TY - JOUR
T1 - Hospitalised COVID-19 patients of the Mount Sinai Health System
T2 - A retrospective observational study using the electronic medical records
AU - Wang, Zichen
AU - Zheutlin, Amanda
AU - Kao, Yu Han
AU - Ayers, Kristin
AU - Gross, Susan
AU - Kovatch, Patricia
AU - Nirenberg, Sharon
AU - Charney, Alexander
AU - Nadkarni, Girish
AU - De Freitas, Jessica K.
AU - O'Reilly, Paul
AU - Just, Allan
AU - Horowitz, Carol
AU - Martin, Glenn
AU - Branch, Andrea
AU - Glicksberg, Benjamin S.
AU - Charney, Dennis
AU - Reich, David
AU - Oh, William K.
AU - Schadt, Eric
AU - Chen, Rong
AU - Li, Li
N1 - Publisher Copyright:
©
PY - 2020/10/26
Y1 - 2020/10/26
N2 - Objective To assess association of clinical features on COVID-19 patient outcomes. Design Retrospective observational study using electronic medical record data. Setting Five member hospitals from the Mount Sinai Health System in New York City (NYC). Participants 28 336 patients tested for SARS-CoV-2 from 24 February 2020 to 15 April 2020, including 6158 laboratory-confirmed COVID-19 cases. Main outcomes and measures Positive test rates and in-hospital mortality were assessed for different racial groups. Among positive cases admitted to the hospital (N=3273), we estimated HR for both discharge and death across various explanatory variables, including patient demographics, hospital site and unit, smoking status, vital signs, lab results and comorbidities. Results Hispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to their representation in the overall NYC population (p<0.05); however, no differences in mortality rates were observed in hospitalised patients based on race. Outcomes differed significantly between hospitals (Gray's T=248.9; p<0.05), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR 1.05, 95% CI 1.04 to 1.06; p=1.15e-32), oxygen saturation (HR 0.985, 95% CI 0.982 to 0.988; p=1.57e-17), care in intensive care unit areas (HR 1.58, 95% CI 1.29 to 1.92; p=7.81e-6) and elevated creatinine (HR 1.75, 95% CI 1.47 to 2.10; p=7.48e-10), white cell count (HR 1.02, 95% CI 1.01 to 1.04; p=8.4e-3) and body mass index (BMI) (HR 1.02, 95% CI 1.00 to 1.03; p=1.09e-2). Deceased patients were more likely to have elevated markers of inflammation. Conclusions While race was associated with higher risk of infection, we did not find racial disparities in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. In addition, we identified key clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk of a severe infection response and predict survival.
AB - Objective To assess association of clinical features on COVID-19 patient outcomes. Design Retrospective observational study using electronic medical record data. Setting Five member hospitals from the Mount Sinai Health System in New York City (NYC). Participants 28 336 patients tested for SARS-CoV-2 from 24 February 2020 to 15 April 2020, including 6158 laboratory-confirmed COVID-19 cases. Main outcomes and measures Positive test rates and in-hospital mortality were assessed for different racial groups. Among positive cases admitted to the hospital (N=3273), we estimated HR for both discharge and death across various explanatory variables, including patient demographics, hospital site and unit, smoking status, vital signs, lab results and comorbidities. Results Hispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to their representation in the overall NYC population (p<0.05); however, no differences in mortality rates were observed in hospitalised patients based on race. Outcomes differed significantly between hospitals (Gray's T=248.9; p<0.05), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR 1.05, 95% CI 1.04 to 1.06; p=1.15e-32), oxygen saturation (HR 0.985, 95% CI 0.982 to 0.988; p=1.57e-17), care in intensive care unit areas (HR 1.58, 95% CI 1.29 to 1.92; p=7.81e-6) and elevated creatinine (HR 1.75, 95% CI 1.47 to 2.10; p=7.48e-10), white cell count (HR 1.02, 95% CI 1.01 to 1.04; p=8.4e-3) and body mass index (BMI) (HR 1.02, 95% CI 1.00 to 1.03; p=1.09e-2). Deceased patients were more likely to have elevated markers of inflammation. Conclusions While race was associated with higher risk of infection, we did not find racial disparities in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. In addition, we identified key clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk of a severe infection response and predict survival.
KW - COVID-19
KW - epidemiology
KW - health informatics
KW - infectious diseases
UR - http://www.scopus.com/inward/record.url?scp=85094807086&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-040441
DO - 10.1136/bmjopen-2020-040441
M3 - Article
C2 - 33109676
AN - SCOPUS:85094807086
SN - 2044-6055
VL - 10
JO - BMJ Open
JF - BMJ Open
IS - 10
M1 - e040441
ER -