The Clinical Course of Coronavirus Disease 2019 in a US Hospital System: A Multistate Analysis.
Am J Epidemiol
; 190(4): 539-552, 2021 04 06.
Article
in English
| MEDLINE | ID: covidwho-1172015
ABSTRACT
There are limited data on longitudinal outcomes for coronavirus disease 2019 (COVID-19) hospitalizations that account for transitions between clinical states over time. Using electronic health record data from a hospital network in the St. Louis, Missouri, region, we performed multistate analyses to examine longitudinal transitions and outcomes among hospitalized adults with laboratory-confirmed COVID-19 with respect to 15 mutually exclusive clinical states. Between March 15 and July 25, 2020, a total of 1,577 patients in the network were hospitalized with COVID-19 (49.9% male; median age, 63 years (interquartile range, 50-75); 58.8% Black). Overall, 34.1% (95% confidence interval (CI) 26.4, 41.8) had an intensive care unit admission and 12.3% (95% CI 8.5, 16.1) received invasive mechanical ventilation (IMV). The risk of decompensation peaked immediately after admission; discharges peaked around days 3-5, and deaths plateaued between days 7 and 16. At 28 days, 12.6% (95% CI 9.6, 15.6) of patients had died (4.2% (95% CI 3.2, 5.2) had received IMV) and 80.8% (95% CI 75.4, 86.1) had been discharged. Among those receiving IMV, 35.1% (95% CI 28.2, 42.0) remained intubated after 14 days; after 28 days, 37.6% (95% CI 30.4, 44.7) had died and only 37.7% (95% CI 30.6, 44.7) had been discharged. Multistate methods offer granular characterizations of the clinical course of COVID-19 and provide essential information for guiding both clinical decision-making and public health planning.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Respiration, Artificial
/
Pandemics
/
SARS-CoV-2
/
COVID-19
/
Hospitalization
/
Intensive Care Units
Type of study:
Observational study
/
Prognostic study
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
North America
Language:
English
Journal:
Am J Epidemiol
Year:
2021
Document Type:
Article
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