Clinical characteristics of hospitalised patients with COVID-19 and the impact on mortality: a single-network, retrospective cohort study from Pennsylvania state
et al., BMJ Open, doi:10.1136/bmjopen-2020-042549
, Clinical characteristics of hospitalised patients with COVID-19 and the impact on mortality: a single-network,.., BMJ Open, doi:10.1136/bmjopen-2020-042549
Retrospective 283 patients in the USA showing higher mortality with all treatments (not statistically significant). Confounding by indication is likely. In the supplementary appendix, authors note that the treatments were usually given for patients that required oxygen therapy. Oxygen therapy and ICU admission (possibly, the paper includes ICU admission for model 2 in some places but not others) were the only variables indicating severity used in adjustments. Time based confounding is likely because HCQ became increasingly controversial and less used over the time covered (March 1 to May 31, 2020), while overall treatment protocols during this period improved dramatically, i.e., more control patients likely come later in the period when treatment protocols were greatly improved.
This study is excluded in the after exclusion results of meta
analysis:
substantial confounding by time likely due to declining usage over the early stages of the pandemic when overall treatment protocols improved dramatically; substantial unadjusted confounding by indication likely.
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risk of death, 4.8% higher, RR 1.05, p = 0.89, treatment 22 of 55 (40.0%), control 33 of 216 (15.3%), adjusted per study, odds ratio converted to relative risk, multivariate logistic regression.
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| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
Gadhiya et al., 8 Apr 2021, retrospective, USA, peer-reviewed, 4 authors.
Abstract: Open access
Original research
Kinjal P Gadhiya,1 Panupong Hansrivijit ,1 Mounika Gangireddy,1
John D Goldman2
To cite: Gadhiya KP,
Hansrivijit P, Gangireddy M,
et al. Clinical characteristics
of hospitalised patients with
COVID-19 and the impact on
mortality: a single-network,
retrospective cohort study from
Pennsylvania state. BMJ Open
2021;11:e042549. doi:10.1136/
bmjopen-2020-042549
►► Prepublication history and
additional supplemental material
for this paper are available
online. To view these files,
please visit the journal online
(http://dx.doi.o rg/10.1136/
bmjopen-2020-042549).
KPG, PH and MG contributed
equally.
Received 08 July 2020
Revised 07 October 2020
Accepted 18 March 2021
© Author(s) (or their
employer(s)) 2021. Re-use
permitted under CC BY-NC. No
commercial re-use. See rights
and permissions. Published by
BMJ.
1
Department of Internal
Medicine, UPMC Pinnacle,
Harrisburg, Pennsylvania, USA
2
Department of Infectious
Diseases, UPMC Pinnacle,
Harrisburg, Pennsylvania, USA
Correspondence to
Dr Panupong Hansrivijit;
h ansrivijitp@upmc.e du
ABSTRACT
Objective COVID-19 is a respiratory disease caused by
SARS-CoV-2 with the highest burden in the USA. Data
on clinical characteristics of patients with COVID-19 in
US population are limited. Thus, we aim to determine the
clinical characteristics and risk factors for in-hospital
mortality from COVID-19.
Design Retrospective observational study.
Setting Single-network hospitals in Pennsylvania state.
Participants Patients with confirmed SARS-CoV-2
infection who were hospitalised from 1 March to 31 May
2020.
Primary and secondary outcome measures Primary
outcome was in-hospital mortality. Secondary outcomes
were complications, such as acute kidney injury (AKI) and
acute respiratory distress syndrome (ARDS).
Results Of 283 patients, 19.4% were non-survivors.
The mean age of all patients was 64.1±15.9 years.
56.2% were male and 50.2% were white. Several factors
were identified from our adjusted multivariate analyses
to be associated with in-hospital mortality: increasing
age (per 1-year increment; OR 1.07 (1.045 to 1.105)),
hypoxia (oxygen saturation <95%; OR 4.630 (1.934 to
1.111)), opacity/infiltrate on imaging (OR 3.077 (1.276
to 7.407)), leucocytosis (white blood cell >10 109/µL; OR
2.732 (1.412 to 5.263)), ferritin >336 ng/mL (OR 4.016
(1.195 to 13.514)), lactate dehydrogenase >200 U/L
(OR 7.752 (1.639 to 37.037)), procalcitonin >0.25 ng/
mL (OR 2.404 (1.011 to 5.714)), troponin I >0.03 ng/
mL (OR 2.242 (1.080 to 4.673)), need for advanced
oxygen support other than simple nasal cannula (OR
4.608–13.889 (2.053 to 31.250)), intensive care unit
admission/transfer (OR 13.699 (6.135 to 30.303)), renal
replacement therapy (OR 21.277 (5.025 to 90.909)), need
for vasopressor (OR 22.222 (9.434 to 52.632)), ARDS (OR
23.810 (10.204 to 55.556)), respiratory acidosis (OR 7.042
(2.915 to 16.949)), and AKI (OR 3.571 (1.715 to 7.407)).
When critically ill patients were analysed independently,
increasing Sequential Organ Failure Assessment score (OR
1.544 (1.168 to 2.039)), AKI (OR 2.128 (1.111 to 6.667))
and ARDS (OR 6.410 (2.237 to 18.182)) were predictive of
in-hospital mortality.
Strengths and limitations of this study
►► Individual patient’s chart was reviewed.
►► Multivariate analysis (binary logistic regression
model) was used to report the results.
►► Retrospective, observational design.
►► Limited sample size.
►► Only hospitalised patients were..
Late treatment
is less effective
is less effective
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