome coronavirus (MERS-CoV) referral hospital during the peak months of the pandemic. Design: A single-center case series of hospitalized individuals with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in King Saud University Medical City (KSUMC), an academic tertiary care hospital in Riyadh, Saudi Arabia. Clinical and biochemical markers were documented. Risks for ventilatory support, intensive care unit (ICU) admission and death are presented. Results: Out of 12,688 individuals tested for SARS-CoV-2 by real time reverse transcriptase polymerase reaction (RT-PCR) from June 1 to August 31, 2020, 2,683 (21%) were positive for COVID-19. Of the latter, 605 (22%) patients required hospitalization with a median age of 55, 368 (61%) were male. The most common comorbidities were hypertension (43%) and diabetes (42%). Most patients presented with fever (66%), dyspnea (65%), cough (61%), elevated IL-6 (93.5%), D-dimer (90.1%), CRP (86.1%), and lymphopenia (41.7%). No MERS-CoV co-infection was detected. Overall, 91 patients (15%) died; risk factors associated with mortality were an age of 65 years or older OR 2.29 [95%CI 1.43-3.67], presence of two or more comorbidities OR 3.17 [95%CI 2.00-5.02], symptoms duration of seven days or less ) lymphopenia ], high CRP OR 2.85 [95%CI 1.1-7.32], high AST OR 2.95 [95% CI 1.77-4.90], high creatinine OR 3.71 [95%CI 2.30-5.99], and high troponin-I OR 2.84 [95%CI 1.33-6.05]. Conclusion: There is a significant increase in severe cases of COVID-19. Mortality was associated with older age, shorter symptom duration, high CRP, low lymphocyte count, and end-organ damage.
Conflict of interest None declared.
References
Alenazi, Arbash, El-Saed, Alshamrani, Baffoe-Bonnie et al., Identified transmission dynamics of Middle East respiratory syndrome coronavirus infection during an outbreak: implications of an overcrowded emergency department, Clin Infect Dis,
doi:10.1093/cid/cix352Altunok, Alkan, Kamat, Demirok, Satici et al., Clinical characteristics of adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia, J Infect Chemother,
doi:10.1016/j.jiac.2020.10.020Amer, Alqahtani, Alzoman, Aljerian, Memish, Unusual presentation of Middle East respiratory syndrome coronavirus leading to a large outbreak in Riyadh during 2017, Am J Infect Control,
doi:10.1016/j.ajic.2018.02.023Argenzian, Bruc, Slate, Tia, Baldwi et al., Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series, BMJ,
doi:10.1136/bmj.m1996Assiri, Mcgeer, Perl, Price, Rabeeah et al., Hospital outbreak of Middle East respiratory syndrome coronavirus, N Engl J Med,
doi:10.1056/NEJMoa1306742Ayed, Borahmah, Yazdani, Sultan, Mossad et al., Assessment of clinical characteristics and mortality-associated factors in COVID-19 critical cases in Kuwait, Med Princ Pract,
doi:10.1159/000513047Balkhy, Alenazi, Alshamrani, Baffoe-Bonnie, Arabi et al., Description of a hospital outbreak of Middle East respiratory syndrome in a large tertiary care hospital in Saudi Arabia, Infect Control Hosp Epidemiol,
doi:10.1017/ice.2016.132Barry, Almohaya, Alhijji, Akkielah, Alrajhi, Clinical characteristics and outcome of hospitalized COVID-19 patients in a MERS-CoV endemic Area, J Epidemiol Glob Health,
doi:10.2991/jegh.k.200806.002Barry, Ghonem, Alsharidi, Alanazi, Alotaibi et al., Coronavirus disease-2019 pandemic in the Kingdom of Saudi Arabia: mitigation measures and hospital preparedness, J Nat Sci Med,
doi:10.4103/JNSM.JNSM_29_20Barry, Phan, Akkielah, Al-Majed, Alhetheel et al., Nosocomial outbreak of the Middle East Respiratory Syndrome coronavirus: a phylogenetic, epidemiological, clinical and infection control analysis, Travel Med Infect Dis,
doi:10.1016/j.tmaid.2020.101807Beigel, Tomashek, Dodd, Mehta, Zingman et al., Remdesivir for the treatment of Covid-19-final report, N Engl J Med,
