Correspondence

View all COVID-19 Respiratory Digests

Clinical Characteristics of Covid-19 in New York City

Author(s): Goyal P, Choi JJ, Pinheiro LC et al

N Engl J Med. 2020, Apr 17

Respiratory critical care
Respiratory infections
General respiratory patient care
Public health

Digest Author(s): Stylianos Loukides, e-Learning Director / 20 April, 2020

In this study, data obtained from USA patients with COVID-19 infection, is presented. Data was obtained between March 5 and March 27, 2020. Data included demographics, clinical characteristics, comorbid conditions, symptoms, vital signs, laboratory values, and radiographic findings on presentation. 393 patients are involved.

62 was the median age, 38% white, 60% male, 5% current smokers, 35% with increased BMI. 50% of them had Arterial Hypertension, 35% Diabetes, 12% Asthma and 5% COPD. 10% died and 130 patients used invasive mechanical ventilation. From those who used mechanical ventilation, almost 90% had lung infiltrated in the initial Chest X ray.

Fever and cough were the predominant symptoms accounting for 77% and 79% respectively. Almost 25 % of the patients had gastrointestinal symptoms.

Patients who received invasive mechanical ventilation were more likely to be male, to have obesity, and to have elevated liver-function values and inflammatory markers (ferritin, d-dimer, C-reactive protein, and procalcitonin) than were patients who did not receive invasive mechanical ventilation. 30% of the patients who received mechanical ventilation did not need supplementary oxygen on admission. 23% of the patients are still remaining at hospital.

Comments

Compared to what we knew from China experience, patients from USA had higher percentage of gastrointestinal symptoms. Obesity was a risk factor for respiratory failure. The above manifestations may reflect geographic variations and life style factors. Mechanical ventilation strategy was more common in the US. This may reflect early intubation strategy. Interestingly 30% of the patients who received mechanical ventilation were quite stable on admission without need for supplementary oxygen. This means that deterioration may occur in a different time period which is actually within 4-8 days from onset.