Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study
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.
Takeaways
- 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)
Objectives
Method
- 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
bibliovid.org and its content are bibliovid property.