doi:10.1056/NEJMoa2007764Docherty, Harrison, Green, Hardwick, Pius et al., Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO clinical characterisation protocol: prospective observational cohort study, BMJ,
doi:10.1136/bmj.m1985Drosten, Muth, Corman, Hussain, Masri et al., An observational, laboratory-based study of outbreaks of Middle East respiratory syndrome coronavirus in Jeddah and Riyadh, Kingdom of Saudi Arabia, 2014, Clin Infect Dis,
doi:10.1093/cid/ciu812Fagbo, Skakni, Chu, Garbati, Joseph et al., Molecular epidemiology of hospital outbreak of Middle East respiratory syndrome, Riyadh, Saudi Arabia, 2014, Emerg Infect Dis,
doi:10.3201/eid2111.150944Fu, Wang, Yuan, Chen, Ao et al., Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: a systematic review and meta-analysis, J Infect,
doi:10.1016/j.jinf.2020.03.041Gold, Wong, Szablewski, Patel, Rossow et al., Characteristics and clinical outcomes of adult patients hospitalized with COVID-19-Georgia, March 2020, MMWR Morb Mortal Wkly Rep,
doi:10.15585/mmwr.mm6918e1Gupta, Wang, Hayek, Chan, Mathews et al., Association between early treatment with tocilizumab and mortality among critically ill patients with COVID-19, JAMA Intern Med,
doi:10.1001/jamainternmed.2020.6252Hung, Lung, Tso, Liu, Chu et al., Triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial, Lancet,
doi:10.1016/S0140-6736(20)31042-4Jiménez, Vela, Valencia, Fernandez-Jimenez, Álvaro-Alonso et al., Characteristics, complications and outcomes among 1549 patients hospitalised with COVID-19 in a secondary hospital in Madrid, Spain: a retrospective case series study, BMJ Open,
doi:10.1136/bmjopen-2020-042398Juan, Gil, Rong, Zhang, Yang et al., Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review, Ultrasound Obstet Gynecol,
doi:10.1002/uog.22088Lechien, Chiesa-Estomba, Place, Van Laethem, Cabaraux et al., Clinical and epidemiological characteristics of 1,420 European patients with mild-to-moderate coronavirus disease 2019, J Intern Med,
doi:10.1111/joim.13089Li, Xu, Yu, Peng, Luo et al., Clinical characteristics and outcomes of 74 patients with severe or critical COVID-19, Am J Med Sci,
doi:10.1016/j.amjms.2020.05.040Luo, Liu, Qiu, Liu, Liu et al., Tocilizumab treatment in COVID-19: a singlecenter experience, J Med Virol,
doi:10.1002/jmv.25801Oboho, Tomczyk, Al-Asmari, Banjar, Al-Mugti et al., MERS-CoV outbreak in Jeddah -a link to health care facilities, N Engl J Med,
doi:10.1056/NEJMoa1408636Pan, Peto, Henao-Restrepo, Preziosi, Sathiyamoorthy, Repurposed antiviral drugs for Covid-19 -interim WHO solidarity trial results, N Engl J Med,
doi:10.1056/NEJMoa2023184Richardson, Hirsch, Narasimhan, Crawford, Mcginn et al., Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area, JAMA,
doi:10.1001/jama.2020.6775Salvarani, Dolci, Massari, Merlo, Cavuto et al., Effect of tocilizumab vs. standard care on clinical worsening in patients hospitalized with COVID-19 pneumonia: a randomized clinical trial, JAMA Intern Med,
doi:10.1001/jamainternmed.2020.6615Sanders, Monogue, Jodlowski, Cutrell, Pharmacologic treatments for coronavirus disease 2019 (COVID-19), JAMA,
doi:10.1001/jama.2020.6019Sarfraz, Mohammed, Reem, Fahad, Faisal et al., Clinical characteristics of patients with COVID-19 in Saudi Arabia-a single center experience, Res Rev Infect Dis,
doi:10.36959/719/568Sterne, Murthy, Diaz, Slutsky, Villar et al., Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19, JAMA,
doi:10.1001/jama.2020.17023Suleyman, Fadel, Malette, Hammond, Abdulla et al., Clinical characteristics and morbidity associated with coronavirus disease 2019 in a series of patients in Metropolitan Detroit, JAMA Netw Open,
doi:10.1001/jamanetworkopen.2020.12270The, Group, Dexamethasone in hospitalized patients with Covid-19 -preliminary report, N Engl J Med,
doi:10.1056/NEJMoa2021436Who, MERS situation update
