Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 28;9(1):ofab498.
doi: 10.1093/ofid/ofab498. eCollection 2022 Jan.

Clinical Management of Hospitalized Coronavirus Disease 2019 Patients in the United States

Essy Mozaffari  1 , Aastha Chandak  2 , Zhiji Zhang  2 , Shuting Liang  1 , Julie Gayle  3 , Mark Thrun  1 , Robert L Gottlieb  4   5   6   7 , Daniel R Kuritzkes  8 , Paul E Sax  8 , David A Wohl  9 , Roman Casciano  2 , Paul Hodgkins  1 , Richard Haubrich  1
Affiliations

Clinical Management of Hospitalized Coronavirus Disease 2019 Patients in the United States

Essy Mozaffari et al. Open Forum Infect Dis. .

Abstract

Background: The objective of this study was to characterize hospitalized coronavirus disease 2019 (COVID-19) patients and describe their real-world treatment patterns and outcomes over time.

Methods: Adult patients hospitalized on May 1, 2020-December 31, 2020 with a discharge diagnosis of COVID-19 were identified from the Premier Healthcare Database. Patient and hospital characteristics, treatments, baseline severity based on oxygen support, length of stay (LOS), intensive care unit (ICU) utilization, and mortality were examined.

Results: The study included 295657 patients (847 hospitals), with median age of 66 (interquartile range, 54-77) years. Among each set of demographic comparators, the majority were male, white, and over 65. Approximately 85% had no supplemental oxygen charges (NSOc) or low-flow oxygen (LFO) at baseline, whereas 75% received no more than NSOc or LFO as maximal oxygen support at any time during hospitalization. Remdesivir (RDV) and corticosteroid treatment utilization increased over time. By December, 50% were receiving RDV and 80% were receiving corticosteroids. A higher proportion initiated COVID-19 treatments within 2 days of hospitalization in December versus May (RDV, 87% vs 40%; corticosteroids, 93% vs 62%; convalescent plasma, 68% vs 26%). There was a shift toward initiating RDV in patients on NSOc or LFO (68.0% [May] vs 83.1% [December]). Median LOS decreased over time. Overall mortality was 13.5% and it was highest for severe patients (invasive mechanical ventilation/extracorporeal membrane oxygenation [IMV/ECMO], 53.7%; high-flow oxygen/noninvasive ventilation [HFO/NIV], 32.2%; LFO, 11.7%; NSOc, 7.3%). The ICU use decreased, whereas mortality decreased for NSOc and LFO.

Conclusions: Clinical management of COVID-19 is rapidly evolving. This large observational study found that use of evidence-based treatments increased from May to December 2020, whereas improvement in outcomes occurred over this time-period.

Keywords: COVID-19; clinical management; hospitalization; treatment patterns.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Baseline severity upon hospital admission and maximum severity during the hospitalization among all patients hospitalized for coronavirus disease 2019, May–December 2020.
Figure 2.
Figure 2.
Treatment utilization by month among patients hospitalized for coronavirus disease 2019, May–December 2020. IMV/ECMO, invasive mechanical ventilation/extracorporeal membrane oxygenation; LFO, low-flow oxygen; NSOc, supplemental oxygen charges; RDV, remdesivir.
Figure 3.
Figure 3.
Treatment initiation day for remdesivir (RDV), anticoagulants, corticosteroids, and convalescent plasma, May–December 2020. The stripes and the rectangular outline in black are used to indicate patients initiated on a therapy within first 2 days of hospital admission.
Figure 4.
Figure 4.
Outcomes by baseline severity for all patients hospitalized for coronavirus disease 2019, May–December 2020. ∗Overall length of stay (LOS) and intensive care unit (ICU) LOS medians are right-skewed because patients who died and did not die are both included in the analysis. HFO/NIV, high-flow oxygen/noninvasive ventilation; IMV/ECMO, invasive mechanical ventilation/extracorporeal membrane oxygenation; LFO, low-flow oxygen; NSOc, supplemental oxygen charges; RDV, remdesivir.
See this image and copyright information in PMC

References

    1. Helmy YA, Fawzy M, Elaswad A, et al. . The COVID-19 pandemic: a comprehensive review of taxonomy, genetics, epidemiology, diagnosis, treatment, and control. J Clin Med 2020; 9:1225. - PMC - PubMed
    1. Flisiak R, Zarębska-Michaluk D, Berkan-Kawińska A, et al. . Remdesivir-based therapy improved the recovery of patients with COVID-19 in the multicenter, real-world SARSTer study. Pol Arch Intern Med 2021; 131:103–10. doi:10.20452/pamw.15735 - DOI - PubMed
    1. World Health Organization. Weekly epidemiological update—2 February 2021. Available at: https://www.who.int/publications/m/item/weekly-epidemiological-update---.... Accessed 27 February 2021.
    1. Asch DA, Sheils NE, Islam MN, et al. . Variation in US hospital mortality rates for patients admitted with COVID-19 during the first 6 months of the pandemic. JAMA Intern Med 2021; 181:471–8. - PMC - PubMed
    1. Horwitz LI, Jones SA, Cerfolio RJ, et al. . Trends in COVID-19 risk-adjusted mortality rates. J Hosp Med 2021; 16:90–2. - PubMed