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Clinical Outcomes of Patients Hospitalized with Coronavirus Disease 2019 (COVID-19) in Boston
Areej El-Jawahri1,2, Hacho B Bohossian3,4, Michael K Paasche-Orlow5,6
1Department of Hematology Oncology, Massachusetts General Hospital, Boston, MA, USA. ael-jawahri@partners.org.
Insights
Most hospitalized COVID-19 patients survived, even those needing mechanical ventilation. Further research should explore public health and system factors influencing these positive outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Public Health
Background:
- Limited data exists on COVID-19 patient outcomes in non-crisis hospital settings.
- Understanding these outcomes is crucial for effective healthcare system management.
Purpose of the Study:
- To analyze clinical characteristics and outcomes of hospitalized COVID-19 patients in a non-crisis setting.
- To identify factors associated with mortality in this patient population.
Main Methods:
- Retrospective analysis of 470 consecutive COVID-19 patients hospitalized between January 1 and April 15, 2020.
- Collected data on intensive care unit (ICU) admission, mechanical ventilation, vasopressor use, and mortality.
- Employed multivariable logistic regression to determine factors linked to mortality.
Main Results:
- The majority of hospitalized COVID-19 patients (74.9%) and those requiring mechanical ventilation (66.4%) survived.
- Common comorbidities included diabetes (38.5%) and obesity (41.3%).
- Factors associated with increased mortality were older age, male sex, higher comorbidity burden, elevated lactate dehydrogenase, and need for supplemental oxygen on admission.
Conclusions:
- Most hospitalized COVID-19 patients, including those on mechanical ventilation, survived in this non-crisis setting.
- Findings underscore the importance of investigating public health and system-level factors contributing to improved patient outcomes.
Background:
Outcomes of hospitalized patients with COVID-19 have been described in health systems overwhelmed with a surge of cases. However, studies examining outcomes of patients admitted to hospitals not in crisis are lacking.
Objective:
To describe clinical characteristic and outcomes of all patients with COVID-19 who are admitted to hospitals not in crisis, and factors associated with mortality in this population.
Design:
A retrospective analysis PARTICIPANTS: In total, 470 consecutive patients with COVID-19 requiring hospitalization in one health system in Boston from January 1, 2020 to April 15, 2020.
Main Measures:
We collected clinical outcomes during hospitalization including intensive care unit (ICU) admission, receipt of mechanical ventilation, and vasopressors. We utilized multivariable logistic regression models to examine factors associated with mortality.
Key Results:
A total of 470 patients (median age 66 [range 23-98], 54.0% male) were included. The most common comorbidities were diabetes (38.5%, 181/470) and obesity (41.3%, 194/470). On admission, 41.9% (197/470) of patients were febrile and 60.6% (285/470) required supplemental oxygen. During hospitalization, 37.9% (178/470) were admitted to the ICU, 33.6% (158/470) received mechanical ventilation, 29.4% (138/470) received vasopressors, 16.4% (77/470) reported limitations on their desire for life-sustaining therapies such as intubation and cardiopulmonary resuscitation, and 25.1% (118/470) died. Among those admitted to the ICU (N=178), the median number of days on the ventilator was 10 days (IQR 1-29), and 58.4% (104/178) were discharged alive. Older age (OR=1.04, P<0.001), male sex (OR=2.14, P=0.007), higher comorbidities (OR=1.20, P=0.001), higher lactate dehydrogenase on admission (2nd tertile: OR=4.07, P<0.001; 3rd tertile: OR=8.04, P<0.001), and the need for supplemental oxygen on admission (OR=2.17, P=0.014) were all associated with higher mortality.
Conclusions:
The majority of hospitalized patients with COVID-19 and those who received mechanical ventilation survived. These data highlight the need to examine public health and system factors that contribute to improved outcomes for this population.
