Characteristics and Outcomes of US Patients Hospitalized With COVID-19

Abstract

Background: Understanding COVID-19 epidemiology is crucial to clinical care and to clinical trial design and interpretation.

Objective: To describe characteristics, treatment, and outcomes among patients hospitalized with COVID-19 early in the pandemic.

Methods: A retrospective cohort study of consecutive adult patients with laboratory-confirmed, symptomatic SARS-CoV-2 infection admitted to 57 US hospitals from March 1 to April 1, 2020.

Results: Of 1480 inpatients with COVID-19, median (IQR) age was 62.0 (49.4-72.9) years, 649 (43.9%) were female, and 822 of 1338 (61.4%) were non-White or Hispanic/Latino. Intensive care unit admission occurred in 575 patients (38.9%), mostly within 4 days of hospital presentation. Respiratory failure affected 583 patients (39.4%), including 284 (19.2%) within 24 hours of hospital presentation and 413 (27.9%) who received invasive mechanical ventilation. Median (IQR) hospital stay was 8 (5-15) days overall and 15 (9-24) days among intensive care unit patients. Hospital mortality was 17.7% (n = 262). Risk factors for hospital death identified by penalized multivariable regression included older age; male sex; comorbidity burden; symptoms-to-admission interval; hypotension; hypoxemia; and higher white blood cell count, creatinine level, respiratory rate, and heart rate. Of 1218 survivors, 221 (18.1%) required new respiratory support at discharge and 259 of 1153 (22.5%) admitted from home required new health care services.

Conclusions: In a geographically diverse early-pandemic COVID-19 cohort with complete hospital folllow-up, hospital mortality was associated with older age, comorbidity burden, and male sex. Intensive care unit admissions occurred early and were associated with protracted hospital stays. Survivors often required new health care services or respiratory support at discharge.

Figure 1

Map of contributing hospitals with associated county-level COVID-19 incidence during cohort eligibility. Choropleth map illustrates spatial variation in county-level COVID-19 incidence rate (cases per 10 000 residents) during the third week of March 2020 (see Supplement 1). Dots represent contributing hospitals. For closely adjacent hospitals, a single dot indicates the location of multiple hospitals and is labeled with the number of contributing sites represented.

Figure 2

Hospital level of care from arrival at study hospital through discharge or hospital day 60. Alluvial diagram depicts patients’ transitions between treatment intensity levels during their hospitalization and ends on study hospital discharge. Because patients were not followed up beyond hospital discharge, patients do not transition out of postdischarge status of home or facility.

Figure 3

Organ support therapy combinations and associated hospital mortality among patients requiring organ support therapy. Includes 567 patients receiving at least 1 advanced organ support therapy. Abbreviations: HFNC, high-flow nasal cannula; IMV, invasive mechanical ventilation; NIPPV, noninvasive positive pressure ventilation.