Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study.

Autor:	Cummings MJ; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA., Baldwin MR; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA., Abrams D; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA., Jacobson SD; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA., Meyer BJ; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA., Balough EM; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA., Aaron JG; Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA., Claassen J; Department of Medicine; Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA., Rabbani LE; Division of Cardiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA., Hastie J; Division of Critical Care Medicine, Department of Anesthesiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA., Hochman BR; Division of Critical Care Medicine, Department of Anesthesiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA; Division of General Surgery, Department of Surgery, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA., Salazar-Schicchi J; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA., Yip NH; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA., Brodie D; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA., O'Donnell MR; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. Electronic address: mo2130@columbia.edu.
Jazyk:	angličtina
Zdroj:	Lancet (London, England) [Lancet] 2020 Jun 06; Vol. 395 (10239), pp. 1763-1770. Date of Electronic Publication: 2020 May 19.
DOI:	10.1016/S0140-6736(20)31189-2
Abstrakt:	Background: Over 40 000 patients with COVID-19 have been hospitalised in New York City (NY, USA) as of April 28, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed. Methods: This prospective observational cohort study took place at two NewYork-Presbyterian hospitals affiliated with Columbia University Irving Medical Center in northern Manhattan. We prospectively identified adult patients (aged ≥18 years) admitted to both hospitals from March 2 to April 1, 2020, who were diagnosed with laboratory-confirmed COVID-19 and were critically ill with acute hypoxaemic respiratory failure, and collected clinical, biomarker, and treatment data. The primary outcome was the rate of in-hospital death. Secondary outcomes included frequency and duration of invasive mechanical ventilation, frequency of vasopressor use and renal replacement therapy, and time to in-hospital clinical deterioration following admission. The relation between clinical risk factors, biomarkers, and in-hospital mortality was modelled using Cox proportional hazards regression. Follow-up time was right-censored on April 28, 2020 so that each patient had at least 28 days of observation. Findings: Between March 2 and April 1, 2020, 1150 adults were admitted to both hospitals with laboratory-confirmed COVID-19, of which 257 (22%) were critically ill. The median age of patients was 62 years (IQR 51-72), 171 (67%) were men. 212 (82%) patients had at least one chronic illness, the most common of which were hypertension (162 [63%]) and diabetes (92 [36%]). 119 (46%) patients had obesity. As of April 28, 2020, 101 (39%) patients had died and 94 (37%) remained hospitalised. 203 (79%) patients received invasive mechanical ventilation for a median of 18 days (IQR 9-28), 170 (66%) of 257 patients received vasopressors and 79 (31%) received renal replacement therapy. The median time to in-hospital deterioration was 3 days (IQR 1-6). In the multivariable Cox model, older age (adjusted hazard ratio [aHR] 1·31 [1·09-1·57] per 10-year increase), chronic cardiac disease (aHR 1·76 [1·08-2·86]), chronic pulmonary disease (aHR 2·94 [1·48-5·84]), higher concentrations of interleukin-6 (aHR 1·11 [95%CI 1·02-1·20] per decile increase), and higher concentrations of D-dimer (aHR 1·10 [1·01-1·19] per decile increase) were independently associated with in-hospital mortality. Interpretation: Critical illness among patients hospitalised with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extrapulmonary organ dysfunction, and substantial in-hospital mortality. Funding: National Institute of Allergy and Infectious Diseases and the National Center for Advancing Translational Sciences, National Institutes of Health, and the Columbia University Irving Institute for Clinical and Translational Research. (Copyright © 2020 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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