Community Experience of COVID-19 Hospitalizations

Background Every American was affected by the COVID-19 pandemic. The novelty and virulence spurred the rapid evolution of treatment strategies. While large multicenter studies established key mortality risk factors and treatment efficacy, community hospital experiences are underrepresented. Methods This retrospective study examines clinical characteristics, mortality predictors, and outcome trends among 1,949 adults hospitalized with COVID-19 at a Southern California community hospital from January 31, 2020, through May 11, 2023. Results Overall mortality was 7.6%, and the mean length of stay was 9.2 days. Older age was independently associated with increased mortality, with the odds of death nearly doubling for every decade of life (adjusted odds ratio (aOR) 1.98, 95% CI 1.65-2.39, P < 0.001). Univariable laboratory predictors of inpatient mortality, and log transformation of D-dimer, demonstrated that D-dimer was the best predictor of inpatient mortality. Septic shock was associated with a twofold increase in mortality (aOR 2.26, 95% CI 1.11-4.63, P = 0.025). Respiratory failure requiring a mechanical ventilator is a marker for disease severity and was the strongest predictor of mortality in this cohort. Mechanical ventilation was associated with a 10-fold increase in the odds of death (aOR 10.07, 95% CI 6.18-16.38, P < 0.001). Multivariable analysis comparing mortality and pharmaceutical treatments identified that receipt of systemic corticosteroids was associated with higher odds of in-hospital mortality (aOR 6.70; 95% CI 4.00-11.22; P < 0.001). Receipt of tocilizumab was also associated with higher mortality (aOR 3.87; 95% CI 2.06-7.26; P < 0.001). Time-lapse analysis of the interval between admission and mortality demonstrated a 23% reduction in the odds of death per successive year (aOR 0.77 per year, 95% CI 0.62-0.96, P = 0.018). Conclusion Mortality decreased nearly one-fourth each year. D-dimer was the best laboratory predictor of death. Older age, septic shock, and ventilator need were associated with increased risk of inpatient mortality. Receipt of systemic steroids and tocilizumab was associated with higher mortality. These are not causal treatment effects, as medication receipt at that time was related to disease severity. These community hospital findings complement larger studies and reinforce the importance of early risk stratification and evidence-based treatments.