Patient Characteristics and Outcomes of 11,721 Patients with COVID19 Hospitalized Across the United States
Fried et al.
, Patient Characteristics and Outcomes of 11,721 Patients with COVID19 Hospitalized Across the United States
, Clinical Infectious Disease, doi:10.1093/cid/ciaa1268
Database analysis of 11,721 hospitalized patients, 4,232 on HCQ. Strong evidence for confounding by indication
and compassionate use of HCQ. 24.9% of HCQ patients were on mechanical ventilation versus 12.2% control. Ventilation mortality was 70.5% versus 11.6%.
This study does not adjust for the differences in comorbid conditions and disease severity, and therefore does not make a conclusion. Unadjusted HCQ mortality was 24.8% versus control 19.6%. Adjusting for ventilation only gives us 17.7% HCQ versus 19.6% control (adjusting the HCQ group to have the same proportion of ventilation patients), RR 0.90. Hopefully authors can do a full adjustment analysis. Comorbidities may favor control, while patients remaining in the hospital (5.3%) may favor HCQ (other studies show faster resolution for HCQ patients).
Data inconsistencies have been found in this study, for example 99.4% of patients treated with HCQ were treated in urban hospitals, compared to 65% of untreated patients (Supplemental Table 3), while patients are distributed in a more balanced manner between teaching or not-teaching hospitals, as well as in the most urbanized (Northeast) and less urbanized (Midwest) regions of the United States [academic.oup.com]
This study is excluded in the after exclusion results of meta
excessive unadjusted differences between groups; substantial unadjusted confounding by indication
risk of death, 27.0% higher, RR 1.27, p < 0.001, treatment 1,048 of 4,232 (24.8%), control 1,466 of 7,489 (19.6%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Fried et al., 28 Aug 2020, retrospective, database analysis, USA, peer-reviewed, 11 authors.
Abstract: Clinical Infectious Diseases
Patient Characteristics and Outcomes of 11 721 Patients
With Coronavirus Disease 2019 (COVID-19) Hospitalized
Across the United States
Michael W. Fried,1 Julie M. Crawford,1 Andrea R. Mospan,1 Stephanie E. Watkins,1 Breda Munoz,1 Richard C. Zink,1 Sherry Elliott,2
Kyle Burleson,1 Charles Landis,3 K. Rajender Reddy,4 and Robert S. Brown Jr5
Background. 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.
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.
Keywords. SARS-CoV-2; COVID-19; observational study; hydroxychloroquine; remdesivir.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
 is a novel coronavirus identified initially in Wuhan, China, in
2019. The virus causes coronavirus disease 2019 (COVID-19) ,
which subsequently has created outbreaks across the world, resulting in over 5.2 million cases and over 327 000 deaths globally
. In the United States, the first case of COVID-19 was reported
on 20 January 2020 in Washington state . As of 5 August 2020,
there have been over 4.6 million confirmed cases and 154 952
deaths attributed to COVID-19 in the United States .
In early reports in China and the United States, increasing
age and comorbid diseases, most notably cardiovascular disease, diabetes, hypertension, and chronic kidney disease, were
associated with increased disease severity and death [5–7].
According to the Centers for Disease Control and Prevention
Received 5 June 2020; editorial decision 19 August 2020; accepted 24 August 2020; published
online August 28, 2020.
Correspondence: M. W. Fried, TARGET PharmaSolutions, Inc., 2520 Meridian Pkwy, Suite
105, Durham, NC 27713 (firstname.lastname@example.org).
Clinical Infectious Diseases® 2021;72(10):e558–65
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society
of America. All rights reserved. For permissions,..
is less effective
Please send us corrections, updates, or comments. Vaccines and
treatments are complementary. All practical, effective, and safe means should
be used based on risk/benefit analysis. No treatment, vaccine, or intervention
is 100% available and effective for all current and future variants. We do not
provide medical advice. Before taking any medication, consult a qualified
physician who can provide personalized advice and details of risks and
benefits based on your medical history and situation. FLCCC
provide treatment protocols.