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Published on: September 24, 2020
Clinical Management of Hospitalized Coronavirus Disease 2019 Patients in the United States
Essy Mozaffari1, Aastha Chandak2, Zhiji Zhang2
1Gilead Sciences, Foster City, California, USA.
Insights
Treatment for hospitalized COVID-19 patients rapidly evolved, with increased use of remdesivir and corticosteroids from May to December 2020. This led to improved patient outcomes and decreased mortality over the study period.
Area of Science:
- Infectious Diseases
- Epidemiology
- Health Services Research
Background:
- Characterizing hospitalized coronavirus disease 2019 (COVID-19) patients is crucial for understanding real-world treatment patterns.
- Describing treatment evolution and outcomes over time provides insights into clinical management strategies.
Purpose of the Study:
- To characterize hospitalized COVID-19 patients.
- To describe real-world treatment patterns and outcomes over time.
Main Methods:
- Retrospective analysis of adult patients hospitalized with COVID-19 from May to December 2020.
- Examination of patient and hospital characteristics, treatments, baseline severity, length of stay, ICU utilization, and mortality.
Main Results:
- Increased utilization of remdesivir and corticosteroids over time, with 50% and 80% receiving these by December 2020, respectively.
- Earlier initiation of COVID-19 treatments and a shift towards using remdesivir in less severe patients.
- Decreased median length of stay and intensive care unit (ICU) utilization, with reduced mortality for patients receiving no supplemental oxygen or low-flow oxygen.
Conclusions:
- Clinical management of COVID-19 evolved significantly between May and December 2020.
- Increased use of evidence-based treatments correlated with improved patient outcomes and reduced mortality.
Background:
The objective of this study was to characterize hospitalized coronavirus disease 2019 (COVID-19) patients and describe their real-world treatment patterns and outcomes over time.
Methods:
Adult patients hospitalized on May 1, 2020-December 31, 2020 with a discharge diagnosis of COVID-19 were identified from the Premier Healthcare Database. Patient and hospital characteristics, treatments, baseline severity based on oxygen support, length of stay (LOS), intensive care unit (ICU) utilization, and mortality were examined.
Results:
The study included 295657 patients (847 hospitals), with median age of 66 (interquartile range, 54-77) years. Among each set of demographic comparators, the majority were male, white, and over 65. Approximately 85% had no supplemental oxygen charges (NSOc) or low-flow oxygen (LFO) at baseline, whereas 75% received no more than NSOc or LFO as maximal oxygen support at any time during hospitalization. Remdesivir (RDV) and corticosteroid treatment utilization increased over time. By December, 50% were receiving RDV and 80% were receiving corticosteroids. A higher proportion initiated COVID-19 treatments within 2 days of hospitalization in December versus May (RDV, 87% vs 40%; corticosteroids, 93% vs 62%; convalescent plasma, 68% vs 26%). There was a shift toward initiating RDV in patients on NSOc or LFO (68.0% [May] vs 83.1% [December]). Median LOS decreased over time. Overall mortality was 13.5% and it was highest for severe patients (invasive mechanical ventilation/extracorporeal membrane oxygenation [IMV/ECMO], 53.7%; high-flow oxygen/noninvasive ventilation [HFO/NIV], 32.2%; LFO, 11.7%; NSOc, 7.3%). The ICU use decreased, whereas mortality decreased for NSOc and LFO.
Conclusions:
Clinical management of COVID-19 is rapidly evolving. This large observational study found that use of evidence-based treatments increased from May to December 2020, whereas improvement in outcomes occurred over this time-period.
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