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Trends Over Time in the Risk of Adverse Outcomes Among Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection.
Ioannou, George N; O'Hare, Ann M; Berry, Kristin; Fan, Vincent S; Crothers, Kristina; Eastment, McKenna C; Locke, Emily; Green, Pamela; Shah, Javeed A; Dominitz, Jason A.
  • Ioannou GN; Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, USA.
  • O'Hare AM; Division of Nephrology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, USA.
  • Berry K; Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.
  • Fan VS; Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, USA.
  • Crothers K; Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, USA.
  • Eastment MC; Division of Allergy and Infectious Diseases, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, USA.
  • Locke E; Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.
  • Green P; Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.
  • Shah JA; Division of Allergy and Infectious Diseases, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, USA.
  • Dominitz JA; Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, USA.
Clin Infect Dis ; 74(3): 416-426, 2022 02 11.
Article in English | MEDLINE | ID: covidwho-1387822
Preprint
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Semantic information from SemMedBD (by NLM)
1. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
2. Mechanical ventilation TREATS Patients
Subject
Mechanical ventilation
Predicate
TREATS
Object
Patients
3. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
4. Mechanical ventilation TREATS Patients
Subject
Mechanical ventilation
Predicate
TREATS
Object
Patients
ABSTRACT

BACKGROUND:

We aimed to describe trends in adverse outcomes among patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between February and September 2020 within a national healthcare system.

METHODS:

We identified enrollees in the national United States Veterans Affairs healthcare system who tested positive for SARS-CoV-2 between 28 February 2020 and 30 September 2020 (n = 55 952), with follow-up extending to 19 November 2020. We determined trends over time in incidence of the following outcomes that occurred within 30 days of testing positive hospitalization, intensive care unit (ICU) admission, mechanical ventilation, and death.

RESULTS:

Between February and July 2020, there were marked downward trends in the 30-day incidence of hospitalization (44.2% to 15.8%), ICU admission (20.3% to 5.3%), mechanical ventilation (12.7% to 2.2%), and death (12.5% to 4.4%), which subsequently plateaued between July and September 2020. These trends persisted after adjustment for sociodemographic characteristics, comorbid conditions, documented symptoms, and laboratory tests, including among subgroups of patients hospitalized, admitted to the ICU, or treated with mechanical ventilation. From February to September, there were decreases in the use of hydroxychloroquine (56.5% to 0%), azithromycin (48.3% to 16.6%), vasopressors (20.6% to 8.7%), and dialysis (11.6% to 3.8%) and increases in the use of dexamethasone (3.4% to 53.1%), other corticosteroids (4.9% to 29.0%), and remdesivir (1.7% to 45.4%) among hospitalized patients.

CONCLUSIONS:

The risk of adverse outcomes in SARS-CoV-2-positive patients decreased markedly between February and July, with subsequent stabilization from July to September. These trends were not explained by changes in measured baseline patient characteristics and may reflect changing treatment practices or viral pathogenicity.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Etiology study / Prognostic study / Risk factors Limits: Humans Country/Region as subject: North America Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: CID

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Etiology study / Prognostic study / Risk factors Limits: Humans Country/Region as subject: North America Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: CID