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

Aims

The authors aim to analyze characteristics and outcomes of patients with COVID-19. They analyzed the New York City Area to further understand the outbreak in the United States.


Introduction

The first COVID-19 outbreaks in the United States were in Washington State and California. Now, the United States has more infections than in Italy and China combined. New York City has the greatest population density, so New York has more than 30%% of the cases in the United States. New York also has more cases than every single state as of April 20, 2020.

There is limited information about COVID-19. A study from China revealed the demographics and the comorbidities of COVID-19. But, the population demographics in China is very different from that in the United States.


Methods

Patients studied came from those at the Northwell Health System. Northwell is the largest academic hospital system, with patients from Long Island, New York City, and Westchester County. A patient had an infection if the patient tested positive from the polymerase chain reaction test. Physicians tested patients using nasopharyngeal samples. Patients were retested if the quality of the sample was low. If there was a patient transfer within a system, this was counted as one visit. There were no patient transfers out of the system. Statistical analyses were done using R.

The researchers collected data in categories, including initial laboratory tests, demographic information, comorbidities, treatments, and outcome. The data for outcome include the length of hospital stay and if the patient was discharged alive. Patients self-reported race and ethnicity. Researchers used the Charlson Comorbidity Index in the analysis of comorbidity. The Charlson Comorbidity Index gives the percent chance of survival in the next 10 years given a certain comorbidity. 


Results

The study included 5,700 patients (Table 1). The median time for test results was 15.4 hours. The most common comorbidities were hypertension, obesity, and diabetes. The Charlson Comorbidity Index predicted a median of 53%% survival for 10 years. The most common symptoms were fever and high respiratory rate (Table 2 and 3). Most patients (96.8%%) tested positive the first time. There were no mortalities of people under 20 years of age. Males had a higher mortality rate than females at every age interval. 

2634 patients were discharged or died when the study ended. Of these patients, 14.2 percent were in the ICU, 12.2 percent received mechanical ventilation, 3.2 percent underwent kidney replacement therapy, and 21 percent died. For patients on mechanical ventilation, mortality rates were much higher than for patients that did not need mechanical ventilation. About 2.2 percent of patients were readmitted after a median of 3 days. Out of the patients with a final outcome, 436 patients were under 50 years old and had no comorbidities. Nine of these patients died.

A greater percentage of patients between 18 and 65 years old were in the ICU and required ventilation than those over 65 (Table 5). Older patients had lower lymphocyte counts and higher readmission rates. More patients with diabetes that have died were on ventilation and in the ICU than those without diabetes. A higher percentage of those without hypertension received ventilation and ICU care than those with hypertension. Diabetes patients were more likely to experience kidney damage.

For patients with outcomes, the researchers had prescription medicine data for 2411 (92 percent) of them. 7.8 percent of these 2411 patients were on angiotensin-converting enzyme inhibitor (ACEi), and 11.1 percent were on angiotensin II receptor blocker (ARB). These medications lower blood pressure. They are important to consider because they increase the transcription of cardiac angiotensin-converting enzyme 2 (ACE2). Thus, ACEi and ARB may affect COVID-19, since ACE2 is used by some coronaviruses to enter the cell. More studies need to be done.

Older people, men, and those with hypertension and/or diabetes were more prevalent in the United States population than the China population. But, there is a lower mortality rate in the United States. But, all outcomes are not known, and the data can change with time.

Limitations

This study only included patients in the New York City Area. Researchers stored data electronically rather than collecting in person. Also, only 46.2%% of patients in this study had final outcomes because the reset are still hospitalized. Physicians followed up on patients in a median of 4.4 days, which is short. More time is needed to analyze the full course of the disease.