Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York.
JAMA. 2020 May 26;323(20):2052-2059. doi: 10.1001/jama.2020.6775.
There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
To describe the clinical characteristics and outcomes of patients with COVID-19 hospitalized in a US health care system.
DESIGN, SETTING, AND PARTICIPANTS: Case series of patients with COVID-19 admitted to 12 hospitals in New York City, Long Island, and Westchester County, New York, within the Northwell Health system. The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates.
Confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample among patients requiring admission.
Clinical outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death. Demographics, baseline comorbidities, presenting vital signs, and test results were also collected.
A total of 5700 patients were included (median age, 63 years [interquartile range {IQR}, 52-75; range, 0-107 years]; 39.7% female). The most common comorbidities were hypertension (3026; 56.6%), obesity (1737; 41.7%), and diabetes (1808; 33.8%). At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/min, and 27.8% received supplemental oxygen. The rate of respiratory virus co-infection was 2.1%. Outcomes were assessed for 2634 patients who were discharged or had died at the study end point. During hospitalization, 373 patients (14.2%) (median age, 68 years [IQR, 56-78]; 33.5% female) were treated in the intensive care unit care, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died. As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital. The median postdischarge follow-up time was 4.4 days (IQR, 2.2-9.3). A total of 45 patients (2.2%) were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0-4.5) for readmitted patients. Among the 3066 patients who remained hospitalized at the final study follow-up date (median age, 65 years [IQR, 54-75]), the median follow-up at time of censoring was 4.5 days (IQR, 2.4-8.1).
This case series provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID-19 in the New York City area.
有关因 2019 年冠状病毒病（COVID-19）需要住院治疗的美国患者的临床表现和结局的信息有限。
描述在一家美国医疗机构中住院治疗的 COVID-19 患者的临床特征和结局。
设计、地点和参与者：这是一项病例系列研究，纳入了纽约市、长岛和威彻斯特县的 Northwell Health 系统内 12 家医院内连续收治的 COVID-19 患者。研究纳入了 2020 年 3 月 1 日至 2020 年 4 月 4 日期间需要住院的所有连续收治的患者，包括这些日期内的患者。
需要入院的患者的鼻咽样本经聚合酶链反应检测证实为严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染。
住院期间的临床结局，如需要接受有创机械通气、肾脏替代治疗和死亡。还收集了患者的人口统计学资料、基线合并症、入院时的生命体征和检查结果。
共纳入 5700 例患者（中位年龄 63 岁[四分位距 {IQR}，52-75；范围，0-107 岁]；39.7%为女性）。最常见的合并症为高血压（3026 例；56.6%）、肥胖症（1737 例；41.7%）和糖尿病（1808 例；33.8%）。分诊时，30.7%的患者发热，17.3%的患者呼吸频率大于 24 次/分，27.8%的患者接受补充氧气。呼吸道病毒合并感染的发生率为 2.1%。研究终点时，对 2634 例出院或已死亡的患者进行了结局评估。在住院期间，373 例（14.2%）（中位年龄 68 岁[IQR，56-78]；33.5%为女性）患者在重症监护病房接受治疗，320 例（12.2%）接受有创机械通气，81 例（3.2%）接受肾脏替代治疗，553 例（21%）死亡。截至 2020 年 4 月 4 日，需要接受机械通气的患者（n = 1151，20.2%）中，38 例（3.3%）存活出院，282 例（24.5%）死亡，831 例（72.2%）仍在住院。出院后的中位随访时间为 4.4 天（IQR，2.2-9.3）。在研究期间共有 45 例患者（2.2%）再次入院。再次入院患者的中位再入院时间为 3 天（IQR，1.0-4.5）。在最终的研究随访日期仍住院的 3066 例患者中（中位年龄 65 岁[IQR，54-75]），截止时的中位随访时间为 4.5 天（IQR，2.4-8.1）。
本病例系列研究提供了纽约市地区确诊 COVID-19 需住院治疗的患者的特征和早期结局。
