1. COVID-19-positive adults were commonly found to have at least one comorbid condition, including hypertension and diabetes.
2. In-hospital mortality was independently associated with older age, chronic cardiac and pulmonary diseases, and elevated concentrations of interleukin-6 and D-dimer.
3. Critical illness is associated with elevated need for invasive mechanical ventilation, as well as extrapulmonary dysfunction.
Evidence Rating Level: 2 (Good)
As of April 28, 2020, more than 40,000 COVID-19 patients have been hospitalized in New York City. Given the ongoing and precarious nature of this pandemic, it is important to investigate the epidemiology, clinical course, and outcomes of patients who become critically ill due to COVID-19. This prospective observational cohort study, taking place at two hospitals affiliated with Columbia University Irving Medical Center identified adult, COVID-19-positive patients from March 2 to April 1, 2020 who were critically ill with acute hypoxemic respiratory failure to collect biomarker, clinical, and treatment data. A total of 1,150 adults with COVID-19 were admitted to the two hospitals (M [IQR] = 62 [51 to 72] years, 33% female), 22% of whom were critically ill. Approximately 82% of patients presented with at least one comorbid illness, with the most common being hypertension (63%), diabetes (36%), and obesity (46%). By April 28, 2020, 39% of the patients had passed away and 37% were still hospitalized. Of those who remained hospitalized, 79% required invasive mechanical ventilation (median [IQR] duration = 18 [9 to 28] days), 66% received vasopressors, and 31% received renal replacement therapy. In-hospital deterioration was found to have a median duration of 3 days (IQR 1 to 6 days). Increased in-hospital mortality was independently associated with older age (adjusted HR 1.31, 95% CI 1.09 to 1.57), chronic cardiac disease (adjusted HR 1.76, 95% CI 1.08 to 2.86), chronic pulmonary disease (adjusted HR 2.94, 95% CI 1.48 to 5.84), elevated concentrations of interleukin-6 (adjusted HR 1.11, 95% CI 1.02 to 1.20 per decile increase), and higher D-dimer concentrations (adjusted HR 1.10, 95% CI 1.01 to 1.19 per decile increase). Overall, this study aligns with those previously published while remaining specific to COVID-19 patients in New York City. Hypertension and diabetes are common comorbidities and mortality is associated with specific risk factors that should be considered as we learn more about how to control the spread of the virus.
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