First prospective study of severe COVID-19 patients in New York

The largest prospective study of adult COVID-19 patients in the United States to date has confirmed that severe illness is common among hospitalized patients (22%, 257/1150). Severe COVID-19 patients frequently require mechanical ventilation (79%, 203/257) and the mortality rate of such patients is high (39%, 101/257). Risk factors associated with in-hospital death such as old age and chronic cardiopulmonary disease are consistent with reports from Italy, China and the United Kingdom.

A detailed report was published today from 257 COVID-19 patients admitted to two hospitals in New York City, USA, from March 2, 2020 to April 1, 2020, followed for at least 28 days. LancetProvides a snapshot of how the virus affects adults in need Hospitalization care..

The study reported a high incidence of serious illness (22%, 257/1150) and a high reliance on mechanical ventilation to support breathing in critically ill patients (79%, 203/257). I will. Researchers say this has important implications for US hospital systems, especially the need to prepare for large numbers of patients in intensive care.

The findings reflect reports from China, Italy and the United Kingdom, with older age and pre-existing conditions being the strongest risk factors associated with poor outcomes.

Dr. Natalie Yup, one of the authors of research at the Irving Medical Center at Columbia University in the United States, said: “In the United States, there are about 1.5 million confirmed cases of COVID-19 and about 90,000 deaths. Reports from China and Italy have characterized the disease, but to date, the virus has A detailed understanding of how it affects severely ill patients was limited to reports from a small number of cases. Risk factor It is associated with the death of a critically ill patient with COVID-19 in a US hospital. ”

The study focused on two hospitals in New York City, USA, which belong to the University of Columbia Irving Medical Center in northern Manhattan. Between March 2 and April 1, 2020, 1,150 adults (aged 18 and over) were admitted to both hospitals in a COVID-19-confirmed laboratory. Of the patients admitted to the hospital, 257 (22%) were severe and required treatment in a highly dependent or intensive care unit. most Common symptoms Shortness of breath, fever, cough, muscle aches and diarrhea have been reported. As of April 28, 2020, almost 40% of seriously ill patients died (39%, 101/257) and more than a third remained in hospitals (37%, 94/257). Less than a quarter were alive and discharged (23%, 58/257).

More than three-quarters of critically ill patients needed mechanical ventilation to help breathing (79%, 203/257). Patients spent an average of 18 days on the ventilator (range 9-28 days). This rate is higher than reported in a small case study in Washington, USA [3, 4]But that’s consistent with a recent report from Italy, the researchers say. In addition, nearly one-third of patients develop severe renal impairment, requiring treatment to support renal function, such as dialysis (31%, 79/257).

The majority of severely ill patients were men (67%, 171/257). Serious illness was more common in elderly patients (median 62 years), but about 1 in 5 patients was younger than 50 years (22%, 55/257). More than 80% of critically ill patients have at least one chronic disease, the most common of which are hypertension (63%, 162/257) and diabetes (36%, 92/257). Nearly half of patients are obese (46%, 119/257), consistent with the trend seen in the UK. Nearly two-thirds of critically ill patients were Hispanic or Latino (62%, 159/257) and one in five were black or African American (19%, 49/257).

People with preexisting lung or heart disease were at the highest risk of poor outcome. Consistent with reports from China and Italy, hypertension was also associated with poor survival in critically ill patients.

5% of seriously ill patients were hired as health care workers (13/257). Since the virus had already spread to the community at the time, it was not possible to reliably determine if it was infected while working in the clinical setting. However, the findings highlight the risks faced by frontline healthcare professionals and emphasize the importance of consistent access to personal protective equipment by hospital staff.

Dr. Max O’Donnell, lead author of research at the Irving Medical Center at Columbia University in the United States, said: “Our study provides a deeper understanding of how COVID-19 affects critically ill patients in US hospitals. Of particular interest is more than three-quarters of critically ill patients The need for a heartbeat device and about one-third need renal dialysis support in hospitals that have limited access to the equipment and specialized staff needed to provide this level of care. Has a significant impact on resource allocation for. ”

Researchers warn that their findings may not be generalizable to others hospital This is especially important when considering the demographic characteristics of the patient population, as they only saw patients in two New York City hospitals. To confirm these findings, studies on racially, ethnically and geographically diverse patient groups are needed.

Giacomo Grasselli, who wrote the linked comment article and was not involved in the study at the University of Milan, said: However, despite providing important insights, this work leaves some open questions. While waiting for the availability of the COVID-19 vaccine, especially early non-invasive respiratory support strategies, timing of intubation, optimal settings Mechanical ventilation, And the efficacy and safety of immunomodulators and anticoagulation strategies. ”