3219 hospitalised patients with COVID-19 in Southeast Michigan: a retrospective case cohort study
Mulhem et al.
, 3219 hospitalised patients with COVID-19 in Southeast Michigan: a retrospective case cohort study
, BMJ Open, doi:10.1136/bmjopen-2020-042042
Retrospective database analysis of 3,219 hospitalized patients in the USA. Very different results in the time period analysis (Table S2), and results significantly different to other studies for the same medications (e.g., heparin OR 3.06 [2.44-3.83]) suggest significant confounding by indication
and confounding by time
.[Gérard, Wu, Zhou]
show significantly increased risk of acute kidney injury with remdesivir.
This study is excluded in the after exclusion results of meta
substantial unadjusted confounding by indication
likely; substantial confounding by time
likely due to declining usage over the early stages of the pandemic when overall treatment protocols improved dramatically.
risk of death, 85.7% higher, RR 1.86, p = 0.54, treatment 1 of 8 (12.5%), control 515 of 3,211 (16.0%), adjusted per study, odds ratio converted to relative risk, logistic regression.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Mulhem et al., 7 Apr 2021, retrospective, database analysis, USA, peer-reviewed, 3 authors.
Abstract: Open access
Elie Mulhem , Andrew Oleszkowicz, David Lick
To cite: Mulhem E,
Oleszkowicz A, Lick D. 3219
hospitalised patients with
COVID-19 in Southeast
Michigan: a retrospective
case cohort study. BMJ Open
►► Prepublication history and
additional supplemental material
for this paper are available
online. To view these files,
please visit the journal online
Received 23 June 2020
Revised 10 November 2020
Accepted 16 March 2021
© Author(s) (or their
employer(s)) 2021. Re-use
permitted under CC BY-NC. No
commercial re-use. See rights
and permissions. Published by
Department of Family Medicine
and Community Health, Oakland
University William Beaumont
School of Medicine, Rochester,
Dr Elie Mulhem;
Objective To report the clinical characteristics of patients
hospitalised with COVID-19 in Southeast Michigan.
Design Retrospective cohort study.
Setting Eight hospitals in Southeast Michigan.
Participants 3219 hospitalised patients with a positive
SARS-CoV-2 infection by nasopharyngeal PCR test from 13
March 2020 until 29 April 2020.
Main outcomes measures Outcomes were discharge
from the hospital or in-hospital death. Examined predictors
included patient demographics, chronic diseases,
home medications, mechanical ventilation, in-hospital
medications and timeframe of hospital admission.
Multivariable logistic regression was conducted to identify
risk factors for in-hospital mortality.
Results During the study period, 3219 (90.4%) patients
were discharged or died in the hospital. The median age
was 65.2 (IQR 52.6–77.2) years, the median length of
stay in the hospital was 6.0 (IQR 3.2–10.1) days, and 51%
were female. Hypertension was the most common chronic
disease, occurring in 2386 (74.1%) patients. Overall
mortality rate was 16.0%. Blacks represented 52.3%
of patients and had a mortality rate of 13.5%. Mortality
was highest at 18.5% in the prepeak hospital COVID-19
volume, decreasing to 15.3% during the peak period and
to 10.8% in the postpeak period. Multivariable regression
showed increasing odds of in-hospital death associated
with older age (OR 1.04, 95% CI 1.03 to 1.05, p<0.001) for
every increase in 1 year of age and being male (OR 1.47,
95% CI 1.21 to 1.81, p<0.001). Certain chronic diseases
increased the odds of in-hospital mortality, especially
chronic kidney disease. Administration of vitamin C,
corticosteroids and therapeutic heparin in the hospital was
associated with higher odds of death.
Conclusion In-hospital mortality was highest in early
admissions and improved as our experience in treating
patients with COVID-19 increased. Blacks were more likely
to get admitted to the hospital and to receive mechanical
ventilation, but less likely to die in the hospital than whites.
COVID-19 was first reported as an outbreak
of pneumonia of unknown cause in Wuhan,
China in December 2019.1 The virus responsible was subsequently named SARS-
The first confirmed case in the USA was
reported on 31 January 2020, and the first
case in Michigan was reported on 10 March
2020.2 As of 1 June 2020, 57 532 cases have
Strengths and limitations of this study
►► This is the largest study to date to describe the
hospitalised patient population with SARS-CoV-2 in
►► The study population represents a large and..
is less effective
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