Journal article

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Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

Author(s): Richardson S, Hirsch S, Narasimhan M et al

JAMA. Published online April 22, 2020. doi:10.1001/jama.2020.6775

Respiratory critical care
Respiratory infections
Epidemiology
General respiratory patient care
Public health

Digest Author(s): Stylianos Loukides, e-Learning Director / 25 April, 2020

The first confirmed case of coronavirus disease 2019 (COVID-19) in the US was reported from Washington State on January 31, 2020. In New York city the rate of infections was the biggest in the whole US. In this observational study the authors describe the clinical & laboratory characteristics, the co-morbidities and the early outcomes.

5700 were analyzed. Median age 63 years, 60% males, 40% white.

  • High prevalence of cardiovascular co-morbidities including arterial hypertension [approximately 75%].
  • Low prevalence of chronic respiratory diseases as asthma (5%) and COPD (9%).
  • 42% of them ηαδ ΒΜΙ >30 while 19% had a BMI >35.
  • Diabetes was observed in 33% of the patients.
  • On admission 31% had fever >38 °C.
  • 28% received supplementary oxygen.
  • 20% had saturation less than 90% while 17% had RR >24/min.
  • 60% had Lymphocyte AC <1000.
  • Abnormal values of troponin in 22% of the patients.
  • Respiratory viral panel, positive for non–COVID-19 respiratory virus in just 2%.

373 (14.2%) were treated in the ICU, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died. Mortality for those who received mechanical ventilation was 88.1%. Interestingly patients with diabetes were at increased risk to receive invasive mechanical ventilation. Mortality rates for patients with hypertension not taking an ACEi or ARB, taking an ACEi, and taking an ARB were 26.7%, 32.7%, and 30.6%, respectively.

Comments

This is a large study for patients infected with COVID-19. 3 important points:

  • Increased mortality rates without reasonable explanation and not consistent with those reported for Europe or/and China.
  • The concern about anti-hypertensive treatment remains a complex issue. No definite answers were given by the current study.
  • Finally, some co-morbidities need further attention like diabetes and metabolic syndrome.