Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study

Prognosis InfectiologyPulmonologyAnesthesia-intensive care
Petrilli CM et al

Main result

11,544 people tested, 5,566 (48.2%) positive.

Cohort of 5,279 people included (94.8% of positive people) (median age 54 years, 49.5% men, 22.6% with diabetes, 35.3% with obesity, 52.1% with cardiovascular pathology).

Of the 2,741 (51.9%) people admitted to hospital :

  •     1,904 (69.5%) were discharged alive without palliative care
  •     665 (24.3%) were admitted to hospice palliative care or died
  •     647 (23.6%) required mechanical ventilation, of which 391 (60.4%) deaths and 170 (26.2%) were extubated or discharged.

The risk of hospitalization was associated with :

  •     Age, with OR>2 for all age groups over 44 years and 37.9 (95% CI 26.1-56.0) for those 75 years of age and older.
  •     Heart failure (OR=4.4, 95% CI 2.6 to 8.0)
  •     Male (OR=2.8, 95% CI 2.4 to 3.2)
  •     Chronic renal failure (OR=2.6, 95% CI 1.9 to 3.6)
  •     Any increase in body mass index (BMI) (for example, for BMI> 40: OR=2.5, 95% CI 1.8 to 3.4).

The risk of serious illness was increased with :

  •     Age
  •     Heart failure (OR=1.9, 95% CI1.4 to 2.5)
  •     BMI> 40 (OR=1.5, 95% CI 1.0 to 2.2)
  •     Male (OR=1.5, 95% CI 1.3 to 1.8).

         However, the following factors were more strongly associated with a severe form than age or comorbidities :

  •     Oxygen saturation <88% on admission (OR=3.7, 95% CI 2.8 to 4.8)
  •     Troponin > 1 (OR=4.8, 95% CI 2.1 to 10.9)
  •     CRP > 200 (OR=5.1, 95% CI 2.8 to 9.2)
  •     D-dimer > 2500 (OR=3.9, 95% CI 2.6 to 6.0)

          The risk of serious illness decreased significantly over the study period.


  • In this prospective study in a New York City health care system, the overall mortality rate of patients admitted to hospital was between 24% and 30%.
  • Age, heart failure, male sex, chronic kidney disease and obesity were associated with hospitalization and the development of severe disease.
  • Hypoxia and increased biological markers of inflammation on admission were factors indicating a pejorative course.

Strength of evidence Weak

- Prospective cohort study, in a New York City health system, n=5,279
- Data for the study were obtained from the electronic health record, which includes data on inpatient and outpatient visits to the health care system.
- Possible admissions to other centers, re-admissions or deaths not included in the study
- No clinical or biological data in positive patients followed on an outpatient basis.
- No biology protocol on admission at the beginning of the epidemic
- Change in the conditions for carrying out the tests: after 16 March, only nasopharyngeal PCR will be carried out by the healthcare system, a new PCR device will be added on 31 March, from 26 March, restriction of the tests previously carried out on mild or moderate forms.
- 172 patients still hospitalized (3.3% of cohort, 6.3% of inpatients)


Describe the outcomes of individuals admitted to hospital for COVID-19 in the United States, and the clinical and biological characteristics associated with a severe form of the disease.


  • Prospective cohort study conducted in a health care system in New York (including 4 hospitals).
  • Inclusion criteria: Inpatients hospitalized with laboratory-confirmed SARS-CoV-2 infection between March 1 and April 8. The final follow-up date was May 5.
  • Exclusion criteria: individuals with no previous visit to the health care system.
  • Judgement criteria: hospital admission, severe forms of illness (intensive care, mechanical ventilation) and for inpatients: palliative care admission or death.
  • Analysis with multivariate logistic regression

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