Risk Factors Associated With In-Hospital Mortality in a US National Sample of Patients With COVID-19
Retrospective database analysis of 64,781 hospitalized patients in the USA, showing lower mortality with vitamin C or vitamin D (authors do not distinguish between the two), and higher mortality with zinc and HCQ, statistically significant for zinc. Authors excluded hospital-based outpatient visits, without explanation. Confounding by indication
is likely, adjustments do not appear to include any information on COVID-19 severity at baseline.
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confounding by indication
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risk of death, 8.0% higher, OR 1.08, p = 0.13, adjusted per study, multivariable, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Rosenthal et al., 10 Dec 2020, retrospective, database analysis, USA, peer-reviewed, 5 authors.
Abstract: Original Investigation | Infectious Diseases
Risk Factors Associated With In-Hospital Mortality in a US National Sample
of Patients With COVID-19
Ning Rosenthal, MD, MPH, PhD; Zhun Cao, PhD; Jake Gundrum, MS; Jim Sianis, PharmD, MBA; Stella Safo, MD, MPH
IMPORTANCE Coronavirus disease 2019 (COVID-19) has infected more than 8.1 million US residents
and killed more than 221 000. There is a dearth of research on epidemiology and clinical outcomes
in US patients with COVID-19.
Question What are the epidemiologic
characteristics of patients with
coronavirus disease 2019 (COVID-19)
treated in US hospitals, and what risk
OBJECTIVES To characterize patients with COVID-19 treated in US hospitals and to examine risk
factors are associated with mortality?
Findings In this cohort study of 64 781
factors associated with in-hospital mortality.
patients with COVID-19 treated in 592
DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using Premier
US hospitals during April and May 2020,
Healthcare Database, a large geographically diverse all-payer hospital administrative database
the in-hospital mortality rate was 20.3%
including 592 acute care hospitals in the United States. Inpatient and hospital-based outpatient visits
among inpatients, and severe
with a principal or secondary discharge diagnosis of COVID-19 (International Classification of
complications were common. Receipt of
Diseases, Tenth Revision, Clinical Modification diagnosis code, U07.1) between April 1 and May 31,
statin, angiotensin-converting enzyme
2020, were included.
inhibitors, and calcium channel blockers
were associated with decreased odds
EXPOSURES Characteristics of patients were reported by inpatient/outpatient and survival status.
of mortality, but the combination use of
Risk factors associated with death examined included patient characteristics, acute complications,
hydroxychloroquine and azithromycin
comorbidities, and medications.
was associated with increased odds of
MAIN OUTCOMES AND MEASURES In-hospital mortality, intensive care unit (ICU) admission, use
of invasive mechanical ventilation, total hospital length of stay (LOS), ICU LOS, acute complications,
and treatment patterns.
Meaning In this study, COVID-19 was
associated with severe complications
and deaths among patients hospitalized
in the United States; certain medications
RESULTS Overall, 64 781 patients with COVID-19 (29 479 [45.5%] outpatients; 35 302 [54.5%]
inpatients) were analyzed. The median (interquartile range [IQR]) age was 46 (33-59) years for
may be associated with decreased odds
outpatients and 65 (52-77) years for inpatients; 31 968 (49.3%) were men, 25 841 (39.9%) were
White US residents, and 14 340 (22.1%) were Black US residents. In-hospital mortality was 20.3%
among inpatients (7164 patients). A total of 5625 inpatients (15.9%) received invasive mechanical
ventilation, and 6849 (19.4%) were admitted to the ICU. Median (IQR) inpatient LOS was 6 (3-10)
days. Median (IQR) ICU LOS was 5 (2-10) days. Common acute complications among inpatients
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included acute respiratory failure (19 706 [55.8%]), acute kidney failure (11 971 [33.9%]), and sepsis
(11 910 [33.7%]). Older age was the risk factor most strongly associated with death (eg, age ⱖ80
years vs 18-34 years: odds ratio [OR], 16.20; 95% CI,..
is less effective
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