Patient Characteristics and Outcomes of 11 721 Patients With Coronavirus Disease 2019 (COVID-19) Hospitalized Across the United States
Michael W Fried, Julie M Crawford, Andrea R Mospan, Stephanie E Watkins, Breda Munoz, Richard C Zink, Sherry Elliott, Kyle Burleson, Charles Landis, K Rajender Reddy, Robert S Brown Jr
Clinical Infectious Diseases, doi:10.1093/cid/ciaa1268
Background. As coronavirus disease 2019 disseminates throughout the United States, a better understanding of the patient characteristics associated with hospitalization, morbidity, and mortality in diverse geographic regions is essential. Methods. Hospital chargemaster data on adult patients with COVID-19 admitted to 245 hospitals across 38 states between 15 February and 20 April 2020 were assessed. The clinical course from admission, through hospitalization, and to discharge or death was analyzed. Results. A total of 11 721 patients were included (majority were >60 years of age [59.9%] and male [53.4%]). Comorbidities included hypertension (46.7%), diabetes (27.8%), cardiovascular disease (18.6%), obesity (16.1%), and chronic kidney disease (12.2%). Mechanical ventilation was required by 1967 patients (16.8%). Mortality among hospitalized patients was 21.4% and increased to 70.5% among those on mechanical ventilation. Male sex, older age, obesity, geographic region, and the presence of chronic kidney disease or a preexisting cardiovascular disease were associated with increased odds of mechanical ventilation. All aforementioned risk factors, with the exception of obesity, were associated with increased odds of death (all P values < .001). Many patients received investigational medications for treatment of COVID-19, including 48 patients on remdesivir and 4232 on hydroxychloroquine. Conclusions. This large observational cohort describes the clinical course and identifies factors associated with the outcomes of hospitalized patients with COVID-19 across the United States. These data can inform strategies to prioritize prevention and treatment for this disease.
Supplementary Data Supplementary materials are available at Clinical Infectious Diseases online. Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author.
Notes Disclaimer. TARGET was responsible for the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review and approval of the manuscript; and decision to submit the manuscript for publication. The data were derived from a commercial insurance claims database that requires a data sharing agreement and data license for access. institutional grants from TARGET-HCC, TARGET-NASH and HCV-TARGET. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
References
Andreani, Bideau, Duflot, In vitro testing of combined hydroxychloroquine and azithromycin on SARS-CoV-2 shows synergistic effect, Microb Pathog
Brufsky, Distinct viral clades of SARS-CoV-2: implications for modeling of viral spread, J Med Virol
Caputo, Strayer, Levitan, Early self-proning in awake, non-intubated patients in the emergency department: a single ED's experience during the COVID-19 pandemic, Acad Emerg Med
Cavalcanti, Zampieri, Rosa, Hydroxychloroquine with or without azithromycin in mild-to-moderate COVID-19, New Eng J Med,
doi:10.1056/nejmoa2019014Dias, Shardell, Golden, Ahima, Crews, Racial/ethnic trends in prevalence of diabetic kidney disease in the United States, Kidney Int Rep
Garg, Kim, Whitaker, Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019-COVID-NET, 14 States, MMWR Morb Mortal Wkly Rep
Gautret, Lagier, Parola, Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, Int J Antimicrob Agents
Geleris, Sun, Platt, Observational study of hydroxychloroquine in hospitalized patients with COVID-19, N Engl J Med
Ghebreyesus, Director-general's remarks at the media briefing on 2019-nCoV on 11
Gorbalenya, Baker, Baric, The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2, Nat Microbiol
Goyal, Choi, Pinheiro, Clinical characteristics of COVID-19 in New York City, N Engl J Med
Grein, Myers, Brainard, Compassionate use of remdesivir in COVID-19. Reply, N Engl J Med
Hackler E 3 Rd, Lew, Gore, Racial differences in cardiovascular biomarkers in the general population, J Am Heart Assoc
Holshue, Debolt, Lindquist, Washington State 2019 Novel Coronavirus (2019-nCoV) Case Investigation Team. First case of 2019 novel coronavirus in the United States, N Engl J Med
Lippi, Henry, Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19), Eur J Intern Med
Liu, Cao, Xu, Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro, Cell Discov
Pastick, Okafor, Wang, Review: hydroxychloroquine and chloroquine for treatment of SARS-CoV-2 (COVID-19), Open Forum Infect Dis
Richardson, Hirsch, Narasimhan, Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area, JAMA
Schneeweiss, Avorn, A review of uses of health care utilization databases for epidemiologic research on therapeutics, J Clin Epidemiol