Zaki, Van Boheemen, Bestebroer, Osterhaus, Fouchier, Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia, N Engl J Med,
doi:10.1056/NEJMoa1211721Zhou, Yu, Du, Fan, Liu et al., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet,
doi:10.1016/S0140-6736(20)30566-3{ 'indexed': {'date-parts': [[2023, 12, 9]], 'date-time': '2023-12-09T05:24:41Z', 'timestamp': 1702099481943},
'reference-count': 42,
'publisher': 'Elsevier BV',
'license': [ { 'start': { 'date-parts': [[2021, 5, 1]],
'date-time': '2021-05-01T00:00:00Z',
'timestamp': 1619827200000},
'content-version': 'tdm',
'delay-in-days': 0,
'URL': 'https://www.elsevier.com/tdm/userlicense/1.0/'},
{ 'start': { 'date-parts': [[2021, 3, 18]],
'date-time': '2021-03-18T00:00:00Z',
'timestamp': 1616025600000},
'content-version': 'vor',
'delay-in-days': 0,
'URL': 'http://creativecommons.org/licenses/by-nc-nd/4.0/'}],
'content-domain': { 'domain': [ 'ijidonline.com', 'clinicalkey.jp', 'clinicalkey.com', 'clinicalkey.es',
'clinicalkey.fr', 'clinicalkey.com.au', 'elsevier.com',
'sciencedirect.com'],
'crossmark-restriction': True},
'published-print': {'date-parts': [[2021, 5]]},
'DOI': '10.1016/j.ijid.2021.03.058',
'type': 'journal-article',
'created': {'date-parts': [[2021, 3, 23]], 'date-time': '2021-03-23T20:47:16Z', 'timestamp': 1616532436000},
'page': '43-51',
'update-policy': 'http://dx.doi.org/10.1016/elsevier_cm_policy',
'source': 'Crossref',
'is-referenced-by-count': 12,
'title': 'Clinical characteristics and outcomes of hospitalized COVID-19 patients in a MERS-CoV referral '
'hospital during the peak of the pandemic',
'prefix': '10.1016',
'volume': '106',
'author': [ { 'ORCID': 'http://orcid.org/0000-0003-2274-007X',
'authenticated-orcid': False,
'given': 'Mazin',
'family': 'Barry',
'sequence': 'first',
'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0002-2030-4461',
'authenticated-orcid': False,
'given': 'Nouf',
'family': 'Althabit',
'sequence': 'additional',
'affiliation': []},
{'given': 'Layan', 'family': 'Akkielah', 'sequence': 'additional', 'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0003-4532-4626',
'authenticated-orcid': False,
'given': 'AbdulEllah',
'family': 'AlMohaya',
'sequence': 'additional',
'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0001-7480-2741',
'authenticated-orcid': False,
'given': 'Muath',
'family': 'Alotaibi',
'sequence': 'additional',
'affiliation': []},
{'given': 'Sara', 'family': 'Alhasani', 'sequence': 'additional', 'affiliation': []},
{'given': 'Abdulwahab', 'family': 'Aldrees', 'sequence': 'additional', 'affiliation': []},
{'given': 'Abdulaziz', 'family': 'AlRajhi', 'sequence': 'additional', 'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0003-2074-8916',
'authenticated-orcid': False,
'given': 'Ali',
'family': 'AlHiji',
'sequence': 'additional',
'affiliation': []},
{'given': 'Fahad', 'family': 'Almajid', 'sequence': 'additional', 'affiliation': []},
{'given': 'Aynaa', 'family': 'AlSharidi', 'sequence': 'additional', 'affiliation': []},
{'given': 'Fatimah S.', 'family': 'Al-Shahrani', 'sequence': 'additional', 'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0001-6529-356X',
'authenticated-orcid': False,
'given': 'Naif H.',
'family': 'Alotaibi',
'sequence': 'additional',
'affiliation': []},
{'given': 'Abdulkarim', 'family': 'AlHetheel', 'sequence': 'additional', 'affiliation': []}],
'member': '78',
'reference': [ { 'key': '10.1016/j.ijid.2021.03.058_bib0005',
'doi-asserted-by': 'crossref',
'first-page': '675',
'DOI': '10.1093/cid/cix352',
'article-title': 'Identified transmission dynamics of Middle East respiratory syndrome '
'coronavirus infection during an outbreak: implications of an '
'overcrowded emergency department',
'volume': '65',
'author': 'Alenazi',
'year': '2017',
'journal-title': 'Clin Infect Dis'},
{ 'issue': '2',
'key': '10.1016/j.ijid.2021.03.058_bib0010',
'doi-asserted-by': 'crossref',
'first-page': '306',
