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. 2020 May 29:369:m1996.
doi: 10.1136/bmj.m1996.

Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series

Michael G Argenziano  1   2 , Samuel L Bruce  1   2 , Cody L Slater  1   2 , Jonathan R Tiao  1   2 , Matthew R Baldwin  3 , R Graham Barr  4 , Bernard P Chang  5 , Katherine H Chau  6 , Justin J Choi  7 , Nicholas Gavin  5 , Parag Goyal  7 , Angela M Mills  5 , Ashmi A Patel  4 , Marie-Laure S Romney  5 , Monika M Safford  7 , Neil W Schluger  3 , Soumitra Sengupta  2 , Magdalena E Sobieszczyk  8 , Jason E Zucker  8 , Paul A Asadourian  1 , Fletcher M Bell  1 , Rebekah Boyd  1 , Matthew F Cohen  1 , MacAlistair I Colquhoun  1 , Lucy A Colville  1 , Joseph H de Jonge  1 , Lyle B Dershowitz  1 , Shirin A Dey  1 , Katherine A Eiseman  1 , Zachary P Girvin  1 , Daniella T Goni  1 , Amro A Harb  1 , Nicholas Herzik  1 , Sarah Householder  1 , Lara E Karaaslan  1 , Heather Lee  1 , Evan Lieberman  1 , Andrew Ling  1 , Ree Lu  1 , Arthur Y Shou  1 , Alexander C Sisti  1 , Zachary E Snow  1 , Colin P Sperring  1 , Yuqing Xiong  1 , Henry W Zhou  1 , Karthik Natarajan  2 , George Hripcsak  2 , Ruijun Chen  9   7
Affiliations

Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series

Michael G Argenziano et al. BMJ. .

Abstract

Objective: To characterize patients with coronavirus disease 2019 (covid-19) in a large New York City medical center and describe their clinical course across the emergency department, hospital wards, and intensive care units.

Design: Retrospective manual medical record review.

Setting: NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City.

Participants: The first 1000 consecutive patients with a positive result on the reverse transcriptase polymerase chain reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to the emergency department or were admitted to hospital between 1 March and 5 April 2020. Patient data were manually abstracted from electronic medical records.

Main outcome measures: Characterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition.

Results: Of the first 1000 patients, 150 presented to the emergency department, 614 were admitted to hospital (not intensive care units), and 236 were admitted or transferred to intensive care units. The most common presenting symptoms were cough (732/1000), fever (728/1000), and dyspnea (631/1000). Patients in hospital, particularly those treated in intensive care units, often had baseline comorbidities including hypertension, diabetes, and obesity. Patients admitted to intensive care units were older, predominantly male (158/236, 66.9%), and had long lengths of stay (median 23 days, interquartile range 12-32 days); 78.0% (184/236) developed acute kidney injury and 35.2% (83/236) needed dialysis. Only 4.4% (6/136) of patients who required mechanical ventilation were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at three to four days, and at nine days. As of 30 April, 90 patients remained in hospital and 211 had died in hospital.

Conclusions: Patients admitted to hospital with covid-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no competing interests with regards to the submitted work; MMS reports grants from Amgen, outside the submitted work; JJC reports personal fees from Allergan, outside the submitted work; RGB reports grants from Alpha1 Foundation and COPD Foundation, outside the submitted work; GH reports grants from Janssen Research, outside the submitted work; the remaining authors have nothing to disclose.

Figures

Fig 1
Fig 1
Distribution of time from first symptom to intubation for 136 patients who had exact date of first symptom recorded. The time from first symptom to first intubation follows a bimodal distribution (P=0.004 for Hartigan’s dip test18), with modes at three to four days and at nine days
Fig 2
Fig 2
Timeline of patients with coronavirus disease 2019 who were intubated. Exact times of intubation were documented in electronic health records (n=224) at Columbia University Irving Medical Center. Patients are stratified by endpoints: death, discharge, or still in hospital as of 30 April 2020. ED=emergency department; IQR=interquartile range
See this image and copyright information in PMC

Update of

  • Characterization and clinical course of 1000 patients with COVID-19 in New York: retrospective case series.
    Argenziano MG, Bruce SL, Slater CL, Tiao JR, Baldwin MR, Barr RG, Chang BP, Chau KH, Choi JJ, Gavin N, Goyal P, Mills AM, Patel AA, Romney MS, Safford MM, Schluger NW, Sengupta S, Sobieszczyk ME, Zucker JE, Asadourian PA, Bell FM, Boyd R, Cohen MF, Colquhoun MI, Colville LA, de Jonge JH, Dershowitz LB, Dey SA, Eiseman KA, Girvin ZP, Goni DT, Harb AA, Herzik N, Householder S, Karaaslan LE, Lee H, Lieberman E, Ling A, Lu R, Shou AY, Sisti AC, Snow ZE, Sperring CP, Xiong Y, Zhou HW, Natarajan K, Hripcsak G, Chen R. Argenziano MG, et al. medRxiv [Preprint]. 2020 May 7:2020.04.20.20072116. doi: 10.1101/2020.04.20.20072116. medRxiv. 2020. Update in: BMJ. 2020 May 29;369:m1996. doi: 10.1136/bmj.m1996. PMID: 32511507 Free PMC article. Updated. Preprint.

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