Clinical Characteristics and Outcomes of Non-ICU Hospitalization for COVID-19 in a Nonepicenter, Centrally Monitored Healthcare System
| Autor: | Aaron C Hamilton, Bryan Wilner, Meredith Foxx, Carl B. Gillombardo, David M. Nemer, Venu Menon, Oussama M. Wazni, Jose Aguilera, Alicia Burkle, Shannon Pengel, Daniel J. Cantillon, Marc Petre, Joseph Adewumi |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
Patient Transfer medicine.medical_specialty Leadership and Management medicine.medical_treatment 030204 cardiovascular system & hematology Assessment and Diagnosis medicine.disease_cause Azithromycin Ventricular tachycardia 03 medical and health sciences 0302 clinical medicine Internal medicine Medicine Humans Telemetry Decompensation 030212 general & internal medicine Adverse effect Care Planning Original Research Monitoring Physiologic Mechanical ventilation business.industry SARS-CoV-2 Health Policy COVID-19 Hydroxychloroquine General Medicine Odds ratio Middle Aged medicine.disease Hospitalization Fundamentals and skills Female business Nasal cannula medicine.drug |
| Zdroj: | J Hosp Med |
| Popis: | BACKGROUND: The clinical characteristics and outcomes associated with non–intensive care unit (non-ICU) hospitalizations for coronavirus disease 2019 (COVID-19) outside disease epicenters remain poorly characterized. METHODS: Systematic analysis of all non-ICU patient hospitalizations for COVID-19 completing discharge between March 13 and May 1, 2020, in a large US health care system utilizing off-site central monitoring. Variables of interest were examined in relation to a composite event rate of death, ICU transfer, or increased oxygen requirement to high-flow nasal cannula, noninvasive ventilation, or mechanical ventilation. RESULTS: Among 350 patients (age, 64 ± 16 years; 55% male), most (73%) required 3 L/min or less of supplemental oxygen during admission. Telemetry was widely utilized (79%) yet arrhythmias were uncommon (14%) and were predominantly (90%) among patients with abnormal troponin levels or known cardiovascular disease. Ventricular tachycardia was rare (5%), nonsustained, and not associated with hydroxychloroquine/azithromycin treatment. Adverse events occurred in 62 patients (18%), including 22 deaths (6%), 48 ICU transfers (14%), and 49 patients with increased oxygen requirement (14%) and were independently associated with elevated C-reactive protein (odds ratio, 1.09 per 1 mg/dL; 95% CI, 1.01-1.18; P = .04) and lactate dehydrogenase (OR, 1.006 per 1U/L; 95% CI, 1.001-1.012; P = .03) in multivariable analysis. CONCLUSION: Among non–critically ill patients hospitalized within a nonepicenter health care system, overall survival was 94% with the development of more severe illness or death independently associated with higher levels of C-reactive protein and lactate dehydrogenase on admission. Clinical decompensation was largely respiratory-related, while serious cardiac arrhythmias were rare, which suggests that telemetry can be prioritized for high-risk patients. |
| Databáze: | OpenAIRE |
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