'DOI': '10.1016/j.jiac.2020.10.020',
'article-title': 'Clinical characteristics of adult patients hospitalized with '
'laboratory-confirmed COVID-19 pneumonia',
'volume': '27',
'author': 'Altunok',
'year': '2021',
'journal-title': 'J Infect Chemother'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0015',
'doi-asserted-by': 'crossref',
'first-page': '1022',
'DOI': '10.1016/j.ajic.2018.02.023',
'article-title': 'Unusual presentation of Middle East respiratory syndrome coronavirus '
'leading to a large outbreak in Riyadh during 2017',
'volume': '46',
'author': 'Amer',
'year': '2018',
'journal-title': 'Am J Infect Control'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0020',
'article-title': 'Characterization and clinical course of 1000 patients with coronavirus '
'disease 2019 in New York: retrospective case series',
'volume': '369',
'author': 'Argenzian',
'year': '2020',
'journal-title': 'BMJ'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0025',
'doi-asserted-by': 'crossref',
'first-page': '407',
'DOI': '10.1056/NEJMoa1306742',
'article-title': 'Hospital outbreak of Middle East respiratory syndrome coronavirus',
'volume': '369',
'author': 'Assiri',
'year': '2013',
'journal-title': 'N Engl J Med'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0030',
'first-page': '407',
'article-title': 'Assessment of clinical characteristics and mortality-associated factors '
'in COVID-19 critical cases in Kuwait',
'volume': '369',
'author': 'Ayed',
'year': '2020',
'journal-title': 'Med Princ Pract'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0035',
'doi-asserted-by': 'crossref',
'first-page': '1147',
'DOI': '10.1017/ice.2016.132',
'article-title': 'Description of a hospital outbreak of Middle East respiratory syndrome '
'in a large tertiary care hospital in Saudi Arabia',
'volume': '37',
'author': 'Balkhy',
'year': '2016',
'journal-title': 'Infect Control Hosp Epidemiol'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0040',
'doi-asserted-by': 'crossref',
'first-page': '214',
'DOI': '10.2991/jegh.k.200806.002',
'article-title': 'Clinical characteristics and outcome of hospitalized COVID-19 patients '
'in a MERS-CoV endemic Area',
'volume': '10',
'author': 'Barry',
'year': '2020',
'journal-title': 'J Epidemiol Glob Health'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0045',
'first-page': '155',
'article-title': 'Coronavirus disease-2019 pandemic in the Kingdom of Saudi Arabia: '
'mitigation measures and hospital preparedness',
'volume': '3',
'author': 'Barry',
'year': '2020',
'journal-title': 'J Nat Sci Med'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0050',
'doi-asserted-by': 'crossref',
'DOI': '10.1016/j.tmaid.2020.101807',
'article-title': 'Nosocomial outbreak of the Middle East Respiratory Syndrome '
'coronavirus: a phylogenetic, epidemiological, clinical and infection '
'control analysis',
'volume': '37',
'author': 'Barry',
'year': '2020',
'journal-title': 'Travel Med Infect Dis'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0055',
'doi-asserted-by': 'crossref',
'first-page': '1813',
'DOI': '10.1056/NEJMoa2007764',
'article-title': 'Remdesivir for the treatment of Covid-19—final report',
'volume': '383',
'author': 'Beigel',
'year': '2020',
'journal-title': 'N Engl J Med'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0060',
'first-page': '1',
'article-title': 'Features of 20 133 UK patients in hospital with covid-19 using the '
'ISARIC WHO clinical characterisation protocol: prospective '
'observational cohort study',
'volume': '369',
'author': 'Docherty',
'year': '2020',
'journal-title': 'BMJ'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0065',
'doi-asserted-by': 'crossref',
'first-page': '369',
'DOI': '10.1093/cid/ciu812',
'article-title': 'An observational, laboratory-based study of outbreaks of Middle East '
