Fried Michael W, Crawford Julie M, Mospan Andrea R, Watkins Stephanie E, Munoz Breda, Zink Richard C, Elliott Sherry, Burleson Kyle, Landis Charles, Reddy K Rajender, Brown Robert S
TARGET PharmaSolutions Inc., Durham, North Carolina, USA.
Elliott Health Information Pros Inc., Cary, North Carolina, USA.
Clin Infect Dis. 2021 May 18;72(10):e558-e565. doi: 10.1093/cid/ciaa1268.
As coronavirus disease 2019 (COVID-19) disseminates throughout the United States, a better understanding of the patient characteristics associated with hospitalization, morbidity, and mortality in diverse geographic regions is essential.
Hospital chargemaster data on adult patients with COVID-19 admitted to 245 hospitals across 38 states between 15 February and 20 April 2020 were assessed. The clinical course from admission, through hospitalization, and to discharge or death was analyzed.
A total of 11 721 patients were included (majority were >60 years of age [59.9%] and male [53.4%]). Comorbidities included hypertension (46.7%), diabetes (27.8%), cardiovascular disease (18.6%), obesity (16.1%), and chronic kidney disease (12.2%). Mechanical ventilation was required by 1967 patients (16.8%). Mortality among hospitalized patients was 21.4% and increased to 70.5% among those on mechanical ventilation. Male sex, older age, obesity, geographic region, and the presence of chronic kidney disease or a preexisting cardiovascular disease were associated with increased odds of mechanical ventilation. All aforementioned risk factors, with the exception of obesity, were associated with increased odds of death (all P values < .001). Many patients received investigational medications for treatment of COVID-19, including 48 patients on remdesivir and 4232 on hydroxychloroquine.
This large observational cohort describes the clinical course and identifies factors associated with the outcomes of hospitalized patients with COVID-19 across the United States. These data can inform strategies to prioritize prevention and treatment for this disease.
随着2019冠状病毒病（COVID-19）在美国传播，更好地了解不同地理区域与住院、发病和死亡相关的患者特征至关重要。
评估了2020年2月15日至4月20日期间美国38个州245家医院收治的成年COVID-19患者的医院收费主数据。分析了从入院、住院到出院或死亡的临床病程。
共纳入11721例患者（大多数年龄>60岁[59.9%]，男性[53.4%]）。合并症包括高血压（46.7%）、糖尿病（27.8%）、心血管疾病（18.6%）、肥胖（16.1%）和慢性肾脏病（12.2%）。1967例患者（16.8%）需要机械通气。住院患者死亡率为21.4%，机械通气患者死亡率升至70.5%。男性、年龄较大、肥胖、地理区域以及存在慢性肾脏病或既往有心血管疾病与机械通气几率增加相关。除肥胖外，所有上述危险因素均与死亡几率增加相关（所有P值<0.001）。许多患者接受了用于治疗COVID-19的试验性药物，包括48例接受瑞德西韦治疗的患者和4232例接受羟氯喹治疗的患者。
这项大型观察性队列研究描述了临床病程，并确定了美国住院COVID-19患者预后的相关因素。这些数据可为该疾病预防和治疗的优先策略提供参考。
