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

Autor: Benjamin J. Meyer, Jan Claassen, Elizabeth M. Balough, Beth Hochman, Darryl Abrams, Matthew R. Baldwin, Matthew J. Cummings, John Salazar-Schicchi, Le Roy E. Rabbani, Daniel Brodie, Jonathan Hastie, Max R. O'Donnell, Justin G. Aaron, Samuel D. Jacobson, Natalie H Yip
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Pediatrics
medicine.medical_treatment
030204 cardiovascular system & hematology
0302 clinical medicine
Risk Factors
Interquartile range
Epidemiology
Medicine
030212 general & internal medicine
Hospital Mortality
Prospective Studies
Prospective cohort study
Aged
80 and over
Respiratory Distress Syndrome
Hazard ratio
Age Factors
Clinical course
General Medicine
Middle Aged
Hospitalization
Biomarker (medicine)
Female
medicine.symptom
Coronavirus Infections
Cohort study
Adult
medicine.medical_specialty
Critical Illness
Pneumonia
Viral
Article
Fibrin Fibrinogen Degradation Products
03 medical and health sciences
Young Adult
Betacoronavirus
Internal medicine
Diabetes mellitus
Correspondence
Humans
Renal replacement therapy
Pandemics
Aged
Proportional Hazards Models
Mechanical ventilation
Proportional hazards model
Interleukin-6
SARS-CoV-2
business.industry
Organ dysfunction
COVID-19
medicine.disease
Respiration
Artificial
New York City
business
Biomarkers
Zdroj: medRxiv
The Lancet
Lancet (London, England)
Popis: 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.
Databáze: OpenAIRE
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