Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY, United States of America.
Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America.
PLoS One. 2020 Nov 23;15(11):e0242760. doi: 10.1371/journal.pone.0242760. eCollection 2020.
Despite evidence of socio-demographic disparities in outcomes of COVID-19, little is known about characteristics and clinical outcomes of patients admitted to public hospitals during the COVID-19 outbreak.
To assess demographics, comorbid conditions, and clinical factors associated with critical illness and mortality among patients diagnosed with COVID-19 at a public hospital in New York City (NYC) during the first month of the COVID-19 outbreak.
Retrospective chart review of patients diagnosed with COVID-19 admitted to NYC Health + Hospitals / Bellevue Hospital from March 9th to April 8th, 2020.
A total of 337 patients were diagnosed with COVID-19 during the study period. Primary analyses were conducted among those requiring supplemental oxygen (n = 270); half of these patients (135) were admitted to the intensive care unit (ICU). A majority were male (67.4%) and the median age was 58 years. Approximately one-third (32.6%) of hypoxic patients managed outside the ICU required non-rebreather or non-invasive ventilation. Requirement of renal replacement therapy occurred in 42.3% of ICU patients without baseline end-stage renal disease. Overall, 30-day mortality among hypoxic patients was 28.9% (53.3% in the ICU, 4.4% outside the ICU). In adjusted analyses, risk factors associated with mortality included dementia (adjusted risk ratio (aRR) 2.11 95%CI 1.50-2.96), age 65 or older (aRR 1.97, 95%CI 1.31-2.95), obesity (aRR 1.37, 95%CI 1.07-1.74), and male sex (aRR 1.32, 95%CI 1.04-1.70).
COVID-19 demonstrated severe morbidity and mortality in critically ill patients. Modifications in care delivery outside the ICU allowed the hospital to effectively care for a surge of critically ill and severely hypoxic patients.
尽管有证据表明 COVID-19 的结局存在社会人口统计学差异，但对于在 COVID-19 爆发期间入住公立医院的患者的特征和临床结局知之甚少。
评估在 COVID-19 爆发的第一个月期间，在纽约市（NYC）的一家公立医院中诊断出的 COVID-19 患者的人口统计学、合并症和与重症和死亡相关的临床因素。
对 2020 年 3 月 9 日至 4 月 8 日期间在纽约市健康与贝尔维尤医院（NYC Health + Hospitals / Bellevue Hospital）住院的 COVID-19 患者进行回顾性图表审查。
在研究期间，共有 337 例患者被诊断为 COVID-19。主要分析是在需要补充氧气的患者中进行的（n = 270）；其中一半（135 人）被收入重症监护病房（ICU）。大多数患者为男性（67.4%），中位年龄为 58 岁。大约三分之一（32.6%）在 ICU 外接受低氧治疗的患者需要非再呼吸或无创通气。无基线终末期肾脏疾病的 ICU 患者中，有 42.3%需要肾脏替代治疗。总体而言，低氧血症患者的 30 天死亡率为 28.9%（ICU 为 53.3%，ICU 外为 4.4%）。在调整后的分析中，与死亡率相关的危险因素包括痴呆（调整后的风险比[aRR] 2.11，95%置信区间[CI] 1.50-2.96）、年龄 65 岁或以上（aRR 1.97，95%CI 1.31-2.95）、肥胖（aRR 1.37，95%CI 1.07-1.74）和男性（aRR 1.32，95%CI 1.04-1.70）。
COVID-19 在重症患者中表现出严重的发病率和死亡率。在 ICU 之外的护理方式的改变使得医院能够有效地照顾大量重症和严重低氧血症患者。