Wang, Cao, Zhang, Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro, Cell Res
Wang, Hu, Hu, Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China, JAMA
Ward, Black, State and regional prevalence of diagnosed multiple chronic conditions among adults aged ≥18 years-United States, 2014, MMWR Morb Mortal Wkly Rep
Yancy, COVID-19 and African Americans, JAMA
Zhao, Meng, Kumar, The impact of COPD and smoking history on the severity of COVID-19: a systemic review and meta-analysis, J Med Virol,
doi:10.1002/jmv.25889Zhao, Zhang, Li, Incidence, clinical characteristics and prognostic factor of patients with COVID-19: a systematic review and meta-analysis, medRxiv,
doi:10.1101/2020.03.17.20037572Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet
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'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:sec>\n'
' <jats:title>Background</jats:title>\n'
' <jats:p>As coronavirus disease 2019 (COVID-19) disseminates throughout the '
'United States, a better understanding of the patient characteristics associated with '
'hospitalization, morbidity, and mortality in diverse geographic regions is '
'essential.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Methods</jats:title>\n'
' <jats:p>Hospital chargemaster data on adult patients with COVID-19 admitted '
'to 245 hospitals across 38 states between 15 February and 20 April 2020 were assessed. The '
'clinical course from admission, through hospitalization, and to discharge or death was '
'analyzed.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Results</jats:title>\n'
' <jats:p>A total of 11 721 patients were included (majority were &gt;60 '
'years of age [59.9%] and male [53.4%]). Comorbidities included hypertension (46.7%), diabetes '
'(27.8%), cardiovascular disease (18.6%), obesity (16.1%), and chronic kidney disease (12.2%). '
'Mechanical ventilation was required by 1967 patients (16.8%). Mortality among hospitalized '
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'and 4232 on hydroxychloroquine.</jats:p>\n'
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' <jats:sec>\n'
' <jats:title>Conclusions</jats:title>\n'
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'journal-title': 'Nat Microbiol'},
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'laboratory-confirmed coronavirus disease 2019—COVID-NET, 14 States, '
'March 1–30, 2020',
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'author': 'Garg',
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'journal-title': 'MMWR Morb Mortal Wkly Rep'},
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'doi-asserted-by': 'crossref',
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'research on therapeutics',
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'for potential COVID-19 treatment',
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'Affairs'},
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'author': 'Lippi',
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'first-page': '465',
'DOI': '10.15585/mmwr.mm6915e4',
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'States, February 12-April 7, 2020',
'volume': '69',
'year': '2020',
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{ 'key': '2021051810402368300_CIT0022',
'doi-asserted-by': 'crossref',
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'article-title': 'Distinct viral clades of SARS-CoV-2: implications for modeling of viral '
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'author': 'Brufsky',
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'doi-asserted-by': 'crossref',
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'DOI': '10.1056/NEJMoa2007016',
'article-title': 'Compassionate use of remdesivir in COVID-19. Reply',
'volume': '382',
'author': 'Grein',
'year': '2020',
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{ 'key': '2021051810402368300_CIT0024',
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'doi-asserted-by': 'crossref',
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'author': 'Andreani',
'year': '2020',
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'doi-asserted-by': 'crossref',
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'of an open-label non-randomized clinical trial',
'volume': '56',
'author': 'Gautret',
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'journal-title': 'Int J Antimicrob Agents'},
{ 'key': '2021051810402368300_CIT0027',
'doi-asserted-by': 'crossref',
'first-page': '1–27',
'DOI': '10.1093/ofid/ofaa130',
'article-title': 'Review: hydroxychloroquine and chloroquine for treatment of SARS-CoV-2 '
'(COVID-19)',
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'author': 'Pastick',
'year': '2020',
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