'respiratory syndrome coronavirus in Jeddah and Riyadh, Kingdom of Saudi '
'Arabia, 2014',
'volume': '60',
'author': 'Drosten',
'year': '2015',
'journal-title': 'Clin Infect Dis'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0070',
'doi-asserted-by': 'crossref',
'first-page': '1981',
'DOI': '10.3201/eid2111.150944',
'article-title': 'Molecular epidemiology of hospital outbreak of Middle East respiratory '
'syndrome, Riyadh, Saudi Arabia, 2014',
'volume': '21',
'author': 'Fagbo',
'year': '2015',
'journal-title': 'Emerg Infect Dis'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0075',
'doi-asserted-by': 'crossref',
'first-page': '656',
'DOI': '10.1016/j.jinf.2020.03.041',
'article-title': 'Clinical characteristics of coronavirus disease 2019 (COVID-19) in '
'China: a systematic review and meta-analysis',
'volume': '80',
'author': 'Fu',
'year': '2020',
'journal-title': 'J Infect'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0080',
'doi-asserted-by': 'crossref',
'first-page': '545',
'DOI': '10.15585/mmwr.mm6918e1',
'article-title': 'Characteristics and clinical outcomes of adult patients hospitalized '
'with COVID-19—Georgia, March 2020',
'volume': '69',
'author': 'Gold',
'year': '2020',
'journal-title': 'MMWR Morb Mortal Wkly Rep'},
{ 'issue': '1',
'key': '10.1016/j.ijid.2021.03.058_bib0085',
'doi-asserted-by': 'crossref',
'first-page': '41',
'DOI': '10.1001/jamainternmed.2020.6252',
'article-title': 'Association between early treatment with tocilizumab and mortality '
'among critically ill patients with COVID-19',
'volume': '181',
'author': 'Gupta',
'year': '2021',
'journal-title': 'JAMA Intern Med'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0090',
'doi-asserted-by': 'crossref',
'first-page': '1695',
'DOI': '10.1016/S0140-6736(20)31042-4',
'article-title': 'Triple combination of interferon beta-1b, lopinavir-ritonavir, and '
'ribavirin in the treatment of patients admitted to hospital with '
'COVID-19: an open-label, randomised, phase 2 trial',
'volume': '395',
'author': 'Hung',
'year': '2020',
'journal-title': 'Lancet'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0095',
'doi-asserted-by': 'crossref',
'first-page': '1',
'DOI': '10.1136/bmjopen-2020-042398',
'article-title': 'Characteristics, complications and outcomes among 1549 patients '
'hospitalised with COVID-19 in a secondary hospital in Madrid, Spain: a '
'retrospective case series study',
'volume': '10',
'author': 'Jiménez',
'year': '2020',
'journal-title': 'BMJ Open'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0100',
'doi-asserted-by': 'crossref',
'first-page': '15',
'DOI': '10.1002/uog.22088',
'article-title': 'Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal '
'and neonatal outcome: systematic review',
'volume': '56',
'author': 'Juan',
'year': '2020',
'journal-title': 'Ultrasound Obstet Gynecol'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0105',
'doi-asserted-by': 'crossref',
'first-page': '335',
'DOI': '10.1111/joim.13089',
'article-title': 'Clinical and epidemiological characteristics of 1,420 European patients '
'with mild-to-moderate coronavirus disease 2019',
'volume': '288',
'author': 'Lechien',
'year': '2020',
'journal-title': 'J Intern Med'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0110',
'doi-asserted-by': 'crossref',
'first-page': '229',
'DOI': '10.1016/j.amjms.2020.05.040',
'article-title': 'Clinical characteristics and outcomes of 74 patients with severe or '
'critical COVID-19',
'volume': '360',
'author': 'Li',
'year': '2020',
'journal-title': 'Am J Med Sci'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0115',
'doi-asserted-by': 'crossref',
'first-page': '814',
'DOI': '10.1002/jmv.25801',
'article-title': 'Tocilizumab treatment in COVID‐19: a single-center experience',
'volume': '92',
'author': 'Luo',
'year': '2020',
'journal-title': 'J Med Virol'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0120',
