Study: Nearly 90% of inpatients with COVID-19 on mechanical ventilation died; obesity, diabetes, hypertension common among the 5700 patients.
Nearly 90% of patients hospitalized with COVID-19 who required mechanical ventilation (MV) died, with fatalities reaching nearly 100% among those aged >65 years. In stark contrast, just one-quarter (26%) of those aged >65 years who did not require MV died.The findings come from the first large case series of sequentially hospitalized patients with confirmed COVID-19 in the US. Among the 5700 cases reviewed, older persons, men, and those with obesity, hypertension, and diabetes were highly prevalent, a pattern similar to data that have been reported in China, according to the study authors. The report was published online April 22, 2020, in the Journal of the American Medical Association. Results are summarized in the slides below.
Results from: Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.
Data collection
Study population: 63y, median age (16% aged <50y); 40% women, 40% white, 23% African American.
Patient characteristics at triage: 31% were febrile, 17% had a respiratory rate greater than 24 breath/minute, and 28% received supplemental oxygen. About 2% of patients had respiratory co-infections.
Outcomes for 2634 patients (of 5700) who were discharged or died at study end: 14% were treated in the intensive care unit (ICU), 12.2% received invasive mechanical ventilation, and 21% died. Mortality was higher for men vs women at every adult 10-year age interval over age 20 years.
Mechanical ventilation outcomes. Mortality among those requiring MV was 88%. Among those, mortality was 76.4% for adults aged 18 to 65 years, and 97.2% for those older than age 65. In contrast, mortality in these age groups among those who did not receive MV was 19.8% and 26.6%, respectively.
Most common comorbidities.Hypertension, 56.6%, obesity, 41.7%, and diabetes 33.8%, were the leading comorbidities identified. The majority of patients (88%) had >1 comorbidity and only 6% did not have other underlying medical conditions. Of patients who died, those with diabetes were more likely to have received invasive MV, been treated in ICU, or developed acute kidney injury vs those without diabetes.
Angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, & mortality. According to study authors, ACEi and ARB medications can "significantly increase mRNA expression of cardiac angiotensin-converting enzyme 2, leading to speculation about the possible adverse, protective, or biphasic effects of treatment with these medications."
Length of stay, readmission. Median LOS was 4 days; 2.2% of patients were readmitted during the study period and median time to readmission was 3 days. of 3 days. There were no deaths among patients aged <18 years. Among those with outcome data, 436 patients were aged <50 years, and there were only 9 fatalities.
3066 patients remained hospitalized at study end. Median age inpatients at end of the study was 65 years and median follow-up at end of censoring was 4.5 days.
Study limitations: Geographically limited to the NYC area, data were collected from an electronic record database and lacked detail of a manual medical record. Findings also could have been biased as clinical outcome data were onl available for less than half of admitted patients.
