Clinical characteristics of hospitalised patients with COVID-19 and the impact on mortality: a single-network, retrospective cohort study from Pennsylvania state
Kinjal P Gadhiya, Dr Panupong Hansrivijit, Mounika Gangireddy, John D Goldman
BMJ Open, doi:10.1136/bmjopen-2020-042549
Objective COVID-19 is a respiratory disease caused by SARS-CoV-2 with the highest burden in the USA. Data on clinical characteristics of patients with COVID-19 in US population are limited. Thus, we aim to determine the clinical characteristics and risk factors for in-hospital mortality from COVID-19. Design Retrospective observational study. Setting Single-network hospitals in Pennsylvania state. Participants Patients with confirmed SARS-CoV-2 infection who were hospitalised from 1 March to 31 May 2020. Primary and secondary outcome measures Primary outcome was in-hospital mortality. Secondary outcomes were complications, such as acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS). Results Of 283 patients, 19.4% were non-survivors. The mean age of all patients was 64.1±15.9 years. 56.2% were male and 50.2% were white. Several factors were identified from our adjusted multivariate analyses to be associated with in-hospital mortality: increasing age (per 1-year increment; OR 1.07 (1.045 to 1.105)), hypoxia (oxygen saturation <95%; OR 4.630 (1.934 to 1.111)), opacity/infiltrate on imaging (OR 3.077 (1.276 to 7.407)), leucocytosis (white blood cell >10 109/µL ; OR 2.732 (1.412 to 5.263)), ferritin >336 ng/mL (OR 4.016 (1.195 to 13.514)), lactate dehydrogenase >200 U/L (OR 7.752 (1.639 to 37.037)), procalcitonin >0.25 ng/ mL (OR 2.404 (1.011 to 5.714)), troponin I >0.03 ng/ mL (OR 2.242 (1.080 to 4.673)), need for advanced oxygen support other than simple nasal cannula (OR 4.608-13.889 (2.053 to 31.250)), intensive care unit admission/transfer (OR 13.699 (6.135 to 30.303)), renal replacement therapy (OR 21.277 (5.025 to 90.909)), need for vasopressor (OR 22.222 (9.434 to 52.632)), ARDS (OR 23.810 (10.204 to 55.556)), respiratory acidosis (OR 7.042 (2.915 to 16.949)), and AKI (OR 3.571 (1.715 to 7.407)). When critically ill patients were analysed independently, increasing Sequential Organ Failure Assessment score (OR 1.544 (1.168 to 2.039)), AKI (OR 2.128 (1.111 to 6.667)) and ARDS (OR 6.410 (2.237 to 18.182)) were predictive of in-hospital mortality. Conclusion We reported the characteristics of ethnically diverse, hospitalised patients with COVID-19 from Pennsylvania state.
Competing interests None declared. Patient consent for publication Not required.
Ethics approval The protocol of this study has been approved by the UPMC Pinnacle Institutional Review Board and UPMC Pinnacle Ethics Committee (#20E024). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available upon reasonable request. Raw data are available upon reasonable request. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise. Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is..
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'abstract': '<jats:sec><jats:title>Objective</jats:title><jats:p>COVID-19 is a respiratory disease caused '
'by SARS-CoV-2 with the highest burden in the USA. Data on clinical characteristics of '
'patients with COVID-19 in US population are limited. Thus, we aim to determine the clinical '
'characteristics and risk factors for in-hospital mortality from '
'COVID-19.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Retrospective '
'observational '
'study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Single-network '
'hospitals in Pennsylvania '
'state.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Patients '
'with confirmed SARS-CoV-2 infection who were hospitalised from 1 March to 31 May '
'2020.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcome '
'measures</jats:title><jats:p>Primary outcome was in-hospital mortality. Secondary outcomes '
'were complications, such as acute kidney injury (AKI) and acute respiratory distress syndrome '
'(ARDS).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 283 patients, '
'19.4% were non-survivors. The mean age of all patients was 64.1±15.9 years. 56.2% were male '
'and 50.2% were white. Several factors were identified from our adjusted multivariate analyses '
'to be associated with in-hospital mortality: increasing age (per 1-year increment; OR 1.07 '
'(1.045 to 1.105)), hypoxia (oxygen saturation <95%; OR 4.630 (1.934 to 1.111)), '
'opacity/infiltrate on imaging (OR 3.077 (1.276 to 7.407)), leucocytosis (white blood cell '
'>10<jats:sup>109/µL</jats:sup>; OR 2.732 (1.412 to 5.263)), ferritin >336 ng/mL (OR '
'4.016 (1.195 to 13.514)), lactate dehydrogenase >200 U/L (OR 7.752 (1.639 to 37.037)), '
'procalcitonin >0.25 ng/mL (OR 2.404 (1.011 to 5.714)), troponin I >0.03 ng/mL (OR 2.242 '
'(1.080 to 4.673)), need for advanced oxygen support other than simple nasal cannula (OR '
'4.608–13.889 (2.053 to 31.250)), intensive care unit admission/transfer (OR 13.699 (6.135 to '
'30.303)), renal replacement therapy (OR 21.277 (5.025 to 90.909)), need for vasopressor (OR '
'22.222 (9.434 to 52.632)), ARDS (OR 23.810 (10.204 to 55.556)), respiratory acidosis (OR '
'7.042 (2.915 to 16.949)), and AKI (OR 3.571 (1.715 to 7.407)). When critically ill patients '
'were analysed independently, increasing Sequential Organ Failure Assessment score (OR 1.544 '
'(1.168 to 2.039)), AKI (OR 2.128 (1.111 to 6.667)) and ARDS (OR 6.410 (2.237 to 18.182)) were '
'predictive of in-hospital '
'mortality.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>We '
'reported the characteristics of ethnically diverse, hospitalised patients with COVID-19 from '
'Pennsylvania state.</jats:p></jats:sec>',
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