'series-title': 'Middle East respiratory syndrome coronavirus; guidelines for healthcare '
'professionals',
'author': 'Ministry of Health Command and Control Center',
'year': '2018'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0125',
'doi-asserted-by': 'crossref',
'first-page': '846',
'DOI': '10.1056/NEJMoa1408636',
'article-title': '2014 MERS-CoV outbreak in Jeddah — a link to health care facilities',
'volume': '372',
'author': 'Oboho',
'year': '2015',
'journal-title': 'N Engl J Med'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0130',
'doi-asserted-by': 'crossref',
'first-page': '2052',
'DOI': '10.1001/jama.2020.6775',
'article-title': 'Presenting characteristics, comorbidities, and outcomes among 5700 '
'patients hospitalized with COVID-19 in the New York City area',
'volume': '323',
'author': 'Richardson',
'year': '2020',
'journal-title': 'JAMA'},
{ 'issue': '1',
'key': '10.1016/j.ijid.2021.03.058_bib0135',
'doi-asserted-by': 'crossref',
'first-page': '24',
'DOI': '10.1001/jamainternmed.2020.6615',
'article-title': 'Effect of tocilizumab vs. standard care on clinical worsening in '
'patients hospitalized with COVID-19 pneumonia: a randomized clinical '
'trial',
'volume': '181',
'author': 'Salvarani',
'year': '2021',
'journal-title': 'JAMA Intern Med'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0140',
'first-page': '1824',
'article-title': 'Pharmacologic treatments for coronavirus disease 2019 (COVID-19)',
'volume': '323',
'author': 'Sanders',
'year': '2020',
'journal-title': 'JAMA'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0145',
'doi-asserted-by': 'crossref',
'first-page': '68',
'DOI': '10.36959/719/568',
'article-title': 'Clinical characteristics of patients with COVID-19 in Saudi Arabia—a '
'single center experience',
'volume': '3',
'author': 'Sarfraz',
'year': '2020',
'journal-title': 'Res Rev Infect Dis'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0150',
'unstructured': 'Saudi Arabia Ministry of Health. COVID 19 Dashboard: Saudi Arabia. n.d. '
'https://covid19.moh.gov.sa/.'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0155',
'unstructured': 'Saudi Arabia Ministry of Health. MOH health events: Epi-week 23, 2020, '
'n.d. https://moh.gov.sa/EN/CCC/EVENTS/NATIONAL/PAGES/2020.ASPX. '
'(Accessed 17 October 2020).'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0160',
'unstructured': 'Saudi MoH Protocol for Patients Suspected of/Confirmed with COVID-19. '
'(Version 21) July 31, 2020, n.d. '
'https://www.moh.gov.sa/Ministry/MediaCenter/Publications/Documents/MOH-therapeutic-protocol-for-COVID-19.pdf.'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0165',
'doi-asserted-by': 'crossref',
'first-page': '1330',
'DOI': '10.1001/jama.2020.17023',
'article-title': 'Association between administration of systemic corticosteroids and '
'mortality among critically ill patients with COVID-19',
'volume': '324',
'author': 'Sterne',
'year': '2020',
'journal-title': 'JAMA'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0170',
'doi-asserted-by': 'crossref',
'DOI': '10.1001/jamanetworkopen.2020.12270',
'article-title': 'Clinical characteristics and morbidity associated with coronavirus '
'disease 2019 in a series of patients in Metropolitan Detroit',
'volume': '3',
'author': 'Suleyman',
'year': '2020',
'journal-title': 'JAMA Netw Open'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0175',
'doi-asserted-by': 'crossref',
'DOI': '10.1056/NEJMoa2022926',
'article-title': 'Dexamethasone in hospitalized patients with Covid-19 — preliminary '
'report',
'author': 'The RECOVERY Collaborative Group',
'year': '2020',
'journal-title': 'N Engl J Med'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0180',
'doi-asserted-by': 'crossref',
'first-page': '401',
'DOI': '10.1016/j.jinf.2020.02.018',
