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[Preprint]. 2020 May 7:2020.04.20.20072116.
doi: 10.1101/2020.04.20.20072116.

Characterization and clinical course of 1000 patients with COVID-19 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  2   7
Affiliations

Characterization and clinical course of 1000 patients with COVID-19 in New York: retrospective case series

Michael G Argenziano et al. medRxiv. .

Update in

  • Characterization and clinical course of 1000 patients with coronavirus disease 2019 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. BMJ. 2020 May 29;369:m1996. doi: 10.1136/bmj.m1996. BMJ. 2020. PMID: 32471884 Free PMC article.

Abstract

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

Design: Retrospective manual medical record review.

Setting: NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC.

Participants: The first 1000 consecutive patients with laboratory-confirmed COVID-19.

Methods: We identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record.

Main outcome measures: We describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition.

Results: Among the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital.

Conclusions: Hospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed the ICMJE uniform disclosure form 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 MGA, SLB, CLS, JRT, KN, RC, MRB, BPC, NG, PG, AMM, AAP, MSR, NWS, SS, MDS, KN, PAA, FMB, RB, MFC, MIC, LAC, JHD, LBD, SAD, KAE, ZPG, DTG, AAH, NH, SH, LEK, EL, AL, AYS, ACS, ZES, CPS, YX, HWZ, and RL have nothing to disclose.

Figures

Figure 1.
Figure 1.. Distribution of Time from First Symptom to Intubation
136 patients had a specific recorded date for first symptom onset. These patients are visualized in this figure. Days from first symptom to first intubation follows a bimodal distribution (p = 0.0088 for Hartigan’s Dip Test), with modes at 3–4 days and 9 days. 4.4% of patients are intubated for the first time more than 14 days after the onset of symptoms.
Figure 2.
Figure 2.. Timeline of Intubated Patients
The time course for COVID-19 positive patients intubated with exact times of intubation documented in the EHR (n=227A) at CUIMC is shown above. Patients are separated based on their current endpoints, separated into death, discharge, or currently hospitalized. 86 patientsB are still hospitalized, 31 have been discharged, 107 have died, and 74 have been extubated. A 7 patients acquired COVID-19 after intubation and are excluded from this plot. B Data collection remains ongoing for currently hospitalized patients.
See this image and copyright information in PMC

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