'article-title': 'Characteristics of COVID-19 infection in Beijing',
'volume': '80',
'author': 'Tian',
'year': '2020',
'journal-title': 'J Infect'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0185',
'series-title': 'Coronavirus (COVID-19) Update: FDA revokes emergency use authorization '
'for chloroquine and hydroxychloroquine',
'author': 'US Food and Drug Administration',
'year': '2020'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0190',
'unstructured': 'WHO. MERS situation update January 2020. Eastern Mediterr Reg Off. n.d. '
'http://www.emro.who.int/health-topics/mers-cov/mers-outbreaks.html. '
'(Accessed 23 October 2020).'},
{ 'issue': '6',
'key': '10.1016/j.ijid.2021.03.058_bib0195',
'doi-asserted-by': 'crossref',
'first-page': '497',
'DOI': '10.1056/NEJMoa2023184',
'article-title': 'Repurposed antiviral drugs for Covid-19 — interim WHO solidarity trial '
'results',
'volume': '384',
'author': 'WHO Solidarity Trial Consortium',
'year': '2021',
'journal-title': 'N Engl J Med'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0200',
'doi-asserted-by': 'crossref',
'unstructured': 'World Health Organization. WHO coronavirus disease (COVID-19) Dashboard. '
'n.d. https://covid19.who.int/. (Accessed 10 October 2020).',
'DOI': '10.46945/bpj.10.1.03.01'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0205',
'doi-asserted-by': 'crossref',
'first-page': '1814',
'DOI': '10.1056/NEJMoa1211721',
'article-title': 'Isolation of a novel coronavirus from a man with pneumonia in Saudi '
'Arabia',
'volume': '367',
'author': 'Zaki',
'year': '2012',
'journal-title': 'N Engl J Med'},
{ 'key': '10.1016/j.ijid.2021.03.058_bib0210',
'doi-asserted-by': 'crossref',
'first-page': '1054',
'DOI': '10.1016/S0140-6736(20)30566-3',
'article-title': 'Clinical course and risk factors for mortality of adult inpatients with '
'COVID-19 in Wuhan, China: a retrospective cohort study',
'volume': '395',
'author': 'Zhou',
'year': '2020',
'journal-title': 'Lancet'}],
'container-title': 'International Journal of Infectious Diseases',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://api.elsevier.com/content/article/PII:S1201971221002769?httpAccept=text/xml',
'content-type': 'text/xml',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'https://api.elsevier.com/content/article/PII:S1201971221002769?httpAccept=text/plain',
'content-type': 'text/plain',
'content-version': 'vor',
'intended-application': 'text-mining'}],
'deposited': { 'date-parts': [[2022, 1, 11]],
'date-time': '2022-01-11T22:34:31Z',
'timestamp': 1641940471000},
'score': 1,
'resource': {'primary': {'URL': 'https://linkinghub.elsevier.com/retrieve/pii/S1201971221002769'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2021, 5]]},
'references-count': 42,
'alternative-id': ['S1201971221002769'],
'URL': 'http://dx.doi.org/10.1016/j.ijid.2021.03.058',
'relation': {},
'ISSN': ['1201-9712'],
'subject': ['Infectious Diseases', 'Microbiology (medical)', 'General Medicine'],
'container-title-short': 'International Journal of Infectious Diseases',
'published': {'date-parts': [[2021, 5]]},
'assertion': [ {'value': 'Elsevier', 'name': 'publisher', 'label': 'This article is maintained by'},
{ 'value': 'Clinical characteristics and outcomes of hospitalized COVID-19 patients in a '
'MERS-CoV referral hospital during the peak of the pandemic',
'name': 'articletitle',
'label': 'Article Title'},
{ 'value': 'International Journal of Infectious Diseases',
'name': 'journaltitle',
'label': 'Journal Title'},
{ 'value': 'https://doi.org/10.1016/j.ijid.2021.03.058',
'name': 'articlelink',
'label': 'CrossRef DOI link to publisher maintained version'},
{'value': 'article', 'name': 'content_type', 'label': 'Content Type'},
{ 'value': '© 2021 The Author(s). Published by Elsevier Ltd on behalf of International '
'Society for Infectious Diseases.',
'name': 'copyright',
'label': 'Copyright'}]}
